|
GUIDEWIRE ASAHI CONFIANZA PRO12 180CM
|
Facility
|
OP
|
$4,454.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,297.00 |
| 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: Aetna Managed Medicare |
$1,297.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,010.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,316.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,223.44
|
| 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: Dean Health DHI/DHP/ASO |
$2,592.23
|
| Rate for Payer: Health EOS Commercial |
$4,122.62
|
| Rate for Payer: HFN Commercial |
$4,261.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,474.12
|
| Rate for Payer: Multiplan Commercial |
$3,705.73
|
| Rate for Payer: NAPHCARE Commercial |
$2,779.30
|
| 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 |
$3,010.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,779.30
|
| Rate for Payer: The Alliance Commercial |
$2,316.08
|
| Rate for Payer: WEA Trust Commercial |
$2,547.69
|
| Rate for Payer: WPS Commercial |
$3,430.92
|
|
|
GUIDEWIRE ASAHI CONFIANZA PRO9 180CM
|
Facility
|
IP
|
$3,552.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,810.10 |
| Max. Negotiated Rate |
$3,398.55 |
| Rate for Payer: Aetna Commercial |
$3,324.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,176.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,957.86
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$3,398.55
|
| Rate for Payer: Health EOS Commercial |
$3,287.73
|
| Rate for Payer: HFN Commercial |
$3,398.55
|
| Rate for Payer: Multiplan Commercial |
$2,955.26
|
| Rate for Payer: Preferred Network Access Commercial |
$3,398.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,810.10
|
| Rate for Payer: Quartz Commercial |
$2,216.45
|
| Rate for Payer: WEA Trust Commercial |
$2,031.74
|
| Rate for Payer: WPS Commercial |
$2,736.11
|
|
|
GUIDEWIRE ASAHI CONFIANZA PRO9 180CM
|
Facility
|
OP
|
$3,552.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,034.34 |
| Max. Negotiated Rate |
$3,398.55 |
| Rate for Payer: Aetna Commercial |
$3,324.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,176.91
|
| Rate for Payer: Aetna Managed Medicare |
$1,034.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,401.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,847.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,773.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,957.86
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$3,398.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,067.26
|
| Rate for Payer: Health EOS Commercial |
$3,287.73
|
| Rate for Payer: HFN Commercial |
$3,398.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,770.56
|
| Rate for Payer: Multiplan Commercial |
$2,955.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,216.45
|
| Rate for Payer: Preferred Network Access Commercial |
$3,398.55
|
| Rate for Payer: Quartz Beloit One Network |
$1,810.10
|
| Rate for Payer: Quartz Commercial |
$2,401.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,216.45
|
| Rate for Payer: The Alliance Commercial |
$1,847.04
|
| Rate for Payer: WEA Trust Commercial |
$2,031.74
|
| Rate for Payer: WPS Commercial |
$2,736.11
|
|
|
GUIDEWIRE ASAHI CONFIANZA ST 300CM
|
Facility
|
OP
|
$4,454.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,297.00 |
| 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: Aetna Managed Medicare |
$1,297.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,010.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,316.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,223.44
|
| 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: Dean Health DHI/DHP/ASO |
$2,592.23
|
| Rate for Payer: Health EOS Commercial |
$4,122.62
|
| Rate for Payer: HFN Commercial |
$4,261.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,474.12
|
| Rate for Payer: Multiplan Commercial |
$3,705.73
|
| Rate for Payer: NAPHCARE Commercial |
$2,779.30
|
| 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 |
$3,010.90
|
| Rate for Payer: Quartz Medicare Advantage |
$2,779.30
|
| Rate for Payer: The Alliance Commercial |
$2,316.08
|
| Rate for Payer: WEA Trust Commercial |
$2,547.69
|
| Rate for Payer: WPS Commercial |
$3,430.92
|
|
|
GUIDEWIRE ASAHI CONFIANZA ST 300CM
|
Facility
|
IP
|
$4,454.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449512
|
|
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
|
|
|
GUIDEWIRE ASAHI CONFIANZA ST9 180CM
|
Facility
|
IP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,357.92 |
| Max. Negotiated Rate |
$4,427.11 |
| Rate for Payer: Aetna Commercial |
$4,330.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,138.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,550.40
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,427.11
|
| Rate for Payer: Health EOS Commercial |
$4,282.75
|
| Rate for Payer: HFN Commercial |
$4,427.11
|
| Rate for Payer: Multiplan Commercial |
$3,849.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,427.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,357.92
|
| Rate for Payer: Quartz Commercial |
$2,887.25
|
| Rate for Payer: WEA Trust Commercial |
$2,646.64
|
| Rate for Payer: WPS Commercial |
$3,564.18
|
|
|
GUIDEWIRE ASAHI CONFIANZA ST9 180CM
|
Facility
|
OP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,347.38 |
| Max. Negotiated Rate |
$4,427.11 |
| Rate for Payer: Aetna Commercial |
$4,330.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,138.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,347.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,127.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,406.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,309.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,550.40
