|
GUIDE WIRE 2.0 X 150MM THREADED ASNIS III 702460
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5582938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.62 |
| Max. Negotiated Rate |
$780.75 |
| Rate for Payer: Aetna Commercial |
$763.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$729.83
|
| Rate for Payer: Aetna Managed Medicare |
$237.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$551.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$424.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$407.35
|
| 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: Dean Health DHI/DHP/ASO |
$474.91
|
| Rate for Payer: Health EOS Commercial |
$755.29
|
| Rate for Payer: HFN Commercial |
$780.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$636.48
|
| Rate for Payer: Multiplan Commercial |
$678.91
|
| Rate for Payer: NAPHCARE Commercial |
$509.18
|
| Rate for Payer: Preferred Network Access Commercial |
$780.75
|
| Rate for Payer: Quartz Beloit One Network |
$415.83
|
| Rate for Payer: Quartz Commercial |
$551.62
|
| Rate for Payer: Quartz Medicare Advantage |
$509.18
|
| Rate for Payer: The Alliance Commercial |
$424.32
|
| Rate for Payer: WEA Trust Commercial |
$466.75
|
| Rate for Payer: WPS Commercial |
$628.56
|
|
|
GUIDE WIRE 2.0 X 200MM UNTHREADED 705355
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6166130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.83 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Aetna Managed Medicare |
$210.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$489.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$376.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$361.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$421.37
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$564.72
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: NAPHCARE Commercial |
$451.78
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$489.42
|
| Rate for Payer: Quartz Medicare Advantage |
$451.78
|
| Rate for Payer: The Alliance Commercial |
$376.48
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
GUIDE WIRE 2.0 X 200MM UNTHREADED 705355
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6166130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.95 |
| Max. Negotiated Rate |
$692.72 |
| Rate for Payer: Aetna Commercial |
$677.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$647.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.07
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$692.72
|
| Rate for Payer: Health EOS Commercial |
$670.13
|
| Rate for Payer: HFN Commercial |
$692.72
|
| Rate for Payer: Multiplan Commercial |
$602.37
|
| Rate for Payer: Preferred Network Access Commercial |
$692.72
|
| Rate for Payer: Quartz Beloit One Network |
$368.95
|
| Rate for Payer: Quartz Commercial |
$451.78
|
| Rate for Payer: WEA Trust Commercial |
$414.13
|
| Rate for Payer: WPS Commercial |
$557.70
|
|
|
GUIDE WIRE 2.0 X 230 THREADED SPADE POINT 292.652
|
Facility
|
IP
|
$946.00
|
|
| Hospital Charge Code |
2966241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$482.08 |
| Max. Negotiated Rate |
$905.13 |
| Rate for Payer: Aetna Commercial |
$885.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$846.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.44
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$905.13
|
| Rate for Payer: Health EOS Commercial |
$875.62
|
| Rate for Payer: HFN Commercial |
$905.13
|
| Rate for Payer: Multiplan Commercial |
$787.07
|
| Rate for Payer: Preferred Network Access Commercial |
$905.13
|
| Rate for Payer: Quartz Beloit One Network |
$482.08
|
| Rate for Payer: Quartz Commercial |
$590.30
|
| Rate for Payer: WEA Trust Commercial |
$541.11
|
| Rate for Payer: WPS Commercial |
$728.70
|
|
|
GUIDE WIRE 2.0 X 230 THREADED SPADE POINT 292.652
|
Facility
|
OP
|
$946.00
|
|
| Hospital Charge Code |
2966241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.48 |
| Max. Negotiated Rate |
$905.13 |
| Rate for Payer: Aetna Commercial |
$885.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$846.10
|
| Rate for Payer: Aetna Managed Medicare |
$275.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$639.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$491.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$472.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.44
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$905.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$550.57
|
| Rate for Payer: Health EOS Commercial |
$875.62
|
| Rate for Payer: HFN Commercial |
