|
GUIDE WIRE .045 X 5.91 AR-8933K
|
Facility
|
OP
|
$167.00
|
|
| Hospital Charge Code |
5286790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.76 |
| Max. Negotiated Rate |
$668.00 |
| Rate for Payer: Aetna Commercial |
$150.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$143.62
|
| Rate for Payer: Aetna Managed Medicare |
$46.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$108.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$80.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$88.51
|
| Rate for Payer: Cash Price |
$50.10
|
| Rate for Payer: Cigna Commercial |
$153.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.45
|
| Rate for Payer: Health EOS Commercial |
$148.63
|
| Rate for Payer: HFN Commercial |
$153.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$125.25
|
| Rate for Payer: Multiplan Commercial |
$133.60
|
| Rate for Payer: NAPHCARE Commercial |
$100.20
|
| Rate for Payer: Preferred Network Access Commercial |
$153.64
|
| Rate for Payer: Quartz Beloit One Network |
$81.83
|
| Rate for Payer: Quartz Commercial |
$108.55
|
| Rate for Payer: Quartz Medicare Advantage |
$100.20
|
| Rate for Payer: The Alliance Commercial |
$668.00
|
| Rate for Payer: WEA Trust Commercial |
$91.85
|
| Rate for Payer: WPS Commercial |
$123.70
|
|
|
GUIDE WIRE .054 X 6 ACUTRAK WS-1406ST"
|
Facility
|
IP
|
$407.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4494356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$199.43 |
| Max. Negotiated Rate |
$374.44 |
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.71
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$374.44
|
| Rate for Payer: Health EOS Commercial |
$362.23
|
| Rate for Payer: HFN Commercial |
$374.44
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: NAPHCARE Commercial |
$244.20
|
| Rate for Payer: Preferred Network Access Commercial |
$374.44
|
| Rate for Payer: Quartz Beloit One Network |
$199.43
|
| Rate for Payer: Quartz Commercial |
$244.20
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
|
GUIDE WIRE .054 X 6 ACUTRAK WS-1406ST"
|
Facility
|
OP
|
$407.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4494356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$113.96 |
| Max. Negotiated Rate |
$1,628.00 |
| Rate for Payer: Aetna Commercial |
$366.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$350.02
|
| Rate for Payer: Aetna Managed Medicare |
$113.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.71
|
| Rate for Payer: Cash Price |
$122.10
|
| Rate for Payer: Cigna Commercial |
$374.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.76
|
| Rate for Payer: Health EOS Commercial |
$362.23
|
| Rate for Payer: HFN Commercial |
$374.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$305.25
|
| Rate for Payer: Multiplan Commercial |
$325.60
|
| Rate for Payer: NAPHCARE Commercial |
$244.20
|
| Rate for Payer: Preferred Network Access Commercial |
$374.44
|
| Rate for Payer: Quartz Beloit One Network |
$199.43
|
| Rate for Payer: Quartz Commercial |
$264.55
|
| Rate for Payer: Quartz Medicare Advantage |
$244.20
|
| Rate for Payer: The Alliance Commercial |
$1,628.00
|
| Rate for Payer: WEA Trust Commercial |
$223.85
|
| Rate for Payer: WPS Commercial |
$301.46
|
|
|
GUIDE WIRE .054 X 7 ACUTRAK WS-1407ST"
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4206006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$109.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.80
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.25
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$234.60
|
| Rate for Payer: The Alliance Commercial |
$1,564.00
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
GUIDE WIRE .054 X 7 ACUTRAK WS-1407ST"
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4206006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
GUIDE WIRE .062 ACUTRAK WS-1060DT
|
Facility
|
OP
|
$269.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2967387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$75.32 |
| Max. Negotiated Rate |
$1,076.00 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Aetna Managed Medicare |
$75.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$174.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$134.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.53
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.75
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$174.85
|
