|
GUIDE WIRE 2.8 X 450MM TROCAR POINT THREADED 900.726
|
Facility
|
IP
|
$1,629.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$830.14 |
| Max. Negotiated Rate |
$1,558.63 |
| Rate for Payer: Aetna Commercial |
$1,524.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,456.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$897.90
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna Commercial |
$1,558.63
|
| Rate for Payer: Health EOS Commercial |
$1,507.80
|
| Rate for Payer: HFN Commercial |
$1,558.63
|
| Rate for Payer: Multiplan Commercial |
$1,355.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,558.63
|
| Rate for Payer: Quartz Beloit One Network |
$830.14
|
| Rate for Payer: Quartz Commercial |
$1,016.50
|
| Rate for Payer: WEA Trust Commercial |
$931.79
|
| Rate for Payer: WPS Commercial |
$1,254.82
|
|
|
GUIDE WIRE 2.8 X 450MM TROCAR POINT THREADED 900.726
|
Facility
|
OP
|
$1,629.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$474.36 |
| Max. Negotiated Rate |
$1,558.63 |
| Rate for Payer: Aetna Commercial |
$1,524.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,456.98
|
| Rate for Payer: Aetna Managed Medicare |
$474.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$897.90
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna Commercial |
$1,558.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.08
|
| Rate for Payer: Health EOS Commercial |
$1,507.80
|
| Rate for Payer: HFN Commercial |
$1,558.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,270.62
|
| Rate for Payer: Multiplan Commercial |
$1,355.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,016.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,558.63
|
| Rate for Payer: Quartz Beloit One Network |
$830.14
|
| Rate for Payer: Quartz Commercial |
$1,101.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,016.50
|
| Rate for Payer: The Alliance Commercial |
$847.08
|
| Rate for Payer: WEA Trust Commercial |
$931.79
|
| Rate for Payer: WPS Commercial |
$1,254.82
|
|
|
GUIDE WIRE 3.2MM X 290MM 03.010.115
|
Facility
|
OP
|
$1,812.00
|
|
| Hospital Charge Code |
2966248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$527.65 |
| Max. Negotiated Rate |
$1,733.72 |
| Rate for Payer: Aetna Commercial |
$1,696.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,620.65
|
| Rate for Payer: Aetna Managed Medicare |
$527.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,224.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$942.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$904.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.77
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,733.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,054.58
|
| Rate for Payer: Health EOS Commercial |
$1,677.19
|
| Rate for Payer: HFN Commercial |
$1,733.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,413.36
|
| Rate for Payer: Multiplan Commercial |
$1,507.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,130.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,733.72
|
| Rate for Payer: Quartz Beloit One Network |
$923.40
|
| Rate for Payer: Quartz Commercial |
$1,224.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,130.69
|
| Rate for Payer: The Alliance Commercial |
$942.24
|
| Rate for Payer: WEA Trust Commercial |
$1,036.46
|
| Rate for Payer: WPS Commercial |
$1,395.78
|
|
|
GUIDE WIRE 3.2MM X 290MM 03.010.115
|
Facility
|
IP
|
$1,812.00
|
|
| Hospital Charge Code |
2966248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$1,733.72 |
| Rate for Payer: Aetna Commercial |
$1,696.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,620.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.77
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,733.72
|
| Rate for Payer: Health EOS Commercial |
$1,677.19
|
| Rate for Payer: HFN Commercial |
$1,733.72
|
| Rate for Payer: Multiplan Commercial |
$1,507.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,733.72
|
| Rate for Payer: Quartz Beloit One Network |
$923.40
|
| Rate for Payer: Quartz Commercial |
$1,130.69
|
| Rate for Payer: WEA Trust Commercial |
$1,036.46
|
| Rate for Payer: WPS Commercial |
$1,395.78
|
|
|
GUIDE WIRE 3.2MM X 400MM DRILL TIP 03.045.018
|
Facility
|
IP
|
$1,484.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6178980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$756.25 |
| Max. Negotiated Rate |
$1,419.89 |
| Rate for Payer: Aetna Commercial |
$1,389.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.98
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,419.89
|
| Rate for Payer: Health EOS Commercial |
$1,373.59
|
| Rate for Payer: HFN Commercial |
$1,419.89
|
| Rate for Payer: Multiplan Commercial |
$1,234.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.89
|
| Rate for Payer: Quartz Beloit One Network |
$756.25
|
| Rate for Payer: Quartz Commercial |
$926.02
|
| Rate for Payer: WEA Trust Commercial |
$848.85
|
| Rate for Payer: WPS Commercial |
$1,143.13
|
|
|
GUIDE WIRE 3.2MM X 400MM DRILL TIP 03.045.018
|
Facility
|
OP
|
$1,484.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6178980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$432.14 |
| Max. Negotiated Rate |
$1,419.89 |
| Rate for Payer: Aetna Commercial |
$1,389.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,327.29
