|
GUIDE WIRE .062 TROCAR TIP THREADED ARTHREX AR-8941KT
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5611544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.68 |
| Max. Negotiated Rate |
$393.24 |
| Rate for Payer: Aetna Commercial |
$384.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.60
|
| Rate for Payer: Aetna Managed Medicare |
$119.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$205.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.54
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna Commercial |
$393.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$380.42
|
| Rate for Payer: HFN Commercial |
$393.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.58
|
| Rate for Payer: Multiplan Commercial |
$341.95
|
| Rate for Payer: NAPHCARE Commercial |
$256.46
|
| Rate for Payer: Preferred Network Access Commercial |
$393.24
|
| Rate for Payer: Quartz Beloit One Network |
$209.45
|
| Rate for Payer: Quartz Commercial |
$277.84
|
| Rate for Payer: Quartz Medicare Advantage |
$256.46
|
| Rate for Payer: The Alliance Commercial |
$213.72
|
| Rate for Payer: WEA Trust Commercial |
$235.09
|
| Rate for Payer: WPS Commercial |
$316.59
|
|
|
GUIDE WIRE .062 X 12 IN ARTHREX AR-8941-12
|
Facility
|
OP
|
$1,031.00
|
|
| Hospital Charge Code |
5415173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.23 |
| Max. Negotiated Rate |
$986.46 |
| Rate for Payer: Aetna Commercial |
$965.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$922.13
|
| Rate for Payer: Aetna Managed Medicare |
$300.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$536.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$514.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.29
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$986.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$600.04
|
| Rate for Payer: Health EOS Commercial |
$954.29
|
| Rate for Payer: HFN Commercial |
$986.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$804.18
|
| Rate for Payer: Multiplan Commercial |
$857.79
|
| Rate for Payer: NAPHCARE Commercial |
$643.34
|
| Rate for Payer: Preferred Network Access Commercial |
$986.46
|
| Rate for Payer: Quartz Beloit One Network |
$525.40
|
| Rate for Payer: Quartz Commercial |
$696.96
|
| Rate for Payer: Quartz Medicare Advantage |
$643.34
|
| Rate for Payer: The Alliance Commercial |
$536.12
|
| Rate for Payer: WEA Trust Commercial |
$589.73
|
| Rate for Payer: WPS Commercial |
$794.18
|
|
|
GUIDE WIRE .062 X 12 IN ARTHREX AR-8941-12
|
Facility
|
IP
|
$1,031.00
|
|
| Hospital Charge Code |
5415173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.40 |
| Max. Negotiated Rate |
$986.46 |
| Rate for Payer: Aetna Commercial |
$965.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$922.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.29
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$986.46
|
| Rate for Payer: Health EOS Commercial |
$954.29
|
| Rate for Payer: HFN Commercial |
$986.46
|
| Rate for Payer: Multiplan Commercial |
$857.79
|
| Rate for Payer: Preferred Network Access Commercial |
$986.46
|
| Rate for Payer: Quartz Beloit One Network |
$525.40
|
| Rate for Payer: Quartz Commercial |
$643.34
|
| Rate for Payer: WEA Trust Commercial |
$589.73
|
| Rate for Payer: WPS Commercial |
$794.18
|
|
|
GUIDE WIRE .062 X 6 IN ARTHREX AR-8941-6
|
Facility
|
OP
|
$747.00
|
|
| Hospital Charge Code |
5415172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.53 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Aetna Managed Medicare |
$217.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$504.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.75
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.66
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: NAPHCARE Commercial |
$466.13
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$504.97
|
| Rate for Payer: Quartz Medicare Advantage |
$466.13
|
| Rate for Payer: The Alliance Commercial |
$388.44
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
GUIDE WIRE .062 X 6 IN ARTHREX AR-8941-6
|
Facility
|
IP
|
$747.00
|
|
| Hospital Charge Code |
5415172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.67 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$466.13
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
GUIDE WIRE .062 X 7 IN ARTHREX AR-8941-7
|
Facility
|
IP
|
$747.00
|
|
| Hospital Charge Code |
4202661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.67 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$466.13
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
GUIDE WIRE .062 X 7 IN ARTHREX AR-8941-7
|
Facility
|
OP
|
$747.00
|
|
| Hospital Charge Code |
4202661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.53 |
| Max. Negotiated Rate |
$714.73 |
| Rate for Payer: Aetna Commercial |
$699.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$668.12
