|
GUIDE WIRE 1.35MM TROCAR TIP THREADED AR-8943-38
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415025
|
|
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 THREADED AR-8943-38
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415025
|
|
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
|
|
|
GUIDE WIRE 1.6MM CAT-040-16
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.96 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.09
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$394.20
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$257.09
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
GUIDE WIRE 1.6MM CAT-040-16
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.97 |
| Max. Negotiated Rate |
$394.20 |
| Rate for Payer: Aetna Commercial |
$385.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$368.49
|
| Rate for Payer: Aetna Managed Medicare |
$119.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$278.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$214.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$205.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.09
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$394.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.78
|
| Rate for Payer: Health EOS Commercial |
$381.35
|
| Rate for Payer: HFN Commercial |
$394.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$321.36
|
| Rate for Payer: Multiplan Commercial |
$342.78
|
| Rate for Payer: NAPHCARE Commercial |
$257.09
|
| Rate for Payer: Preferred Network Access Commercial |
$394.20
|
| Rate for Payer: Quartz Beloit One Network |
$209.96
|
| Rate for Payer: Quartz Commercial |
$278.51
|
| Rate for Payer: Quartz Medicare Advantage |
$257.09
|
| Rate for Payer: The Alliance Commercial |
$214.24
|
| Rate for Payer: WEA Trust Commercial |
$235.66
|
| Rate for Payer: WPS Commercial |
$317.36
|
|
|
GUIDE WIRE 1.6 X 200MM ARTHREX AR-5050K-1
|
Facility
|
IP
|
$690.00
|
|
| Hospital Charge Code |
6171769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.62 |
| Max. Negotiated Rate |
$660.19 |
| Rate for Payer: Aetna Commercial |
$645.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$617.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$380.33
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$660.19
|
| Rate for Payer: Health EOS Commercial |
$638.66
|
| Rate for Payer: HFN Commercial |
$660.19
|
| Rate for Payer: Multiplan Commercial |
$574.08
|
| Rate for Payer: Preferred Network Access Commercial |
$660.19
|
| Rate for Payer: Quartz Beloit One Network |
$351.62
|
| Rate for Payer: Quartz Commercial |
$430.56
|
| Rate for Payer: WEA Trust Commercial |
$394.68
|
| Rate for Payer: WPS Commercial |
$531.51
|
|
|
GUIDE WIRE 1.6 X 200MM ARTHREX AR-5050K-1
|
Facility
|
OP
|
$690.00
|
|
| Hospital Charge Code |
6171769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.93 |
| Max. Negotiated Rate |
$660.19 |
| Rate for Payer: Aetna Commercial |
$645.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$617.14
|
| Rate for Payer: Aetna Managed Medicare |
$200.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$466.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$358.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$344.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$380.33
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$660.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$401.58
|
| Rate for Payer: Health EOS Commercial |
$638.66
|
| Rate for Payer: HFN Commercial |
$660.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$538.20
|
| Rate for Payer: Multiplan Commercial |
$574.08
|
| Rate for Payer: NAPHCARE Commercial |
$430.56
|
| Rate for Payer: Preferred Network Access Commercial |
$660.19
|
| Rate for Payer: Quartz Beloit One Network |
$351.62
|
| Rate for Payer: Quartz Commercial |
$466.44
|
| Rate for Payer: Quartz Medicare Advantage |
$430.56
|
| Rate for Payer: The Alliance Commercial |
$358.80
|
| Rate for Payer: WEA Trust Commercial |
$394.68
|
| Rate for Payer: WPS Commercial |
$531.51
|
|
|
GUIDE WIRE 1.6 X 200MM DRILL TIP 02.113.001
|
Facility
|
IP
|
$533.27
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5106925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$271.75 |
| Max. Negotiated Rate |
$510.23 |
| Rate for Payer: Aetna Commercial |
$499.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$476.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.94
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cigna Commercial |
$510.23
|
| Rate for Payer: Health EOS Commercial |
$493.59
|
| Rate for Payer: HFN Commercial |
$510.23
|
| Rate for Payer: Multiplan Commercial |
$443.68
|
| Rate for Payer: Preferred Network Access Commercial |