|
| Rate for Payer: Aetna Managed Medicare |
$432.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,003.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$771.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$740.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.98
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,419.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$863.69
|
| Rate for Payer: Health EOS Commercial |
$1,373.59
|
| Rate for Payer: HFN Commercial |
$1,419.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,157.52
|
| Rate for Payer: Multiplan Commercial |
$1,234.69
|
| Rate for Payer: NAPHCARE Commercial |
$926.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,419.89
|
| Rate for Payer: Quartz Beloit One Network |
$756.25
|
| Rate for Payer: Quartz Commercial |
$1,003.18
|
| Rate for Payer: Quartz Medicare Advantage |
$926.02
|
| Rate for Payer: The Alliance Commercial |
$771.68
|
| Rate for Payer: WEA Trust Commercial |
$848.85
|
| Rate for Payer: WPS Commercial |
$1,143.13
|
|
|
GUIDE WIRE 3.2 X 230MM NON-THREADED 705235
|
Facility
|
OP
|
$1,497.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5641643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.93 |
| Max. Negotiated Rate |
$1,432.33 |
| Rate for Payer: Aetna Commercial |
$1,401.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.92
|
| Rate for Payer: Aetna Managed Medicare |
$435.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,011.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$747.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.15
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cigna Commercial |
$1,432.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$871.25
|
| Rate for Payer: Health EOS Commercial |
$1,385.62
|
| Rate for Payer: HFN Commercial |
$1,432.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.66
|
| Rate for Payer: Multiplan Commercial |
$1,245.50
|
| Rate for Payer: NAPHCARE Commercial |
$934.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,432.33
|
| Rate for Payer: Quartz Beloit One Network |
$762.87
|
| Rate for Payer: Quartz Commercial |
$1,011.97
|
| Rate for Payer: Quartz Medicare Advantage |
$934.13
|
| Rate for Payer: The Alliance Commercial |
$778.44
|
| Rate for Payer: WEA Trust Commercial |
$856.28
|
| Rate for Payer: WPS Commercial |
$1,153.14
|
|
|
GUIDE WIRE 3.2 X 230MM NON-THREADED 705235
|
Facility
|
IP
|
$1,497.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5641643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.87 |
| Max. Negotiated Rate |
$1,432.33 |
| Rate for Payer: Aetna Commercial |
$1,401.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.15
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cigna Commercial |
$1,432.33
|
| Rate for Payer: Health EOS Commercial |
$1,385.62
|
| Rate for Payer: HFN Commercial |
$1,432.33
|
| Rate for Payer: Multiplan Commercial |
$1,245.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,432.33
|
| Rate for Payer: Quartz Beloit One Network |
$762.87
|
| Rate for Payer: Quartz Commercial |
$934.13
|
| Rate for Payer: WEA Trust Commercial |
$856.28
|
| Rate for Payer: WPS Commercial |
$1,153.14
|
|
|
GUIDE WIRE 3.2 X 230MM THREADED 705236
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6217043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.36 |
| Max. Negotiated Rate |
$883.13 |
| Rate for Payer: Aetna Commercial |
$863.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$825.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.76
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$883.13
|
| Rate for Payer: Health EOS Commercial |
$854.33
|
| Rate for Payer: HFN Commercial |
$883.13
|
| Rate for Payer: Multiplan Commercial |
$767.94
|
| Rate for Payer: Preferred Network Access Commercial |
$883.13
|
| Rate for Payer: Quartz Beloit One Network |
$470.36
|
| Rate for Payer: Quartz Commercial |
$575.95
|
| Rate for Payer: WEA Trust Commercial |
$527.96
|
| Rate for Payer: WPS Commercial |
$710.99
|
|
|
GUIDE WIRE 3.2 X 230MM THREADED 705236
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6217043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.78 |
| Max. Negotiated Rate |
$883.13 |
| Rate for Payer: Aetna Commercial |
$863.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$825.53
|
| Rate for Payer: Aetna Managed Medicare |
$268.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.76
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$883.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$537.19
|
| Rate for Payer: Health EOS Commercial |
$854.33
|
| Rate for Payer: HFN Commercial |
$883.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.94
|
| Rate for Payer: Multiplan Commercial |
$767.94
|
| Rate for Payer: NAPHCARE Commercial |
$575.95
|
| Rate for Payer: Preferred Network Access Commercial |
$883.13
|
| Rate for Payer: Quartz Beloit One Network |
$470.36
|
| Rate for Payer: Quartz Commercial |
$623.95
|
| Rate for Payer: Quartz Medicare Advantage |
$575.95
|
| Rate for Payer: The Alliance Commercial |
$479.96
|
| Rate for Payer: WEA Trust Commercial |
$527.96
|
| Rate for Payer: WPS Commercial |
$710.99
|
|
|
GUIDE WIRE 3.2 X 400 TFN 357.399
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$509.89 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Aetna Managed Medicare |