|
| Rate for Payer: Aetna Managed Medicare |
$217.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$504.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$388.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$372.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$411.75
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$714.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$434.75
|
| Rate for Payer: Health EOS Commercial |
$691.42
|
| Rate for Payer: HFN Commercial |
$714.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$582.66
|
| Rate for Payer: Multiplan Commercial |
$621.50
|
| Rate for Payer: NAPHCARE Commercial |
$466.13
|
| Rate for Payer: Preferred Network Access Commercial |
$714.73
|
| Rate for Payer: Quartz Beloit One Network |
$380.67
|
| Rate for Payer: Quartz Commercial |
$504.97
|
| Rate for Payer: Quartz Medicare Advantage |
$466.13
|
| Rate for Payer: The Alliance Commercial |
$388.44
|
| Rate for Payer: WEA Trust Commercial |
$427.28
|
| Rate for Payer: WPS Commercial |
$575.41
|
|
|
GUIDE WIRE .079 X 9 STERILE (2 PK) P06 S2292"
|
Facility
|
OP
|
$2,437.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6172202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$709.65 |
| Max. Negotiated Rate |
$2,331.72 |
| Rate for Payer: Aetna Commercial |
$2,281.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,179.65
|
| Rate for Payer: Aetna Managed Medicare |
$709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,647.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,267.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,216.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,343.27
|
| Rate for Payer: Cash Price |
$731.10
|
| Rate for Payer: Cigna Commercial |
$2,331.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,418.33
|
| Rate for Payer: Health EOS Commercial |
$2,255.69
|
| Rate for Payer: HFN Commercial |
$2,331.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,900.86
|
| Rate for Payer: Multiplan Commercial |
$2,027.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,520.69
|
| Rate for Payer: Preferred Network Access Commercial |
$2,331.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,241.90
|
| Rate for Payer: Quartz Commercial |
$1,647.41
|
| Rate for Payer: Quartz Medicare Advantage |
$1,520.69
|
| Rate for Payer: The Alliance Commercial |
$1,267.24
|
| Rate for Payer: WEA Trust Commercial |
$1,393.96
|
| Rate for Payer: WPS Commercial |
$1,877.22
|
|
|
GUIDE WIRE .079 X 9 STERILE (2 PK) P06 S2292"
|
Facility
|
IP
|
$2,437.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6172202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,241.90 |
| Max. Negotiated Rate |
$2,331.72 |
| Rate for Payer: Aetna Commercial |
$2,281.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,179.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,343.27
|
| Rate for Payer: Cash Price |
$731.10
|
| Rate for Payer: Cigna Commercial |
$2,331.72
|
| Rate for Payer: Health EOS Commercial |
$2,255.69
|
| Rate for Payer: HFN Commercial |
$2,331.72
|
| Rate for Payer: Multiplan Commercial |
$2,027.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,331.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,241.90
|
| Rate for Payer: Quartz Commercial |
$1,520.69
|
| Rate for Payer: WEA Trust Commercial |
$1,393.96
|
| Rate for Payer: WPS Commercial |
$1,877.22
|
|
|
GUIDEWIRE 0.86MM TROCAR TIP THREADED AR-8737-40
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5813660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.70 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$135.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.21
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.48
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$290.78
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$315.02
|
| Rate for Payer: Quartz Medicare Advantage |
$290.78
|
| Rate for Payer: The Alliance Commercial |
$242.32
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
GUIDEWIRE 0.86MM TROCAR TIP THREADED AR-8737-40
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5813660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.47 |
| Max. Negotiated Rate |
$445.87 |
| Rate for Payer: Aetna Commercial |
$436.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$256.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$445.87
|
| Rate for Payer: Health EOS Commercial |
$431.33
|
| Rate for Payer: HFN Commercial |
$445.87
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: Preferred Network Access Commercial |
$445.87
|
| Rate for Payer: Quartz Beloit One Network |
$237.47
|
| Rate for Payer: Quartz Commercial |
$290.78
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$358.96
|
|
|
GUIDEWIRE 0.86MM WITH LASER LINE AR-8737-21
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.89 |