| Rate for Payer: Quartz Medicare Advantage |
$161.40
|
| Rate for Payer: The Alliance Commercial |
$1,076.00
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
GUIDE WIRE .062 ACUTRAK WS-1060DT
|
Facility
|
IP
|
$269.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2967387
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.81 |
| Max. Negotiated Rate |
$247.48 |
| Rate for Payer: Aetna Commercial |
$242.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$231.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$142.57
|
| Rate for Payer: Cash Price |
$80.70
|
| Rate for Payer: Cigna Commercial |
$247.48
|
| Rate for Payer: Health EOS Commercial |
$239.41
|
| Rate for Payer: HFN Commercial |
$247.48
|
| Rate for Payer: Multiplan Commercial |
$215.20
|
| Rate for Payer: NAPHCARE Commercial |
$161.40
|
| Rate for Payer: Preferred Network Access Commercial |
$247.48
|
| Rate for Payer: Quartz Beloit One Network |
$131.81
|
| Rate for Payer: Quartz Commercial |
$161.40
|
| Rate for Payer: WEA Trust Commercial |
$147.95
|
| Rate for Payer: WPS Commercial |
$199.25
|
|
|
GUIDE WIRE .062 ACUTRAK WS-1607ST
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4595310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.59 |
| Max. Negotiated Rate |
$359.72 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$234.60
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
GUIDE WIRE .062 ACUTRAK WS-1607ST
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4595310
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.48 |
| Max. Negotiated Rate |
$1,564.00 |
| Rate for Payer: Aetna Commercial |
$351.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$336.26
|
| Rate for Payer: Aetna Managed Medicare |
$109.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$254.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$195.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$207.23
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$359.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.80
|
| Rate for Payer: Health EOS Commercial |
$347.99
|
| Rate for Payer: HFN Commercial |
$359.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$293.25
|
| Rate for Payer: Multiplan Commercial |
$312.80
|
| Rate for Payer: NAPHCARE Commercial |
$234.60
|
| Rate for Payer: Preferred Network Access Commercial |
$359.72
|
| Rate for Payer: Quartz Beloit One Network |
$191.59
|
| Rate for Payer: Quartz Commercial |
$254.15
|
| Rate for Payer: Quartz Medicare Advantage |
$234.60
|
| Rate for Payer: The Alliance Commercial |
$1,564.00
|
| Rate for Payer: WEA Trust Commercial |
$215.05
|
| Rate for Payer: WPS Commercial |
$289.61
|
|
|
GUIDE WIRE .062 TROCAR TIP ARTHREX AR-8941K
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4594699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.31 |
| Max. Negotiated Rate |
$293.48 |
| Rate for Payer: Aetna Commercial |
$287.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.07
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$293.48
|
| Rate for Payer: Health EOS Commercial |
$283.91
|
| Rate for Payer: HFN Commercial |
$293.48
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: NAPHCARE Commercial |
$191.40
|
| Rate for Payer: Preferred Network Access Commercial |
$293.48
|
| Rate for Payer: Quartz Beloit One Network |
$156.31
|
| Rate for Payer: Quartz Commercial |
$191.40
|
| Rate for Payer: WEA Trust Commercial |
$175.45
|
| Rate for Payer: WPS Commercial |
$236.28
|
|
|
GUIDE WIRE .062 TROCAR TIP ARTHREX AR-8941K
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4594699
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$1,276.00 |
| Rate for Payer: Aetna Commercial |
$287.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.34
|
| Rate for Payer: Aetna Managed Medicare |
$89.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$207.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.07
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$293.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.51
|
| Rate for Payer: Health EOS Commercial |
$283.91
|
| Rate for Payer: HFN Commercial |
$293.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.25
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: NAPHCARE Commercial |
$191.40
|
| Rate for Payer: Preferred Network Access Commercial |
$293.48
|
| Rate for Payer: Quartz Beloit One Network |
$156.31
|
| Rate for Payer: Quartz Commercial |
$207.35
|
| Rate for Payer: Quartz Medicare Advantage |