$905.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$737.88
|
| Rate for Payer: Multiplan Commercial |
$787.07
|
| Rate for Payer: NAPHCARE Commercial |
$590.30
|
| Rate for Payer: Preferred Network Access Commercial |
$905.13
|
| Rate for Payer: Quartz Beloit One Network |
$482.08
|
| Rate for Payer: Quartz Commercial |
$639.50
|
| Rate for Payer: Quartz Medicare Advantage |
$590.30
|
| Rate for Payer: The Alliance Commercial |
$491.92
|
| Rate for Payer: WEA Trust Commercial |
$541.11
|
| Rate for Payer: WPS Commercial |
$728.70
|
|
|
Guidewire 22G* - Guidewire Catheter Gauge
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
6179212
|
|
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 22G* - Guidewire Catheter Gauge
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
6179212
|
|
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 2.4MM X 9.25 IN TROCAR TIP AR-8770K
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Aetna Managed Medicare |
$89.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$207.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.67
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.46
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: NAPHCARE Commercial |
$191.57
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$207.53
|
| Rate for Payer: Quartz Medicare Advantage |
$191.57
|
| Rate for Payer: The Alliance Commercial |
$159.64
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
GUIDE WIRE 2.4MM X 9.25 IN TROCAR TIP AR-8770K
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.45 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$191.57
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
GUIDE WIRE 2.5MM DRILL TIP 310.243
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$372.74 |
| Max. Negotiated Rate |
$1,224.70 |
| Rate for Payer: Aetna Commercial |
$1,198.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.83
|
| Rate for Payer: Aetna Managed Medicare |
$372.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$865.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$665.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$638.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.54
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$1,224.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$744.96
|
| Rate for Payer: Health EOS Commercial |
$1,184.77
|
| Rate for Payer: HFN Commercial |
$1,224.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$998.40
|
| Rate for Payer: Multiplan Commercial |
$1,064.96
|
| Rate for Payer: NAPHCARE Commercial |
$798.72
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.70
|
| Rate for Payer: Quartz Beloit One Network |
$652.29
|
| Rate for Payer: Quartz Commercial |
$865.28
|
| Rate for Payer: Quartz Medicare Advantage |
$798.72
|
| Rate for Payer: The Alliance Commercial |
$665.60
|
| Rate for Payer: WEA Trust Commercial |
$732.16
|
| Rate for Payer: WPS Commercial |
$985.98
|
|
|
GUIDE WIRE 2.5MM DRILL TIP 310.243
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$652.29 |
| Max. Negotiated Rate |
$1,224.70 |
| Rate for Payer: Aetna Commercial |
$1,198.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,144.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$705.54
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$1,224.70
|
| Rate for Payer: Health EOS Commercial |
$1,184.77
|
| Rate for Payer: HFN Commercial |
$1,224.70
|
| Rate for Payer: Multiplan Commercial |
$1,064.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,224.70
|
| Rate for Payer: Quartz Beloit One Network |
$652.29
|
| Rate for Payer: Quartz Commercial |
$798.72
|
| Rate for Payer: WEA Trust Commercial |
$732.16
|
| Rate for Payer: WPS Commercial |
$985.98
|
|
|
GUIDE WIRE 2.5 X 230MM WIDESPADE POINT THREADED 900.723
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$511.13 |
| Max. Negotiated Rate |
$959.67 |
| Rate for Payer: Aetna Commercial |
$938.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.85
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$959.67
|
| Rate for Payer: Health EOS Commercial |
$928.38
|
| Rate for Payer: HFN Commercial |
$959.67
|
| Rate for Payer: Multiplan Commercial |
$834.50
|
| Rate for Payer: Preferred Network Access Commercial |
$959.67
|
| Rate for Payer: Quartz Beloit One Network |
$511.13
|
| Rate for Payer: Quartz Commercial |
$625.87
|
| Rate for Payer: WEA Trust Commercial |
$573.72
|
| Rate for Payer: WPS Commercial |
$772.61
|
|
|
GUIDE WIRE 2.5 X 230MM WIDESPADE POINT THREADED 900.723
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.07 |
| Max. Negotiated Rate |
$959.67 |