$509.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,183.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$910.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$874.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,019.08
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,365.78
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: NAPHCARE Commercial |
$1,092.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,183.68
|
| Rate for Payer: Quartz Medicare Advantage |
$1,092.62
|
| Rate for Payer: The Alliance Commercial |
$910.52
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
GUIDE WIRE 3.2 X 400 TFN 357.399
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$892.31 |
| Max. Negotiated Rate |
$1,675.36 |
| Rate for Payer: Aetna Commercial |
$1,638.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,566.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$965.15
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,675.36
|
| Rate for Payer: Health EOS Commercial |
$1,620.73
|
| Rate for Payer: HFN Commercial |
$1,675.36
|
| Rate for Payer: Multiplan Commercial |
$1,456.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,675.36
|
| Rate for Payer: Quartz Beloit One Network |
$892.31
|
| Rate for Payer: Quartz Commercial |
$1,092.62
|
| Rate for Payer: WEA Trust Commercial |
$1,001.57
|
| Rate for Payer: WPS Commercial |
$1,348.80
|
|
|
GUIDE WIRE ALL-STAR .014 190cm J
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972528
|
|
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
|
|
|
GUIDE WIRE ALL-STAR .014 190cm J
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972528
|
|
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 ALL STAR 300cm J #1001741J
|
Facility
|
IP
|
$2,115.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,077.80 |
| Max. Negotiated Rate |
$2,023.63 |
| Rate for Payer: Aetna Commercial |
$1,979.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,891.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,165.79
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$2,023.63
|
| Rate for Payer: Health EOS Commercial |
$1,957.64
|
| Rate for Payer: HFN Commercial |
$2,023.63
|
| Rate for Payer: Multiplan Commercial |
$1,759.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,023.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.80
|
| Rate for Payer: Quartz Commercial |
$1,319.76
|
| Rate for Payer: WEA Trust Commercial |
$1,209.78
|
| Rate for Payer: WPS Commercial |
$1,629.18
|
|
|
GUIDE WIRE ALL STAR 300cm J #1001741J
|
Facility
|
OP
|
$2,115.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.89 |
| Max. Negotiated Rate |
$2,023.63 |
| Rate for Payer: Aetna Commercial |
$1,979.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,891.66
|
| Rate for Payer: Aetna Managed Medicare |
$615.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,429.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,099.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,055.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,165.79
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$2,023.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,230.93
|
| Rate for Payer: Health EOS Commercial |
$1,957.64
|
| Rate for Payer: HFN Commercial |
$2,023.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,649.70
|
| Rate for Payer: Multiplan Commercial |
$1,759.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,319.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,023.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,077.80
|
| Rate for Payer: Quartz Commercial |
$1,429.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,319.76
|
| Rate for Payer: The Alliance Commercial |
$1,099.80
|
| Rate for Payer: WEA Trust Commercial |
$1,209.78
|
| Rate for Payer: WPS Commercial |
$1,629.18
|
|
|
GUIDE WIRE AMPLATZ 3MM J .035 X 145 SUPER STIFF M0066401050
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.93 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$320.74
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
GUIDE WIRE AMPLATZ 3MM J .035 X 145 SUPER STIFF M0066401050
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.68 |
| Max. Negotiated Rate |
$491.80 |
| Rate for Payer: Aetna Commercial |
$481.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$459.72
|
| Rate for Payer: Aetna Managed Medicare |
$149.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.32
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$491.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.15
|
| Rate for Payer: Health EOS Commercial |
$475.76
|
| Rate for Payer: HFN Commercial |
$491.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.92
|
| Rate for Payer: Multiplan Commercial |
$427.65
|
| Rate for Payer: NAPHCARE Commercial |
$320.74
|
| Rate for Payer: Preferred Network Access Commercial |
$491.80
|
| Rate for Payer: Quartz Beloit One Network |
$261.93
|
| Rate for Payer: Quartz Commercial |
$347.46
|
| Rate for Payer: Quartz Medicare Advantage |
$320.74
|
| Rate for Payer: The Alliance Commercial |
$267.28
|
| Rate for Payer: WEA Trust Commercial |
$294.01
|
| Rate for Payer: WPS Commercial |
$395.93
|
|
|
GUIDE WIRE AMPLATZ 3MM J-TIP .038 X 145 SUPER STIFF M0066401070