| Max. Negotiated Rate |
$305.22 |
| Rate for Payer: Aetna Commercial |
$298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.31
|
| Rate for Payer: Aetna Managed Medicare |
$92.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$215.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$165.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.83
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$305.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$185.66
|
| Rate for Payer: Health EOS Commercial |
$295.27
|
| Rate for Payer: HFN Commercial |
$305.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$248.82
|
| Rate for Payer: Multiplan Commercial |
$265.41
|
| Rate for Payer: NAPHCARE Commercial |
$199.06
|
| Rate for Payer: Preferred Network Access Commercial |
$305.22
|
| Rate for Payer: Quartz Beloit One Network |
$162.56
|
| Rate for Payer: Quartz Commercial |
$215.64
|
| Rate for Payer: Quartz Medicare Advantage |
$199.06
|
| Rate for Payer: The Alliance Commercial |
$165.88
|
| Rate for Payer: WEA Trust Commercial |
$182.47
|
| Rate for Payer: WPS Commercial |
$245.73
|
|
|
GUIDEWIRE 0.86MM WITH LASER LINE AR-8737-21
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$162.56 |
| Max. Negotiated Rate |
$305.22 |
| Rate for Payer: Aetna Commercial |
$298.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$285.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$175.83
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$305.22
|
| Rate for Payer: Health EOS Commercial |
$295.27
|
| Rate for Payer: HFN Commercial |
$305.22
|
| Rate for Payer: Multiplan Commercial |
$265.41
|
| Rate for Payer: Preferred Network Access Commercial |
$305.22
|
| Rate for Payer: Quartz Beloit One Network |
$162.56
|
| Rate for Payer: Quartz Commercial |
$199.06
|
| Rate for Payer: WEA Trust Commercial |
$182.47
|
| Rate for Payer: WPS Commercial |
$245.73
|
|
|
GUIDE WIRE 0.86 TROCAR TIP AR-8737-39
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$299.64 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: Aetna Commercial |
$550.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$525.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.11
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$562.60
|
| Rate for Payer: Health EOS Commercial |
$544.25
|
| Rate for Payer: HFN Commercial |
$562.60
|
| Rate for Payer: Multiplan Commercial |
$489.22
|
| Rate for Payer: Preferred Network Access Commercial |
$562.60
|
| Rate for Payer: Quartz Beloit One Network |
$299.64
|
| Rate for Payer: Quartz Commercial |
$366.91
|
| Rate for Payer: WEA Trust Commercial |
$336.34
|
| Rate for Payer: WPS Commercial |
$452.94
|
|
|
GUIDE WIRE 0.86 TROCAR TIP AR-8737-39
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.23 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: Aetna Commercial |
$550.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$525.91
|
| Rate for Payer: Aetna Managed Medicare |
$171.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$397.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$305.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$293.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.11
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$562.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$342.22
|
| Rate for Payer: Health EOS Commercial |
$544.25
|
| Rate for Payer: HFN Commercial |
$562.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$458.64
|
| Rate for Payer: Multiplan Commercial |
$489.22
|
| Rate for Payer: NAPHCARE Commercial |
$366.91
|
| Rate for Payer: Preferred Network Access Commercial |
$562.60
|
| Rate for Payer: Quartz Beloit One Network |
$299.64
|
| Rate for Payer: Quartz Commercial |
$397.49
|
| Rate for Payer: Quartz Medicare Advantage |
$366.91
|
| Rate for Payer: The Alliance Commercial |
$305.76
|
| Rate for Payer: WEA Trust Commercial |
$336.34
|
| Rate for Payer: WPS Commercial |
$452.94
|
|
|
GUIDE WIRE 0.8 X 100 TROCAR TIP 03.333.000
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6228137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.99 |
| Max. Negotiated Rate |
$870.69 |
| Rate for Payer: Aetna Commercial |
$851.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.90
|
| Rate for Payer: Aetna Managed Medicare |
$264.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$615.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$473.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$454.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.59
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$870.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.62
|
| Rate for Payer: Health EOS Commercial |
$842.30
|
| Rate for Payer: HFN Commercial |
$870.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$709.80
|
| Rate for Payer: Multiplan Commercial |
$757.12
|
| Rate for Payer: NAPHCARE Commercial |