$191.40
|
| Rate for Payer: The Alliance Commercial |
$1,276.00
|
| Rate for Payer: WEA Trust Commercial |
$175.45
|
| Rate for Payer: WPS Commercial |
$236.28
|
|
|
GUIDE WIRE .062 TROCAR TIP THREADED ARTHREX AR-8941KT
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5611544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.39 |
| Max. Negotiated Rate |
$378.12 |
| Rate for Payer: Aetna Commercial |
$369.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$353.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.83
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna Commercial |
$378.12
|
| Rate for Payer: Health EOS Commercial |
$365.79
|
| Rate for Payer: HFN Commercial |
$378.12
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: NAPHCARE Commercial |
$246.60
|
| Rate for Payer: Preferred Network Access Commercial |
$378.12
|
| Rate for Payer: Quartz Beloit One Network |
$201.39
|
| Rate for Payer: Quartz Commercial |
$246.60
|
| Rate for Payer: WEA Trust Commercial |
$226.05
|
| Rate for Payer: WPS Commercial |
$304.43
|
|
|
GUIDE WIRE .062 TROCAR TIP THREADED ARTHREX AR-8941KT
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5611544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.08 |
| Max. Negotiated Rate |
$1,644.00 |
| Rate for Payer: Aetna Commercial |
$369.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$353.46
|
| Rate for Payer: Aetna Managed Medicare |
$115.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$267.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$205.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$197.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.83
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna Commercial |
$378.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.00
|
| Rate for Payer: Health EOS Commercial |
$365.79
|
| Rate for Payer: HFN Commercial |
$378.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$308.25
|
| Rate for Payer: Multiplan Commercial |
$328.80
|
| Rate for Payer: NAPHCARE Commercial |
$246.60
|
| Rate for Payer: Preferred Network Access Commercial |
$378.12
|
| Rate for Payer: Quartz Beloit One Network |
$201.39
|
| Rate for Payer: Quartz Commercial |
$267.15
|
| Rate for Payer: Quartz Medicare Advantage |
$246.60
|
| Rate for Payer: The Alliance Commercial |
$1,644.00
|
| Rate for Payer: WEA Trust Commercial |
$226.05
|
| Rate for Payer: WPS Commercial |
$304.43
|
|
|
GUIDE WIRE .062 X 12 IN ARTHREX AR-8941-12
|
Facility
|
IP
|
$1,031.00
|
|
| Hospital Charge Code |
5415173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.19 |
| Max. Negotiated Rate |
$948.52 |
| Rate for Payer: Aetna Commercial |
$927.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.43
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$948.52
|
| Rate for Payer: Health EOS Commercial |
$917.59
|
| Rate for Payer: HFN Commercial |
$948.52
|
| Rate for Payer: Multiplan Commercial |
$824.80
|
| Rate for Payer: NAPHCARE Commercial |
$618.60
|
| Rate for Payer: Preferred Network Access Commercial |
$948.52
|
| Rate for Payer: Quartz Beloit One Network |
$505.19
|
| Rate for Payer: Quartz Commercial |
$618.60
|
| Rate for Payer: WEA Trust Commercial |
$567.05
|
| Rate for Payer: WPS Commercial |
$763.66
|
|
|
GUIDE WIRE .062 X 12 IN ARTHREX AR-8941-12
|
Facility
|
OP
|
$1,031.00
|
|
| Hospital Charge Code |
5415173
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.68 |
| Max. Negotiated Rate |
$4,124.00 |
| Rate for Payer: Aetna Commercial |
$927.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.66
|
| Rate for Payer: Aetna Managed Medicare |
$288.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$670.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.43
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$948.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.95
|
| Rate for Payer: Health EOS Commercial |
$917.59
|
| Rate for Payer: HFN Commercial |
$948.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$773.25
|
| Rate for Payer: Multiplan Commercial |
$824.80
|
| Rate for Payer: NAPHCARE Commercial |
$618.60
|
| Rate for Payer: Preferred Network Access Commercial |
$948.52
|
| Rate for Payer: Quartz Beloit One Network |
$505.19
|
| Rate for Payer: Quartz Commercial |
$670.15
|
| Rate for Payer: Quartz Medicare Advantage |
$618.60
|
| Rate for Payer: The Alliance Commercial |
$4,124.00
|
| Rate for Payer: WEA Trust Commercial |
$567.05
|