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,427.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,692.91
|
| Rate for Payer: Health EOS Commercial |
$4,282.75
|
| Rate for Payer: HFN Commercial |
$4,427.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,609.06
|
| Rate for Payer: Multiplan Commercial |
$3,849.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,887.25
|
| Rate for Payer: Preferred Network Access Commercial |
$4,427.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,357.92
|
| Rate for Payer: Quartz Commercial |
$3,127.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,887.25
|
| Rate for Payer: The Alliance Commercial |
$2,406.04
|
| Rate for Payer: WEA Trust Commercial |
$2,646.64
|
| Rate for Payer: WPS Commercial |
$3,564.18
|
|
|
GUIDEWIRE ASAHI FIELDER FC 180CM
|
Facility
|
IP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,879.91 |
| Max. Negotiated Rate |
$3,529.64 |
| Rate for Payer: Aetna Commercial |
$3,452.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.38
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cigna Commercial |
$3,529.64
|
| Rate for Payer: Health EOS Commercial |
$3,414.54
|
| Rate for Payer: HFN Commercial |
$3,529.64
|
| Rate for Payer: Multiplan Commercial |
$3,069.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,529.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,879.91
|
| Rate for Payer: Quartz Commercial |
$2,301.94
|
| Rate for Payer: WEA Trust Commercial |
$2,110.11
|
| Rate for Payer: WPS Commercial |
$2,841.64
|
|
|
GUIDEWIRE ASAHI FIELDER FC 180CM
|
Facility
|
OP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,074.24 |
| Max. Negotiated Rate |
$3,529.64 |
| Rate for Payer: Aetna Commercial |
$3,452.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,074.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,493.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,918.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,841.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.38
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cigna Commercial |
$3,529.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,147.00
|
| Rate for Payer: Health EOS Commercial |
$3,414.54
|
| Rate for Payer: HFN Commercial |
$3,529.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,877.42
|
| Rate for Payer: Multiplan Commercial |
$3,069.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,301.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,529.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,879.91
|
| Rate for Payer: Quartz Commercial |
$2,493.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,301.94
|
| Rate for Payer: The Alliance Commercial |
$1,918.28
|
| Rate for Payer: WEA Trust Commercial |
$2,110.11
|
| Rate for Payer: WPS Commercial |
$2,841.64
|
|
|
GUIDEWIRE ASAHI FIELDER XT 190CM
|
Facility
|
OP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,347.38 |
| Max. Negotiated Rate |
$4,427.11 |
| Rate for Payer: Aetna Commercial |
$4,330.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,138.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,347.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,127.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,406.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,309.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,550.40
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,427.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,692.91
|
| Rate for Payer: Health EOS Commercial |
$4,282.75
|
| Rate for Payer: HFN Commercial |
$4,427.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,609.06
|
| Rate for Payer: Multiplan Commercial |
$3,849.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,887.25
|
| Rate for Payer: Preferred Network Access Commercial |
$4,427.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,357.92
|
| Rate for Payer: Quartz Commercial |
$3,127.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,887.25
|
| Rate for Payer: The Alliance Commercial |
$2,406.04
|
| Rate for Payer: WEA Trust Commercial |
$2,646.64
|
| Rate for Payer: WPS Commercial |
$3,564.18
|
|
|
GUIDEWIRE ASAHI FIELDER XT 190CM
|
Facility
|
IP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,357.92 |
| Max. Negotiated Rate |
$4,427.11 |
| Rate for Payer: Aetna Commercial |
$4,330.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,138.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,550.40
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,427.11
|
| Rate for Payer: Health EOS Commercial |
$4,282.75
|
| Rate for Payer: HFN Commercial |
$4,427.11
|
| Rate for Payer: Multiplan Commercial |
$3,849.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,427.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,357.92
|
| Rate for Payer: Quartz Commercial |
$2,887.25
|
| Rate for Payer: WEA Trust Commercial |
$2,646.64
|
| Rate for Payer: WPS Commercial |
$3,564.18
|
|
|
GUIDEWIRE ASAHI FIELDER XT 300CM
|
Facility
|
IP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,357.92 |
| Max. Negotiated Rate |
$4,427.11 |
| Rate for Payer: Aetna Commercial |
$4,330.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,138.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,550.40
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,427.11
|
| Rate for Payer: Health EOS Commercial |
$4,282.75
|
| Rate for Payer: HFN Commercial |
$4,427.11
|
| Rate for Payer: Multiplan Commercial |