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5307083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.15 |
| Max. Negotiated Rate |
$563.56 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.66
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$563.56
|
| Rate for Payer: Health EOS Commercial |
$545.18
|
| Rate for Payer: HFN Commercial |
$563.56
|
| Rate for Payer: Multiplan Commercial |
$490.05
|
| Rate for Payer: Preferred Network Access Commercial |
$563.56
|
| Rate for Payer: Quartz Beloit One Network |
$300.15
|
| Rate for Payer: Quartz Commercial |
$367.54
|
| Rate for Payer: WEA Trust Commercial |
$336.91
|
| Rate for Payer: WPS Commercial |
$453.71
|
|
|
GUIDE WIRE AMPLATZ 3MM J-TIP .038 X 145 SUPER STIFF M0066401070
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5307083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.52 |
| Max. Negotiated Rate |
$563.56 |
| Rate for Payer: Aetna Commercial |
$551.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$526.80
|
| Rate for Payer: Aetna Managed Medicare |
$171.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$398.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$306.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.66
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$563.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$342.80
|
| Rate for Payer: Health EOS Commercial |
$545.18
|
| Rate for Payer: HFN Commercial |
$563.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$459.42
|
| Rate for Payer: Multiplan Commercial |
$490.05
|
| Rate for Payer: NAPHCARE Commercial |
$367.54
|
| Rate for Payer: Preferred Network Access Commercial |
$563.56
|
| Rate for Payer: Quartz Beloit One Network |
$300.15
|
| Rate for Payer: Quartz Commercial |
$398.16
|
| Rate for Payer: Quartz Medicare Advantage |
$367.54
|
| Rate for Payer: The Alliance Commercial |
$306.28
|
| Rate for Payer: WEA Trust Commercial |
$336.91
|
| Rate for Payer: WPS Commercial |
$453.71
|
|
|
GUIDE WIRE AMPLATZ STRAIGHT .035 X 145 SUPER STIFF M0066401080
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.08 |
| Max. Negotiated Rate |
$437.26 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Aetna Managed Medicare |
$133.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$228.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.97
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$356.46
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: NAPHCARE Commercial |
$285.17
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$308.93
|
| Rate for Payer: Quartz Medicare Advantage |
$285.17
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
|
GUIDE WIRE AMPLATZ STRAIGHT .035 X 145 SUPER STIFF M0066401080
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.89 |
| Max. Negotiated Rate |
$437.26 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$285.17
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
|
GUIDE WIRE AMPLATZ STRAIGHT TIP .038 X 145 SUPER STIFF M0066401090
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.89 |
| Max. Negotiated Rate |
$437.26 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$285.17
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
|
GUIDE WIRE AMPLATZ STRAIGHT TIP .038 X 145 SUPER STIFF M0066401090
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$133.08 |
| Max. Negotiated Rate |
$437.26 |
| Rate for Payer: Aetna Commercial |
$427.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.74
|
| Rate for Payer: Aetna Managed Medicare |
$133.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$308.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$237.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$228.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.90
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$437.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.97
|
| Rate for Payer: Health EOS Commercial |
$423.00
|
| Rate for Payer: HFN Commercial |
$437.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$356.46
|
| Rate for Payer: Multiplan Commercial |
$380.22
|
| Rate for Payer: NAPHCARE Commercial |
$285.17
|
| Rate for Payer: Preferred Network Access Commercial |
$437.26
|
| Rate for Payer: Quartz Beloit One Network |
$232.89
|
| Rate for Payer: Quartz Commercial |
$308.93
|
| Rate for Payer: Quartz Medicare Advantage |
$285.17
|
| Rate for Payer: The Alliance Commercial |
$237.64
|
| Rate for Payer: WEA Trust Commercial |
$261.40
|
| Rate for Payer: WPS Commercial |
$352.03
|
|
|
GUIDEWIRE ASAHI CONFIANZA PRO12 180CM
|
Facility
|
IP
|
$4,454.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,269.76 |
| Max. Negotiated Rate |
$4,261.59 |
| Rate for Payer: Aetna Commercial |
$4,168.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,983.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,455.04
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,261.59
|
| Rate for Payer: Health EOS Commercial |
$4,122.62
|
| Rate for Payer: HFN Commercial |
$4,261.59
|
| Rate for Payer: Multiplan Commercial |
$3,705.73
|
| Rate for Payer: Preferred Network Access Commercial |
$4,261.59
|
| Rate for Payer: Quartz Beloit One Network |
$2,269.76
|
| Rate for Payer: Quartz Commercial |
$2,779.30
|
| Rate for Payer: WEA Trust Commercial |
$2,547.69
|
| Rate for Payer: WPS Commercial |
$3,430.92
|
|
