|
GUIDE PROX HUMERUS PLATE RIGHT
|
Facility
|
OP
|
$9,698.00
|
|
| Hospital Charge Code |
2966238
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,824.06 |
| Max. Negotiated Rate |
$9,279.05 |
| Rate for Payer: Aetna Commercial |
$9,077.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,673.89
|
| Rate for Payer: Aetna Managed Medicare |
$2,824.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,555.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,042.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,841.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,345.54
|
| Rate for Payer: Cash Price |
$2,909.40
|
| Rate for Payer: Cigna Commercial |
$9,279.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,644.24
|
| Rate for Payer: Health EOS Commercial |
$8,976.47
|
| Rate for Payer: HFN Commercial |
$9,279.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,564.44
|
| Rate for Payer: Multiplan Commercial |
$8,068.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,051.55
|
| Rate for Payer: Preferred Network Access Commercial |
$9,279.05
|
| Rate for Payer: Quartz Beloit One Network |
$4,942.10
|
| Rate for Payer: Quartz Commercial |
$6,555.85
|
| Rate for Payer: Quartz Medicare Advantage |
$6,051.55
|
| Rate for Payer: The Alliance Commercial |
$5,042.96
|
| Rate for Payer: WEA Trust Commercial |
$5,547.26
|
| Rate for Payer: WPS Commercial |
$7,470.37
|
|
|
GUIDE PSI CR FLEX CT 00-5970-000-16
|
Facility
|
OP
|
$5,625.00
|
|
| Hospital Charge Code |
4301878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,638.00 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Aetna Commercial |
$5,265.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,638.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,802.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,925.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,808.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,100.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,382.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,273.75
|
| Rate for Payer: Health EOS Commercial |
$5,206.50
|
| Rate for Payer: HFN Commercial |
$5,382.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,387.50
|
| Rate for Payer: Multiplan Commercial |
$4,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,510.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.50
|
| Rate for Payer: Quartz Commercial |
$3,802.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,510.00
|
| Rate for Payer: The Alliance Commercial |
$2,925.00
|
| Rate for Payer: WEA Trust Commercial |
$3,217.50
|
| Rate for Payer: WPS Commercial |
$4,332.94
|
|
|
GUIDE PSI CR FLEX CT 00-5970-000-16
|
Facility
|
IP
|
$5,625.00
|
|
| Hospital Charge Code |
4301878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,866.50 |
| Max. Negotiated Rate |
$5,382.00 |
| Rate for Payer: Aetna Commercial |
$5,265.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,031.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,100.50
|
| Rate for Payer: Cash Price |
$1,687.50
|
| Rate for Payer: Cigna Commercial |
$5,382.00
|
| Rate for Payer: Health EOS Commercial |
$5,206.50
|
| Rate for Payer: HFN Commercial |
$5,382.00
|
| Rate for Payer: Multiplan Commercial |
$4,680.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,382.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,866.50
|
| Rate for Payer: Quartz Commercial |
$3,510.00
|
| Rate for Payer: WEA Trust Commercial |
$3,217.50
|
| Rate for Payer: WPS Commercial |
$4,332.94
|
|
|
GUIDE ROD 2.0 X 600 71751146
|
Facility
|
IP
|
$1,895.00
|
|
| Hospital Charge Code |
2966014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$965.69 |
| Max. Negotiated Rate |
$1,813.14 |
| Rate for Payer: Aetna Commercial |
$1,773.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,694.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,044.52
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$1,813.14
|
| Rate for Payer: Health EOS Commercial |
$1,754.01
|
| Rate for Payer: HFN Commercial |
$1,813.14
|
| Rate for Payer: Multiplan Commercial |
$1,576.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.14
|
| Rate for Payer: Quartz Beloit One Network |
$965.69
|
| Rate for Payer: Quartz Commercial |
$1,182.48
|
| Rate for Payer: WEA Trust Commercial |
$1,083.94
|
| Rate for Payer: WPS Commercial |
$1,459.72
|
|
|
GUIDE ROD 2.0 X 600 71751146
|
Facility
|
OP
|
$1,895.00
|
|
| Hospital Charge Code |
2966014
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$551.82 |