$567.84
|
| Rate for Payer: Preferred Network Access Commercial |
$870.69
|
| Rate for Payer: Quartz Beloit One Network |
$463.74
|
| Rate for Payer: Quartz Commercial |
$615.16
|
| Rate for Payer: Quartz Medicare Advantage |
$567.84
|
| Rate for Payer: The Alliance Commercial |
$473.20
|
| Rate for Payer: WEA Trust Commercial |
$520.52
|
| Rate for Payer: WPS Commercial |
$700.97
|
|
|
GUIDE WIRE 0.8 X 100 TROCAR TIP 03.333.000
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6228137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.74 |
| Max. Negotiated Rate |
$870.69 |
| Rate for Payer: Aetna Commercial |
$851.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.59
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$870.69
|
| Rate for Payer: Health EOS Commercial |
$842.30
|
| Rate for Payer: HFN Commercial |
$870.69
|
| Rate for Payer: Multiplan Commercial |
$757.12
|
| Rate for Payer: Preferred Network Access Commercial |
$870.69
|
| Rate for Payer: Quartz Beloit One Network |
$463.74
|
| Rate for Payer: Quartz Commercial |
$567.84
|
| Rate for Payer: WEA Trust Commercial |
$520.52
|
| Rate for Payer: WPS Commercial |
$700.97
|
|
|
GUIDE WIRE 1.1 X 150 TROCAR TIP 03.333.001
|
Facility
|
OP
|
$973.14
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6248162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$283.38 |
| Max. Negotiated Rate |
$931.10 |
| Rate for Payer: Aetna Commercial |
$910.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$870.38
|
| Rate for Payer: Aetna Managed Medicare |
$283.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$657.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$506.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$485.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.39
|
| Rate for Payer: Cash Price |
$291.94
|
| Rate for Payer: Cigna Commercial |
$931.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$566.37
|
| Rate for Payer: Health EOS Commercial |
$900.74
|
| Rate for Payer: HFN Commercial |
$931.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$759.05
|
| Rate for Payer: Multiplan Commercial |
$809.65
|
| Rate for Payer: NAPHCARE Commercial |
$607.24
|
| Rate for Payer: Preferred Network Access Commercial |
$931.10
|
| Rate for Payer: Quartz Beloit One Network |
$495.91
|
| Rate for Payer: Quartz Commercial |
$657.84
|
| Rate for Payer: Quartz Medicare Advantage |
$607.24
|
| Rate for Payer: The Alliance Commercial |
$506.03
|
| Rate for Payer: WEA Trust Commercial |
$556.64
|
| Rate for Payer: WPS Commercial |
$749.61
|
|
|
GUIDE WIRE 1.1 X 150 TROCAR TIP 03.333.001
|
Facility
|
IP
|
$973.14
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6248162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$495.91 |
| Max. Negotiated Rate |
$931.10 |
| Rate for Payer: Aetna Commercial |
$910.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$870.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$536.39
|
| Rate for Payer: Cash Price |
$291.94
|
| Rate for Payer: Cigna Commercial |
$931.10
|
| Rate for Payer: Health EOS Commercial |
$900.74
|
| Rate for Payer: HFN Commercial |
$931.10
|
| Rate for Payer: Multiplan Commercial |
$809.65
|
| Rate for Payer: Preferred Network Access Commercial |
$931.10
|
| Rate for Payer: Quartz Beloit One Network |
$495.91
|
| Rate for Payer: Quartz Commercial |
$607.24
|
| Rate for Payer: WEA Trust Commercial |
$556.64
|
| Rate for Payer: WPS Commercial |
$749.61
|
|
|
GUIDE WIRE 1.1X15 254514
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.38 |
| Max. Negotiated Rate |
$664.98 |
| Rate for Payer: Aetna Commercial |
$650.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$621.61
|
| Rate for Payer: Aetna Managed Medicare |
$202.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$469.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$361.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$346.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.08
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$664.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$404.49
|
| Rate for Payer: Health EOS Commercial |
$643.29
|
| Rate for Payer: HFN Commercial |
$664.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$542.10
|
| Rate for Payer: Multiplan Commercial |
$578.24
|
| Rate for Payer: NAPHCARE Commercial |
$433.68
|
| Rate for Payer: Preferred Network Access Commercial |
$664.98
|
| Rate for Payer: Quartz Beloit One Network |
$354.17
|
| Rate for Payer: Quartz Commercial |
$469.82
|
| Rate for Payer: Quartz Medicare Advantage |
$433.68
|
| Rate for Payer: The Alliance Commercial |
$361.40
|
| Rate for Payer: WEA Trust Commercial |
$397.54
|
| Rate for Payer: WPS Commercial |
$535.36
|
|
|
GUIDE WIRE 1.1X15 254514
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.17 |
| Max. Negotiated Rate |
$664.98 |
| Rate for Payer: Aetna Commercial |