$510.23
|
| Rate for Payer: Quartz Beloit One Network |
$271.75
|
| Rate for Payer: Quartz Commercial |
$332.76
|
| Rate for Payer: WEA Trust Commercial |
$305.03
|
| Rate for Payer: WPS Commercial |
$410.78
|
|
|
GUIDE WIRE 1.6 X 200MM DRILL TIP 02.113.001
|
Facility
|
OP
|
$533.27
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5106925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.29 |
| Max. Negotiated Rate |
$510.23 |
| Rate for Payer: Aetna Commercial |
$499.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$476.96
|
| Rate for Payer: Aetna Managed Medicare |
$155.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$360.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$277.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.94
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cigna Commercial |
$510.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$310.36
|
| Rate for Payer: Health EOS Commercial |
$493.59
|
| Rate for Payer: HFN Commercial |
$510.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$415.95
|
| Rate for Payer: Multiplan Commercial |
$443.68
|
| Rate for Payer: NAPHCARE Commercial |
$332.76
|
| Rate for Payer: Preferred Network Access Commercial |
$510.23
|
| Rate for Payer: Quartz Beloit One Network |
$271.75
|
| Rate for Payer: Quartz Commercial |
$360.49
|
| Rate for Payer: Quartz Medicare Advantage |
$332.76
|
| Rate for Payer: The Alliance Commercial |
$277.30
|
| Rate for Payer: WEA Trust Commercial |
$305.03
|
| Rate for Payer: WPS Commercial |
$410.78
|
|
|
GUIDE WIRE 1.6 X 220MM THREADED 03.333.013
|
Facility
|
OP
|
$1,757.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6210964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.64 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Aetna Managed Medicare |
$511.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,187.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$913.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$877.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,022.57
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,370.46
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: NAPHCARE Commercial |
$1,096.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,187.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,096.37
|
| Rate for Payer: The Alliance Commercial |
$913.64
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
GUIDE WIRE 1.6 X 220MM THREADED 03.333.013
|
Facility
|
IP
|
$1,757.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6210964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$895.37 |
| Max. Negotiated Rate |
$1,681.10 |
| Rate for Payer: Aetna Commercial |
$1,644.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,571.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$968.46
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,681.10
|
| Rate for Payer: Health EOS Commercial |
$1,626.28
|
| Rate for Payer: HFN Commercial |
$1,681.10
|
| Rate for Payer: Multiplan Commercial |
$1,461.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,681.10
|
| Rate for Payer: Quartz Beloit One Network |
$895.37
|
| Rate for Payer: Quartz Commercial |
$1,096.37
|
| Rate for Payer: WEA Trust Commercial |
$1,005.00
|
| Rate for Payer: WPS Commercial |
$1,353.42
|
|
|
Guidewire 18G* - Guidewire Catheter Gauge
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
6179210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$53.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.92
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.96
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$113.57
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$123.03
|
| Rate for Payer: Quartz Medicare Advantage |
$113.57
|
| Rate for Payer: The Alliance Commercial |
$94.64
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
Guidewire 18G* - Guidewire Catheter Gauge
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
6179210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
GUIDEWIRE 2.0
|
Facility
|
IP
|
$787.00
|
|
| Hospital Charge Code |
2966249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$401.06 |
| Max. Negotiated Rate |
$753.00 |
| Rate for Payer: Aetna Commercial |
$736.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.79
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$753.00
|
| Rate for Payer: Health EOS Commercial |
$728.45
|
| Rate for Payer: HFN Commercial |
$753.00
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: Preferred Network Access Commercial |
$753.00
|
| Rate for Payer: Quartz Beloit One Network |
$401.06
|
| Rate for Payer: Quartz Commercial |
$491.09
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
GUIDEWIRE 2.0
|
Facility
|
OP
|
$787.00
|
|