$3,849.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,427.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,357.92
|
| Rate for Payer: Quartz Commercial |
$2,887.25
|
| Rate for Payer: WEA Trust Commercial |
$2,646.64
|
| Rate for Payer: WPS Commercial |
$3,564.18
|
|
|
GUIDEWIRE ASAHI FIELDER XT 300CM
|
Facility
|
OP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,347.38 |
| Max. Negotiated Rate |
$4,427.11 |
| Rate for Payer: Aetna Commercial |
$4,330.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,138.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,347.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,127.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,406.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,309.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,550.40
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,427.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,692.91
|
| Rate for Payer: Health EOS Commercial |
$4,282.75
|
| Rate for Payer: HFN Commercial |
$4,427.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,609.06
|
| Rate for Payer: Multiplan Commercial |
$3,849.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,887.25
|
| Rate for Payer: Preferred Network Access Commercial |
$4,427.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,357.92
|
| Rate for Payer: Quartz Commercial |
$3,127.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,887.25
|
| Rate for Payer: The Alliance Commercial |
$2,406.04
|
| Rate for Payer: WEA Trust Commercial |
$2,646.64
|
| Rate for Payer: WPS Commercial |
$3,564.18
|
|
|
GUIDEWIRE ASAHI GRAND SLAM 180CM
|
Facility
|
IP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,879.91 |
| Max. Negotiated Rate |
$3,529.64 |
| Rate for Payer: Aetna Commercial |
$3,452.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.38
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cigna Commercial |
$3,529.64
|
| Rate for Payer: Health EOS Commercial |
$3,414.54
|
| Rate for Payer: HFN Commercial |
$3,529.64
|
| Rate for Payer: Multiplan Commercial |
$3,069.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,529.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,879.91
|
| Rate for Payer: Quartz Commercial |
$2,301.94
|
| Rate for Payer: WEA Trust Commercial |
$2,110.11
|
| Rate for Payer: WPS Commercial |
$2,841.64
|
|
|
GUIDEWIRE ASAHI GRAND SLAM 180CM
|
Facility
|
OP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,074.24 |
| Max. Negotiated Rate |
$3,529.64 |
| Rate for Payer: Aetna Commercial |
$3,452.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,074.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,493.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,918.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,841.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.38
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cigna Commercial |
$3,529.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,147.00
|
| Rate for Payer: Health EOS Commercial |
$3,414.54
|
| Rate for Payer: HFN Commercial |
$3,529.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,877.42
|
| Rate for Payer: Multiplan Commercial |
$3,069.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,301.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,529.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,879.91
|
| Rate for Payer: Quartz Commercial |
$2,493.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,301.94
|
| Rate for Payer: The Alliance Commercial |
$1,918.28
|
| Rate for Payer: WEA Trust Commercial |
$2,110.11
|
| Rate for Payer: WPS Commercial |
$2,841.64
|
|
|
GUIDEWIRE ASAHI GRAND SLAM 300CM
|
Facility
|
OP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,074.24 |
| Max. Negotiated Rate |
$3,529.64 |
| Rate for Payer: Aetna Commercial |
$3,452.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,074.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,493.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,918.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,841.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.38
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cigna Commercial |
$3,529.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,147.00
|
| Rate for Payer: Health EOS Commercial |
$3,414.54
|
| Rate for Payer: HFN Commercial |
$3,529.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,877.42
|
| Rate for Payer: Multiplan Commercial |
$3,069.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,301.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,529.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,879.91
|
| Rate for Payer: Quartz Commercial |
$2,493.76
|
| Rate for Payer: Quartz Medicare Advantage |
$2,301.94
|
| Rate for Payer: The Alliance Commercial |
$1,918.28
|
| Rate for Payer: WEA Trust Commercial |
$2,110.11
|
| Rate for Payer: WPS Commercial |
$2,841.64
|
|
|
GUIDEWIRE ASAHI GRAND SLAM 300CM
|
Facility
|
IP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449506
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,879.91 |
| Max. Negotiated Rate |
$3,529.64 |
| Rate for Payer: Aetna Commercial |
$3,452.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,299.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,033.38
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cigna Commercial |
$3,529.64
|
| Rate for Payer: Health EOS Commercial |
$3,414.54
|
| Rate for Payer: HFN Commercial |
$3,529.64
|
| Rate for Payer: Multiplan Commercial |
$3,069.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,529.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,879.91
|
| Rate for Payer: Quartz Commercial |