$650.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$621.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.08
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$664.98
|
| Rate for Payer: Health EOS Commercial |
$643.29
|
| Rate for Payer: HFN Commercial |
$664.98
|
| Rate for Payer: Multiplan Commercial |
$578.24
|
| Rate for Payer: Preferred Network Access Commercial |
$664.98
|
| Rate for Payer: Quartz Beloit One Network |
$354.17
|
| Rate for Payer: Quartz Commercial |
$433.68
|
| Rate for Payer: WEA Trust Commercial |
$397.54
|
| Rate for Payer: WPS Commercial |
$535.36
|
|
|
GUIDE WIRE 1.35 ARTHREX AR-5050-01
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5459429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.55 |
| Max. Negotiated Rate |
$902.26 |
| Rate for Payer: Aetna Commercial |
$882.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$843.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$519.78
|
| Rate for Payer: Cash Price |
$282.90
|
| Rate for Payer: Cigna Commercial |
$902.26
|
| Rate for Payer: Health EOS Commercial |
$872.84
|
| Rate for Payer: HFN Commercial |
$902.26
|
| Rate for Payer: Multiplan Commercial |
$784.58
|
| Rate for Payer: Preferred Network Access Commercial |
$902.26
|
| Rate for Payer: Quartz Beloit One Network |
$480.55
|
| Rate for Payer: Quartz Commercial |
$588.43
|
| Rate for Payer: WEA Trust Commercial |
$539.40
|
| Rate for Payer: WPS Commercial |
$726.39
|
|
|
GUIDE WIRE 1.35 ARTHREX AR-5050-01
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5459429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$274.60 |
| Max. Negotiated Rate |
$902.26 |
| Rate for Payer: Aetna Commercial |
$882.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$843.42
|
| Rate for Payer: Aetna Managed Medicare |
$274.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$637.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$490.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$470.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$519.78
|
| Rate for Payer: Cash Price |
$282.90
|
| Rate for Payer: Cigna Commercial |
$902.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$548.83
|
| Rate for Payer: Health EOS Commercial |
$872.84
|
| Rate for Payer: HFN Commercial |
$902.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$735.54
|
| Rate for Payer: Multiplan Commercial |
$784.58
|
| Rate for Payer: NAPHCARE Commercial |
$588.43
|
| Rate for Payer: Preferred Network Access Commercial |
$902.26
|
| Rate for Payer: Quartz Beloit One Network |
$480.55
|
| Rate for Payer: Quartz Commercial |
$637.47
|
| Rate for Payer: Quartz Medicare Advantage |
$588.43
|
| Rate for Payer: The Alliance Commercial |
$490.36
|
| Rate for Payer: WEA Trust Commercial |
$539.40
|
| Rate for Payer: WPS Commercial |
$726.39
|
|
|
GUIDE WIRE 1.35MM TROCAR TIP AR-8943-01
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$108.62 |
| Max. Negotiated Rate |
$356.89 |
| Rate for Payer: Aetna Commercial |
$349.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.61
|
| Rate for Payer: Aetna Managed Medicare |
$108.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$252.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$193.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$186.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.60
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$356.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.09
|
| Rate for Payer: Health EOS Commercial |
$345.25
|
| Rate for Payer: HFN Commercial |
$356.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$290.94
|
| Rate for Payer: Multiplan Commercial |
$310.34
|
| Rate for Payer: NAPHCARE Commercial |
$232.75
|
| Rate for Payer: Preferred Network Access Commercial |
$356.89
|
| Rate for Payer: Quartz Beloit One Network |
$190.08
|
| Rate for Payer: Quartz Commercial |
$252.15
|
| Rate for Payer: Quartz Medicare Advantage |
$232.75
|
| Rate for Payer: The Alliance Commercial |
$193.96
|
| Rate for Payer: WEA Trust Commercial |
$213.36
|
| Rate for Payer: WPS Commercial |
$287.32
|
|
|
GUIDE WIRE 1.35MM TROCAR TIP AR-8943-01
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$190.08 |
| Max. Negotiated Rate |
$356.89 |
| Rate for Payer: Aetna Commercial |
$349.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$333.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$205.60
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$356.89
|
| Rate for Payer: Health EOS Commercial |
$345.25
|
| Rate for Payer: HFN Commercial |
$356.89
|
| Rate for Payer: Multiplan Commercial |
$310.34
|
| Rate for Payer: Preferred Network Access Commercial |
$356.89
|
| Rate for Payer: Quartz Beloit One Network |
$190.08
|
| Rate for Payer: Quartz Commercial |
$232.75
|
| Rate for Payer: WEA Trust Commercial |
$213.36
|
| Rate for Payer: WPS Commercial |
$287.32
|
|