| Hospital Charge Code |
2966249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$229.17 |
| Max. Negotiated Rate |
$753.00 |
| Rate for Payer: Aetna Commercial |
$736.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$703.89
|
| Rate for Payer: Aetna Managed Medicare |
$229.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$532.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$409.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$392.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$433.79
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$753.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$458.03
|
| Rate for Payer: Health EOS Commercial |
$728.45
|
| Rate for Payer: HFN Commercial |
$753.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$613.86
|
| Rate for Payer: Multiplan Commercial |
$654.78
|
| Rate for Payer: NAPHCARE Commercial |
$491.09
|
| Rate for Payer: Preferred Network Access Commercial |
$753.00
|
| Rate for Payer: Quartz Beloit One Network |
$401.06
|
| Rate for Payer: Quartz Commercial |
$532.01
|
| Rate for Payer: Quartz Medicare Advantage |
$491.09
|
| Rate for Payer: The Alliance Commercial |
$409.24
|
| Rate for Payer: WEA Trust Commercial |
$450.16
|
| Rate for Payer: WPS Commercial |
$606.23
|
|
|
GUIDE WIRE 2.0 292.26
|
Facility
|
IP
|
$1,692.00
|
|
| Hospital Charge Code |
2966239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$862.24 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,055.81
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
GUIDE WIRE 2.0 292.26
|
Facility
|
OP
|
$1,692.00
|
|
| Hospital Charge Code |
2966239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$492.71 |
| Max. Negotiated Rate |
$1,618.91 |
| Rate for Payer: Aetna Commercial |
$1,583.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,513.32
|
| Rate for Payer: Aetna Managed Medicare |
$492.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.63
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,618.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.74
|
| Rate for Payer: Health EOS Commercial |
$1,566.12
|
| Rate for Payer: HFN Commercial |
$1,618.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,319.76
|
| Rate for Payer: Multiplan Commercial |
$1,407.74
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.81
|
| Rate for Payer: Preferred Network Access Commercial |
$1,618.91
|
| Rate for Payer: Quartz Beloit One Network |
$862.24
|
| Rate for Payer: Quartz Commercial |
$1,143.79
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.81
|
| Rate for Payer: The Alliance Commercial |
$879.84
|
| Rate for Payer: WEA Trust Commercial |
$967.82
|
| Rate for Payer: WPS Commercial |
$1,303.35
|
|
|
GUIDE WIRE 2.0 292.656
|
Facility
|
IP
|
$808.00
|
|
| Hospital Charge Code |
2966240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$411.76 |
| Max. Negotiated Rate |
$773.09 |
| Rate for Payer: Aetna Commercial |
$756.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$722.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.37
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$773.09
|
| Rate for Payer: Health EOS Commercial |
$747.88
|
| Rate for Payer: HFN Commercial |
$773.09
|
| Rate for Payer: Multiplan Commercial |
$672.26
|
| Rate for Payer: Preferred Network Access Commercial |
$773.09
|
| Rate for Payer: Quartz Beloit One Network |
$411.76
|
| Rate for Payer: Quartz Commercial |
$504.19
|
| Rate for Payer: WEA Trust Commercial |
$462.18
|
| Rate for Payer: WPS Commercial |
$622.40
|
|
|
GUIDE WIRE 2.0 292.656
|
Facility
|
OP
|
$808.00
|
|
| Hospital Charge Code |
2966240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$235.29 |
| Max. Negotiated Rate |
$773.09 |
| Rate for Payer: Aetna Commercial |
$756.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$722.68
|
| Rate for Payer: Aetna Managed Medicare |
$235.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$546.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$420.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$403.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$445.37
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$773.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$470.26
|
| Rate for Payer: Health EOS Commercial |
$747.88
|
| Rate for Payer: HFN Commercial |
$773.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$630.24
|
| Rate for Payer: Multiplan Commercial |
$672.26
|
| Rate for Payer: NAPHCARE Commercial |
$504.19
|
| Rate for Payer: Preferred Network Access Commercial |
$773.09
|
| Rate for Payer: Quartz Beloit One Network |
$411.76
|
| Rate for Payer: Quartz Commercial |
$546.21
|
| Rate for Payer: Quartz Medicare Advantage |
$504.19
|
| Rate for Payer: The Alliance Commercial |