$2,301.94
|
| Rate for Payer: WEA Trust Commercial |
$2,110.11
|
| Rate for Payer: WPS Commercial |
$2,841.64
|
|
|
GUIDE WIRE ASAHI PROWATERFLEX 180cm
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.05 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$913.54
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
GUIDE WIRE ASAHI PROWATERFLEX 180cm
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$426.32 |
| Max. Negotiated Rate |
$1,400.76 |
| Rate for Payer: Aetna Commercial |
$1,370.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,309.40
|
| Rate for Payer: Aetna Managed Medicare |
$426.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$989.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$761.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$730.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$806.96
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,400.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.05
|
| Rate for Payer: Health EOS Commercial |
$1,355.08
|
| Rate for Payer: HFN Commercial |
$1,400.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,141.92
|
| Rate for Payer: Multiplan Commercial |
$1,218.05
|
| Rate for Payer: NAPHCARE Commercial |
$913.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,400.76
|
| Rate for Payer: Quartz Beloit One Network |
$746.05
|
| Rate for Payer: Quartz Commercial |
$989.66
|
| Rate for Payer: Quartz Medicare Advantage |
$913.54
|
| Rate for Payer: The Alliance Commercial |
$761.28
|
| Rate for Payer: WEA Trust Commercial |
$837.41
|
| Rate for Payer: WPS Commercial |
$1,127.72
|
|
|
GUIDE WIRE ASAHI PROWATERFLEX 300cm #82358-02
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973601
|
|
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 ASAHI PROWATERFLEX 300cm #82358-02
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973601
|
|
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
|
|
|
GUIDEWIRE ASNIS III DIA 3.2 X 300MM W/O THREAD 702463
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$355.56 |
| Max. Negotiated Rate |
$1,168.25 |
| Rate for Payer: Aetna Commercial |
$1,142.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,092.06
|
| Rate for Payer: Aetna Managed Medicare |
$355.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$825.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$634.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$609.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$673.02
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna Commercial |
$1,168.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$710.62
|
| Rate for Payer: Health EOS Commercial |
$1,130.16
|
| Rate for Payer: HFN Commercial |
$1,168.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$952.38
|
| Rate for Payer: Multiplan Commercial |
$1,015.87
|
| Rate for Payer: NAPHCARE Commercial |
$761.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,168.25
|
| Rate for Payer: Quartz Beloit One Network |
$622.22
|
| Rate for Payer: Quartz Commercial |
$825.40
|
| Rate for Payer: Quartz Medicare Advantage |
$761.90
|
| Rate for Payer: The Alliance Commercial |
$634.92
|
| Rate for Payer: WEA Trust Commercial |
$698.41
|
| Rate for Payer: WPS Commercial |
$940.54
|
|
|
GUIDEWIRE ASNIS III DIA 3.2 X 300MM W/O THREAD 702463
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$622.22 |
| Max. Negotiated Rate |
$1,168.25 |
| Rate for Payer: Aetna Commercial |
$1,142.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,092.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$673.02
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna Commercial |
$1,168.25
|
| Rate for Payer: Health EOS Commercial |
$1,130.16
|
| Rate for Payer: HFN Commercial |
$1,168.25
|
| Rate for Payer: Multiplan Commercial |
$1,015.87
|
| Rate for Payer: Preferred Network Access Commercial |
$1,168.25
|
| Rate for Payer: Quartz Beloit One Network |
$622.22
|
| Rate for Payer: Quartz Commercial |
$761.90
|
| Rate for Payer: WEA Trust Commercial |
$698.41
|
| Rate for Payer: WPS Commercial |
$940.54
|
|
|
GUIDEWIRE ATTAIN HYBRID
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$710.53 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Aetna Managed Medicare |
$710.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,649.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,268.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,218.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,420.08
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,903.20
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: NAPHCARE Commercial |
$1,522.56
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,649.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,522.56
|
| Rate for Payer: The Alliance Commercial |
$1,268.80
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
|
GUIDEWIRE ATTAIN HYBRID
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,243.42 |
| Max. Negotiated Rate |
$2,334.59 |
| Rate for Payer: Aetna Commercial |
$2,283.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,182.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,344.93
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,334.59
|
| Rate for Payer: Health EOS Commercial |
$2,258.46
|
| Rate for Payer: HFN Commercial |
$2,334.59
|
| Rate for Payer: Multiplan Commercial |
$2,030.08
|
| Rate for Payer: Preferred Network Access Commercial |
$2,334.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,243.42
|
| Rate for Payer: Quartz Commercial |
$1,522.56
|
| Rate for Payer: WEA Trust Commercial |
$1,395.68
|
| Rate for Payer: WPS Commercial |
$1,879.53
|
|