| Max. Negotiated Rate |
$1,813.14 |
| Rate for Payer: Aetna Commercial |
$1,773.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,694.89
|
| Rate for Payer: Aetna Managed Medicare |
$551.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,281.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$985.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$945.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,044.52
|
| Rate for Payer: Cash Price |
$568.50
|
| Rate for Payer: Cigna Commercial |
$1,813.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,102.89
|
| Rate for Payer: Health EOS Commercial |
$1,754.01
|
| Rate for Payer: HFN Commercial |
$1,813.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,478.10
|
| Rate for Payer: Multiplan Commercial |
$1,576.64
|
| Rate for Payer: NAPHCARE Commercial |
$1,182.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,813.14
|
| Rate for Payer: Quartz Beloit One Network |
$965.69
|
| Rate for Payer: Quartz Commercial |
$1,281.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,182.48
|
| Rate for Payer: The Alliance Commercial |
$985.40
|
| Rate for Payer: WEA Trust Commercial |
$1,083.94
|
| Rate for Payer: WPS Commercial |
$1,459.72
|
|
|
GUIDE RSA AND BONE MODEL 5901-6101
|
Facility
|
IP
|
$4,918.00
|
|
| Hospital Charge Code |
5787738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,506.21 |
| Max. Negotiated Rate |
$4,705.54 |
| Rate for Payer: Aetna Commercial |
$4,603.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,398.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,710.80
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,705.54
|
| Rate for Payer: Health EOS Commercial |
$4,552.10
|
| Rate for Payer: HFN Commercial |
$4,705.54
|
| Rate for Payer: Multiplan Commercial |
$4,091.78
|
| Rate for Payer: Preferred Network Access Commercial |
$4,705.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,506.21
|
| Rate for Payer: Quartz Commercial |
$3,068.83
|
| Rate for Payer: WEA Trust Commercial |
$2,813.10
|
| Rate for Payer: WPS Commercial |
$3,788.34
|
|
|
GUIDE RSA AND BONE MODEL 5901-6101
|
Facility
|
OP
|
$4,918.00
|
|
| Hospital Charge Code |
5787738
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,432.12 |
| Max. Negotiated Rate |
$4,705.54 |
| Rate for Payer: Aetna Commercial |
$4,603.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,398.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,432.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,324.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,557.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,455.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,710.80
|
| Rate for Payer: Cash Price |
$1,475.40
|
| Rate for Payer: Cigna Commercial |
$4,705.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,862.28
|
| Rate for Payer: Health EOS Commercial |
$4,552.10
|
| Rate for Payer: HFN Commercial |
$4,705.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,836.04
|
| Rate for Payer: Multiplan Commercial |
$4,091.78
|
| Rate for Payer: NAPHCARE Commercial |
$3,068.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,705.54
|
| Rate for Payer: Quartz Beloit One Network |
$2,506.21
|
| Rate for Payer: Quartz Commercial |
$3,324.57
|
| Rate for Payer: Quartz Medicare Advantage |
$3,068.83
|
| Rate for Payer: The Alliance Commercial |
$2,557.36
|
| Rate for Payer: WEA Trust Commercial |
$2,813.10
|
| Rate for Payer: WPS Commercial |
$3,788.34
|
|
|
GUIDE WIRE 0.078 IN AR-4202
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.73 |
| Max. Negotiated Rate |
$376.98 |
| Rate for Payer: Aetna Commercial |
$368.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.39
|
| Rate for Payer: Aetna Managed Medicare |
$114.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$266.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$204.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.17
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$376.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.31
|
| Rate for Payer: Health EOS Commercial |
$364.69
|
| Rate for Payer: HFN Commercial |
$376.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.32
|
| Rate for Payer: Multiplan Commercial |
$327.81
|
| Rate for Payer: NAPHCARE Commercial |
$245.86
|
| Rate for Payer: Preferred Network Access Commercial |
$376.98
|
| Rate for Payer: Quartz Beloit One Network |
$200.78
|
| Rate for Payer: Quartz Commercial |
$266.34
|
| Rate for Payer: Quartz Medicare Advantage |
$245.86
|
| Rate for Payer: The Alliance Commercial |