$420.16
|
| Rate for Payer: WEA Trust Commercial |
$462.18
|
| Rate for Payer: WPS Commercial |
$622.40
|
|
|
Guidewire 20G* - Guidewire Catheter Gauge
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
6179211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$53.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.92
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$141.96
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$113.57
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$123.03
|
| Rate for Payer: Quartz Medicare Advantage |
$113.57
|
| Rate for Payer: The Alliance Commercial |
$94.64
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
Guidewire 20G* - Guidewire Catheter Gauge
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
6179211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$92.75 |
| Max. Negotiated Rate |
$174.14 |
| Rate for Payer: Aetna Commercial |
$170.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.32
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$174.14
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$174.14
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: Preferred Network Access Commercial |
$174.14
|
| Rate for Payer: Quartz Beloit One Network |
$92.75
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$140.19
|
|
|
GUIDE WIRE 2.0MM TROCAR TIP AR-8956K-01
|
Facility
|
IP
|
$466.00
|
|
| Hospital Charge Code |
5599719
|
|
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
|
|
|
GUIDE WIRE 2.0MM TROCAR TIP AR-8956K-01
|
Facility
|
OP
|
$466.00
|
|
| Hospital Charge Code |
5599719
|
|
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
|
|
|
GUIDE WIRE 2.0 X 150MM NON-THREADED ASNIS III 705234
|
Facility
|
OP
|
$1,557.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5582939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.40 |
| Max. Negotiated Rate |
$1,489.74 |
| Rate for Payer: Aetna Commercial |
$1,457.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,392.58
|
| Rate for Payer: Aetna Managed Medicare |
$453.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,052.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$809.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$777.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$858.22
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cigna Commercial |
$1,489.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$906.17
|
| Rate for Payer: Health EOS Commercial |
$1,441.16
|
| Rate for Payer: HFN Commercial |
$1,489.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,214.46
|
| Rate for Payer: Multiplan Commercial |
$1,295.42
|
| Rate for Payer: NAPHCARE Commercial |
$971.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,489.74
|
| Rate for Payer: Quartz Beloit One Network |
$793.45
|
| Rate for Payer: Quartz Commercial |
$1,052.53
|
| Rate for Payer: Quartz Medicare Advantage |
$971.57
|
| Rate for Payer: The Alliance Commercial |
$809.64
|
| Rate for Payer: WEA Trust Commercial |
$890.60
|
| Rate for Payer: WPS Commercial |
$1,199.36
|
|
|
GUIDE WIRE 2.0 X 150MM NON-THREADED ASNIS III 705234
|
Facility
|
IP
|
$1,557.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5582939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$793.45 |
| Max. Negotiated Rate |
$1,489.74 |
| Rate for Payer: Aetna Commercial |
$1,457.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,392.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$858.22
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cigna Commercial |
$1,489.74
|
| Rate for Payer: Health EOS Commercial |
$1,441.16
|
| Rate for Payer: HFN Commercial |
$1,489.74
|
| Rate for Payer: Multiplan Commercial |
$1,295.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,489.74
|
| Rate for Payer: Quartz Beloit One Network |
$793.45
|
| Rate for Payer: Quartz Commercial |
$971.57
|
| Rate for Payer: WEA Trust Commercial |
$890.60
|
| Rate for Payer: WPS Commercial |
$1,199.36
|
|
|
GUIDE WIRE 2.0 X 150MM THREADED ASNIS III 702460
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5582938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.83 |
| Max. Negotiated Rate |
$780.75 |
| Rate for Payer: Aetna Commercial |
$763.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.78
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$780.75
|
| Rate for Payer: Health EOS Commercial |
$755.29
|
| Rate for Payer: HFN Commercial |
$780.75
|
| Rate for Payer: Multiplan Commercial |
$678.91
|
| Rate for Payer: Preferred Network Access Commercial |
$780.75
|
| Rate for Payer: Quartz Beloit One Network |
$415.83
|
| Rate for Payer: Quartz Commercial |
$509.18
|
| Rate for Payer: WEA Trust Commercial |
$466.75
|
| Rate for Payer: WPS Commercial |
$628.56
|
|