| Rate for Payer: Aetna Commercial |
$938.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.08
|
| Rate for Payer: Aetna Managed Medicare |
$292.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$678.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$521.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$500.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.85
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$959.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$583.75
|
| Rate for Payer: Health EOS Commercial |
$928.38
|
| Rate for Payer: HFN Commercial |
$959.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$782.34
|
| Rate for Payer: Multiplan Commercial |
$834.50
|
| Rate for Payer: NAPHCARE Commercial |
$625.87
|
| Rate for Payer: Preferred Network Access Commercial |
$959.67
|
| Rate for Payer: Quartz Beloit One Network |
$511.13
|
| Rate for Payer: Quartz Commercial |
$678.03
|
| Rate for Payer: Quartz Medicare Advantage |
$625.87
|
| Rate for Payer: The Alliance Commercial |
$521.56
|
| Rate for Payer: WEA Trust Commercial |
$573.72
|
| Rate for Payer: WPS Commercial |
$772.61
|
|
|
GUIDE WIRE 2.8MM NON-THREAD 292.61
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4065112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.86 |
| Max. Negotiated Rate |
$722.38 |
| Rate for Payer: Aetna Commercial |
$706.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.27
|
| Rate for Payer: Aetna Managed Medicare |
$219.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$510.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.16
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$722.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.41
|
| Rate for Payer: Health EOS Commercial |
$698.83
|
| Rate for Payer: HFN Commercial |
$722.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.90
|
| Rate for Payer: Multiplan Commercial |
$628.16
|
| Rate for Payer: NAPHCARE Commercial |
$471.12
|
| Rate for Payer: Preferred Network Access Commercial |
$722.38
|
| Rate for Payer: Quartz Beloit One Network |
$384.75
|
| Rate for Payer: Quartz Commercial |
$510.38
|
| Rate for Payer: Quartz Medicare Advantage |
$471.12
|
| Rate for Payer: The Alliance Commercial |
$392.60
|
| Rate for Payer: WEA Trust Commercial |
$431.86
|
| Rate for Payer: WPS Commercial |
$581.58
|
|
|
GUIDE WIRE 2.8MM NON-THREAD 292.61
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4065112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.75 |
| Max. Negotiated Rate |
$722.38 |
| Rate for Payer: Aetna Commercial |
$706.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.16
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$722.38
|
| Rate for Payer: Health EOS Commercial |
$698.83
|
| Rate for Payer: HFN Commercial |
$722.38
|
| Rate for Payer: Multiplan Commercial |
$628.16
|
| Rate for Payer: Preferred Network Access Commercial |
$722.38
|
| Rate for Payer: Quartz Beloit One Network |
$384.75
|
| Rate for Payer: Quartz Commercial |
$471.12
|
| Rate for Payer: WEA Trust Commercial |
$431.86
|
| Rate for Payer: WPS Commercial |
$581.58
|
|
|
GUIDE WIRE 2.8MM X 300MM TROCAR POINT THREADED 292.68
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.56 |
| Max. Negotiated Rate |
$895.56 |
| Rate for Payer: Aetna Commercial |
$876.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$837.16
|
| Rate for Payer: Aetna Managed Medicare |
$272.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$632.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$467.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.92
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$895.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$544.75
|
| Rate for Payer: Health EOS Commercial |
$866.36
|
| Rate for Payer: HFN Commercial |
$895.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$730.08
|
| Rate for Payer: Multiplan Commercial |
$778.75
|
| Rate for Payer: NAPHCARE Commercial |
$584.06
|
| Rate for Payer: Preferred Network Access Commercial |
$895.56
|
| Rate for Payer: Quartz Beloit One Network |
$476.99
|
| Rate for Payer: Quartz Commercial |
$632.74
|
| Rate for Payer: Quartz Medicare Advantage |
$584.06
|
| Rate for Payer: The Alliance Commercial |
$486.72
|
| Rate for Payer: WEA Trust Commercial |
$535.39
|
| Rate for Payer: WPS Commercial |
$721.00
|
|
|
GUIDE WIRE 2.8MM X 300MM TROCAR POINT THREADED 292.68
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.99 |
| Max. Negotiated Rate |
$895.56 |
| Rate for Payer: Aetna Commercial |
$876.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$837.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.92