$204.88
|
| Rate for Payer: WEA Trust Commercial |
$225.37
|
| Rate for Payer: WPS Commercial |
$303.50
|
|
|
GUIDE WIRE 0.078 IN AR-4202
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729757
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.78 |
| Max. Negotiated Rate |
$376.98 |
| Rate for Payer: Aetna Commercial |
$368.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.17
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$376.98
|
| Rate for Payer: Health EOS Commercial |
$364.69
|
| Rate for Payer: HFN Commercial |
$376.98
|
| Rate for Payer: Multiplan Commercial |
$327.81
|
| Rate for Payer: Preferred Network Access Commercial |
$376.98
|
| Rate for Payer: Quartz Beloit One Network |
$200.78
|
| Rate for Payer: Quartz Commercial |
$245.86
|
| Rate for Payer: WEA Trust Commercial |
$225.37
|
| Rate for Payer: WPS Commercial |
$303.50
|
|
|
GUIDE WIRE,.014 HI-TORQ 190cm
|
Facility
|
IP
|
$2,135.00
|
|
| Hospital Charge Code |
2972884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,088.00 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,332.24
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
GUIDE WIRE,.014 HI-TORQ 190cm
|
Facility
|
OP
|
$2,135.00
|
|
| Hospital Charge Code |
2972884
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$621.71 |
| Max. Negotiated Rate |
$2,042.77 |
| Rate for Payer: Aetna Commercial |
$1,998.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,909.54
|
| Rate for Payer: Aetna Managed Medicare |
$621.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,443.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,110.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,065.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,176.81
|
| Rate for Payer: Cash Price |
$640.50
|
| Rate for Payer: Cigna Commercial |
$2,042.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,242.57
|
| Rate for Payer: Health EOS Commercial |
$1,976.16
|
| Rate for Payer: HFN Commercial |
$2,042.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,665.30
|
| Rate for Payer: Multiplan Commercial |
$1,776.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,332.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,042.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,088.00
|
| Rate for Payer: Quartz Commercial |
$1,443.26
|
| Rate for Payer: Quartz Medicare Advantage |
$1,332.24
|
| Rate for Payer: The Alliance Commercial |
$1,110.20
|
| Rate for Payer: WEA Trust Commercial |
$1,221.22
|
| Rate for Payer: WPS Commercial |
$1,644.59
|
|
|
GUIDE WIRE,.014 HI-TORQ,300cm
|
Facility
|
OP
|
$1,684.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.38 |
| Max. Negotiated Rate |
$1,611.25 |
| Rate for Payer: Aetna Commercial |
$1,576.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.17
|
| Rate for Payer: Aetna Managed Medicare |
$490.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.22
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,611.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$980.09
|
| Rate for Payer: Health EOS Commercial |
$1,558.71
|
| Rate for Payer: HFN Commercial |
$1,611.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.52
|
| Rate for Payer: Multiplan Commercial |
$1,401.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,611.25
|
| Rate for Payer: Quartz Beloit One Network |
$858.17
|
| Rate for Payer: Quartz Commercial |
$1,138.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.82
|
| Rate for Payer: The Alliance Commercial |
$875.68
|
| Rate for Payer: WEA Trust Commercial |
$963.25
|
| Rate for Payer: WPS Commercial |
$1,297.19
|
|
|
GUIDE WIRE,.014 HI-TORQ,300cm
|
Facility
|
IP
|
$1,684.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.17 |
| Max. Negotiated Rate |
$1,611.25 |
| Rate for Payer: Aetna Commercial |
$1,576.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,506.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.22
|
| Rate for Payer: Cash Price |
$505.20
|
| Rate for Payer: Cigna Commercial |
$1,611.25
|
| Rate for Payer: Health EOS Commercial |
$1,558.71
|
| Rate for Payer: HFN Commercial |
$1,611.25
|
| Rate for Payer: Multiplan Commercial |
$1,401.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,611.25
|
| Rate for Payer: Quartz Beloit One Network |
$858.17
|
| Rate for Payer: Quartz Commercial |
$1,050.82
|
| Rate for Payer: WEA Trust Commercial |
$963.25
|
| Rate for Payer: WPS Commercial |
$1,297.19
|
|
|
GUIDEWIRE .014 HI-TORQUE EXTRA 300CM
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$410.59 |
| Max. Negotiated Rate |
$1,349.09 |
| Rate for Payer: Aetna Commercial |
$1,319.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.10
|
| Rate for Payer: Aetna Managed Medicare |
$410.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$953.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$733.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$703.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.19
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,349.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$820.62
|
| Rate for Payer: Health EOS Commercial |
$1,305.10
|
| Rate for Payer: HFN Commercial |
$1,349.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,099.80
|
| Rate for Payer: Multiplan Commercial |
$1,173.12
|
| Rate for Payer: NAPHCARE Commercial |
$879.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.09
|
| Rate for Payer: Quartz Beloit One Network |
$718.54
|
| Rate for Payer: Quartz Commercial |
$953.16
|
| Rate for Payer: Quartz Medicare Advantage |
$879.84
|
| Rate for Payer: The Alliance Commercial |
$733.20
|
| Rate for Payer: WEA Trust Commercial |
$806.52
|
| Rate for Payer: WPS Commercial |
$1,086.12
|
|
|
GUIDEWIRE .014 HI-TORQUE EXTRA 300CM
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972405
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.54 |
| Max. Negotiated Rate |
$1,349.09 |
| Rate for Payer: Aetna Commercial |
$1,319.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.19
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,349.09
|
| Rate for Payer: Health EOS Commercial |
$1,305.10
|
| Rate for Payer: HFN Commercial |
$1,349.09
|
| Rate for Payer: Multiplan Commercial |
$1,173.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.09
|
| Rate for Payer: Quartz Beloit One Network |
$718.54
|
| Rate for Payer: Quartz Commercial |
$879.84
|
| Rate for Payer: WEA Trust Commercial |
$806.52
|
| Rate for Payer: WPS Commercial |
$1,086.12
|
|
|
GUIDE WIRE .035 3MM J FC 150CM 6682-41
|
Facility
|
OP
|
$200.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3497498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$58.24 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Aetna Managed Medicare |
$58.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$99.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.40
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.00
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: NAPHCARE Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$135.20
|
| Rate for Payer: Quartz Medicare Advantage |
$124.80
|
| Rate for Payer: The Alliance Commercial |
$104.00
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.06
|
|
|
GUIDE WIRE .035 3MM J FC 150CM 6682-41
|
Facility
|
IP
|
$200.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3497498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$191.36 |
| Rate for Payer: Aetna Commercial |
$187.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$178.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.24
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$191.36
|
| Rate for Payer: Health EOS Commercial |
$185.12
|
| Rate for Payer: HFN Commercial |
$191.36
|
| Rate for Payer: Multiplan Commercial |
$166.40
|
| Rate for Payer: Preferred Network Access Commercial |
$191.36
|
| Rate for Payer: Quartz Beloit One Network |
$101.92
|
| Rate for Payer: Quartz Commercial |
$124.80
|
| Rate for Payer: WEA Trust Commercial |
$114.40
|
| Rate for Payer: WPS Commercial |
$154.06
|
|
|
GUIDE WIRE .035 3MMJ MC-150CM 6693-41
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2970832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$180.96
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$180.96
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
GUIDE WIRE .035 3MMJ MC-150CM 6693-41
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2970832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
GUIDE WIRE .035 ACUTRAK WS-0906-ST
|
Facility
|
OP
|
$254.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2967384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.96 |
| Max. Negotiated Rate |
$243.03 |
| Rate for Payer: Aetna Commercial |
$237.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.18
|
| Rate for Payer: Aetna Managed Medicare |
$73.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$171.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$132.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.00
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$243.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.83