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$895.56
|
| Rate for Payer: Health EOS Commercial |
$866.36
|
| Rate for Payer: HFN Commercial |
$895.56
|
| Rate for Payer: Multiplan Commercial |
$778.75
|
| Rate for Payer: Preferred Network Access Commercial |
$895.56
|
| Rate for Payer: Quartz Beloit One Network |
$476.99
|
| Rate for Payer: Quartz Commercial |
$584.06
|
| Rate for Payer: WEA Trust Commercial |
$535.39
|
| Rate for Payer: WPS Commercial |
$721.00
|
|
|
GUIDE WIRE 2.8MM X 450MM THREADED 292.726
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4065113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$384.75 |
| Max. Negotiated Rate |
$722.38 |
| Rate for Payer: Aetna Commercial |
$706.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.16
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$722.38
|
| Rate for Payer: Health EOS Commercial |
$698.83
|
| Rate for Payer: HFN Commercial |
$722.38
|
| Rate for Payer: Multiplan Commercial |
$628.16
|
| Rate for Payer: Preferred Network Access Commercial |
$722.38
|
| Rate for Payer: Quartz Beloit One Network |
$384.75
|
| Rate for Payer: Quartz Commercial |
$471.12
|
| Rate for Payer: WEA Trust Commercial |
$431.86
|
| Rate for Payer: WPS Commercial |
$581.58
|
|
|
GUIDE WIRE 2.8MM X 450MM THREADED 292.726
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4065113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.86 |
| Max. Negotiated Rate |
$722.38 |
| Rate for Payer: Aetna Commercial |
$706.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$675.27
|
| Rate for Payer: Aetna Managed Medicare |
$219.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$510.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$392.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$376.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$416.16
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$722.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$439.41
|
| Rate for Payer: Health EOS Commercial |
$698.83
|
| Rate for Payer: HFN Commercial |
$722.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$588.90
|
| Rate for Payer: Multiplan Commercial |
$628.16
|
| Rate for Payer: NAPHCARE Commercial |
$471.12
|
| Rate for Payer: Preferred Network Access Commercial |
$722.38
|
| Rate for Payer: Quartz Beloit One Network |
$384.75
|
| Rate for Payer: Quartz Commercial |
$510.38
|
| Rate for Payer: Quartz Medicare Advantage |
$471.12
|
| Rate for Payer: The Alliance Commercial |
$392.60
|
| Rate for Payer: WEA Trust Commercial |
$431.86
|
| Rate for Payer: WPS Commercial |
$581.58
|
|
|
GUIDE WIRE 2.8x180 OLECRANON
|
Facility
|
IP
|
$1,266.00
|
|
| Hospital Charge Code |
2966245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$645.15 |
| Max. Negotiated Rate |
$1,211.31 |
| Rate for Payer: Aetna Commercial |
$1,184.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,132.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$697.82
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,211.31
|
| Rate for Payer: Health EOS Commercial |
$1,171.81
|
| Rate for Payer: HFN Commercial |
$1,211.31
|
| Rate for Payer: Multiplan Commercial |
$1,053.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,211.31
|
| Rate for Payer: Quartz Beloit One Network |
$645.15
|
| Rate for Payer: Quartz Commercial |
$789.98
|
| Rate for Payer: WEA Trust Commercial |
$724.15
|
| Rate for Payer: WPS Commercial |
$975.20
|
|
|
GUIDE WIRE 2.8x180 OLECRANON
|
Facility
|
OP
|
$1,266.00
|
|
| Hospital Charge Code |
2966245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$368.66 |
| Max. Negotiated Rate |
$1,211.31 |
| Rate for Payer: Aetna Commercial |
$1,184.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,132.31
|
| Rate for Payer: Aetna Managed Medicare |
$368.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$855.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$658.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$631.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$697.82
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,211.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$736.81
|
| Rate for Payer: Health EOS Commercial |
$1,171.81
|
| Rate for Payer: HFN Commercial |
$1,211.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$987.48
|
| Rate for Payer: Multiplan Commercial |
$1,053.31
|
| Rate for Payer: NAPHCARE Commercial |
$789.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,211.31
|
| Rate for Payer: Quartz Beloit One Network |
$645.15
|
| Rate for Payer: Quartz Commercial |
$855.82
|
| Rate for Payer: Quartz Medicare Advantage |