|
| Rate for Payer: Health EOS Commercial |
$235.10
|
| Rate for Payer: HFN Commercial |
$243.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$198.12
|
| Rate for Payer: Multiplan Commercial |
$211.33
|
| Rate for Payer: NAPHCARE Commercial |
$158.50
|
| Rate for Payer: Preferred Network Access Commercial |
$243.03
|
| Rate for Payer: Quartz Beloit One Network |
$129.44
|
| Rate for Payer: Quartz Commercial |
$171.70
|
| Rate for Payer: Quartz Medicare Advantage |
$158.50
|
| Rate for Payer: The Alliance Commercial |
$132.08
|
| Rate for Payer: WEA Trust Commercial |
$145.29
|
| Rate for Payer: WPS Commercial |
$195.66
|
|
|
GUIDE WIRE .035 ACUTRAK WS-0906-ST
|
Facility
|
IP
|
$254.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2967384
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.44 |
| Max. Negotiated Rate |
$243.03 |
| Rate for Payer: Aetna Commercial |
$237.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$227.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$140.00
|
| Rate for Payer: Cash Price |
$76.20
|
| Rate for Payer: Cigna Commercial |
$243.03
|
| Rate for Payer: Health EOS Commercial |
$235.10
|
| Rate for Payer: HFN Commercial |
$243.03
|
| Rate for Payer: Multiplan Commercial |
$211.33
|
| Rate for Payer: Preferred Network Access Commercial |
$243.03
|
| Rate for Payer: Quartz Beloit One Network |
$129.44
|
| Rate for Payer: Quartz Commercial |
$158.50
|
| Rate for Payer: WEA Trust Commercial |
$145.29
|
| Rate for Payer: WPS Commercial |
$195.66
|
|
|
GUIDE WIRE .035 AMPLATZ 180cmSUPER STIFF
|
Facility
|
OP
|
$431.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$125.51 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Aetna Managed Medicare |
$125.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.84
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.18
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: NAPHCARE Commercial |
$268.94
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$291.36
|
| Rate for Payer: Quartz Medicare Advantage |
$268.94
|
| Rate for Payer: The Alliance Commercial |
$224.12
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
GUIDE WIRE .035 AMPLATZ 180cmSUPER STIFF
|
Facility
|
IP
|
$431.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972559
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.64 |
| Max. Negotiated Rate |
$412.38 |
| Rate for Payer: Aetna Commercial |
$403.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.57
|
| Rate for Payer: Cash Price |
$129.30
|
| Rate for Payer: Cigna Commercial |
$412.38
|
| Rate for Payer: Health EOS Commercial |
$398.93
|
| Rate for Payer: HFN Commercial |
$412.38
|
| Rate for Payer: Multiplan Commercial |
$358.59
|
| Rate for Payer: Preferred Network Access Commercial |
$412.38
|
| Rate for Payer: Quartz Beloit One Network |
$219.64
|
| Rate for Payer: Quartz Commercial |
$268.94
|
| Rate for Payer: WEA Trust Commercial |
$246.53
|
| Rate for Payer: WPS Commercial |
$332.00
|
|
|
GUIDE WIRE .035 ARCHER 200cmSUPER STIFF
|
Facility
|
OP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3104689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$84.45 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Aetna Managed Medicare |
$84.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$168.78
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.20
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: NAPHCARE Commercial |
$180.96
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$196.04
|
| Rate for Payer: Quartz Medicare Advantage |
$180.96
|
| Rate for Payer: The Alliance Commercial |
$150.80
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
|
GUIDE WIRE .035 ARCHER 200cmSUPER STIFF
|
Facility
|
IP
|
$290.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3104689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$147.78 |
| Max. Negotiated Rate |
$277.47 |
| Rate for Payer: Aetna Commercial |
$271.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.85
|
| Rate for Payer: Cash Price |
$87.00
|
| Rate for Payer: Cigna Commercial |
$277.47
|
| Rate for Payer: Health EOS Commercial |
$268.42
|
| Rate for Payer: HFN Commercial |
$277.47
|
| Rate for Payer: Multiplan Commercial |
$241.28
|
| Rate for Payer: Preferred Network Access Commercial |
$277.47
|
| Rate for Payer: Quartz Beloit One Network |
$147.78
|
| Rate for Payer: Quartz Commercial |
$180.96
|
| Rate for Payer: WEA Trust Commercial |
$165.88
|
| Rate for Payer: WPS Commercial |
$223.39
|
|