$789.98
|
| Rate for Payer: The Alliance Commercial |
$658.32
|
| Rate for Payer: WEA Trust Commercial |
$724.15
|
| Rate for Payer: WPS Commercial |
$975.20
|
|
|
GUIDE WIRE 2.8 X 220 FLUTED TIP 03.333.004
|
Facility
|
OP
|
$1,351.81
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6248158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$393.65 |
| Max. Negotiated Rate |
$1,293.41 |
| Rate for Payer: Aetna Commercial |
$1,265.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,209.06
|
| Rate for Payer: Aetna Managed Medicare |
$393.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$913.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$702.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$674.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.12
|
| Rate for Payer: Cash Price |
$405.54
|
| Rate for Payer: Cigna Commercial |
$1,293.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$786.75
|
| Rate for Payer: Health EOS Commercial |
$1,251.24
|
| Rate for Payer: HFN Commercial |
$1,293.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,054.41
|
| Rate for Payer: Multiplan Commercial |
$1,124.71
|
| Rate for Payer: NAPHCARE Commercial |
$843.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,293.41
|
| Rate for Payer: Quartz Beloit One Network |
$688.88
|
| Rate for Payer: Quartz Commercial |
$913.82
|
| Rate for Payer: Quartz Medicare Advantage |
$843.53
|
| Rate for Payer: The Alliance Commercial |
$702.94
|
| Rate for Payer: WEA Trust Commercial |
$773.24
|
| Rate for Payer: WPS Commercial |
$1,041.30
|
|
|
GUIDE WIRE 2.8 X 220 FLUTED TIP 03.333.004
|
Facility
|
IP
|
$1,351.81
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6248158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$688.88 |
| Max. Negotiated Rate |
$1,293.41 |
| Rate for Payer: Aetna Commercial |
$1,265.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,209.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.12
|
| Rate for Payer: Cash Price |
$405.54
|
| Rate for Payer: Cigna Commercial |
$1,293.41
|
| Rate for Payer: Health EOS Commercial |
$1,251.24
|
| Rate for Payer: HFN Commercial |
$1,293.41
|
| Rate for Payer: Multiplan Commercial |
$1,124.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,293.41
|
| Rate for Payer: Quartz Beloit One Network |
$688.88
|
| Rate for Payer: Quartz Commercial |
$843.53
|
| Rate for Payer: WEA Trust Commercial |
$773.24
|
| Rate for Payer: WPS Commercial |
$1,041.30
|
|
|
GUIDE WIRE 2.8 X 300MM 292.81
|
Facility
|
IP
|
$1,616.00
|
|
| Hospital Charge Code |
2966246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$823.51 |
| Max. Negotiated Rate |
$1,546.19 |
| Rate for Payer: Aetna Commercial |
$1,512.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,445.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$890.74
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$1,546.19
|
| Rate for Payer: Health EOS Commercial |
$1,495.77
|
| Rate for Payer: HFN Commercial |
$1,546.19
|
| Rate for Payer: Multiplan Commercial |
$1,344.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,546.19
|
| Rate for Payer: Quartz Beloit One Network |
$823.51
|
| Rate for Payer: Quartz Commercial |
$1,008.38
|
| Rate for Payer: WEA Trust Commercial |
$924.35
|
| Rate for Payer: WPS Commercial |
$1,244.80
|
|
|
GUIDE WIRE 2.8 X 300MM 292.81
|
Facility
|
OP
|
$1,616.00
|
|
| Hospital Charge Code |
2966246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.58 |
| Max. Negotiated Rate |
$1,546.19 |
| Rate for Payer: Aetna Commercial |
$1,512.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,445.35
|
| Rate for Payer: Aetna Managed Medicare |
$470.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,092.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$840.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$806.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$890.74
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$1,546.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$940.51
|
| Rate for Payer: Health EOS Commercial |
$1,495.77
|
| Rate for Payer: HFN Commercial |
$1,546.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,260.48
|
| Rate for Payer: Multiplan Commercial |
$1,344.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,546.19
|
| Rate for Payer: Quartz Beloit One Network |
$823.51
|
| Rate for Payer: Quartz Commercial |
$1,092.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,008.38
|
| Rate for Payer: The Alliance Commercial |
$840.32
|
| Rate for Payer: WEA Trust Commercial |
$924.35
|
| Rate for Payer: WPS Commercial |
$1,244.80
|
|