| Rate for Payer: WPS Commercial |
$763.66
|
|
|
GUIDE WIRE .062 X 6 IN ARTHREX AR-8941-6
|
Facility
|
IP
|
$747.00
|
|
| Hospital Charge Code |
5415172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.03 |
| Max. Negotiated Rate |
$687.24 |
| Rate for Payer: Aetna Commercial |
$672.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$642.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.91
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: Health EOS Commercial |
$664.83
|
| Rate for Payer: HFN Commercial |
$687.24
|
| Rate for Payer: Multiplan Commercial |
$597.60
|
| Rate for Payer: NAPHCARE Commercial |
$448.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.24
|
| Rate for Payer: Quartz Beloit One Network |
$366.03
|
| Rate for Payer: Quartz Commercial |
$448.20
|
| Rate for Payer: WEA Trust Commercial |
$410.85
|
| Rate for Payer: WPS Commercial |
$553.30
|
|
|
GUIDE WIRE .062 X 6 IN ARTHREX AR-8941-6
|
Facility
|
OP
|
$747.00
|
|
| Hospital Charge Code |
5415172
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.16 |
| Max. Negotiated Rate |
$2,988.00 |
| Rate for Payer: Aetna Commercial |
$672.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$642.42
|
| Rate for Payer: Aetna Managed Medicare |
$209.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$485.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$358.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.91
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.02
|
| Rate for Payer: Health EOS Commercial |
$664.83
|
| Rate for Payer: HFN Commercial |
$687.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.25
|
| Rate for Payer: Multiplan Commercial |
$597.60
|
| Rate for Payer: NAPHCARE Commercial |
$448.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.24
|
| Rate for Payer: Quartz Beloit One Network |
$366.03
|
| Rate for Payer: Quartz Commercial |
$485.55
|
| Rate for Payer: Quartz Medicare Advantage |
$448.20
|
| Rate for Payer: The Alliance Commercial |
$2,988.00
|
| Rate for Payer: WEA Trust Commercial |
$410.85
|
| Rate for Payer: WPS Commercial |
$553.30
|
|
|
GUIDE WIRE .062 X 7 IN ARTHREX AR-8941-7
|
Facility
|
OP
|
$747.00
|
|
| Hospital Charge Code |
4202661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.16 |
| Max. Negotiated Rate |
$2,988.00 |
| Rate for Payer: Aetna Commercial |
$672.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$642.42
|
| Rate for Payer: Aetna Managed Medicare |
$209.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$485.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$358.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.91
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.02
|
| Rate for Payer: Health EOS Commercial |
$664.83
|
| Rate for Payer: HFN Commercial |
$687.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.25
|
| Rate for Payer: Multiplan Commercial |
$597.60
|
| Rate for Payer: NAPHCARE Commercial |
$448.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.24
|
| Rate for Payer: Quartz Beloit One Network |
$366.03
|
| Rate for Payer: Quartz Commercial |
$485.55
|
| Rate for Payer: Quartz Medicare Advantage |
$448.20
|
| Rate for Payer: The Alliance Commercial |
$2,988.00
|
| Rate for Payer: WEA Trust Commercial |
$410.85
|
| Rate for Payer: WPS Commercial |
$553.30
|
|
|
GUIDE WIRE .062 X 7 IN ARTHREX AR-8941-7
|
Facility
|
IP
|
$747.00
|
|
| Hospital Charge Code |
4202661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.03 |
| Max. Negotiated Rate |
$687.24 |
| Rate for Payer: Aetna Commercial |
$672.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$642.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$395.91
|
| Rate for Payer: Cash Price |
$224.10
|
| Rate for Payer: Cigna Commercial |
$687.24
|
| Rate for Payer: Health EOS Commercial |
$664.83
|
| Rate for Payer: HFN Commercial |
$687.24
|
| Rate for Payer: Multiplan Commercial |
$597.60
|
| Rate for Payer: NAPHCARE Commercial |
$448.20
|
| Rate for Payer: Preferred Network Access Commercial |
$687.24
|
| Rate for Payer: Quartz Beloit One Network |
$366.03
|
| Rate for Payer: Quartz Commercial |
$448.20
|
| Rate for Payer: WEA Trust Commercial |
$410.85
|
| Rate for Payer: WPS Commercial |
$553.30
|
|
|
GUIDE WIRE .079 X 9 STERILE (2 PK) P06 S2292"
|
Facility
|
OP
|
$2,437.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6172202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$682.36 |
| Max. Negotiated Rate |
$9,748.00 |
| Rate for Payer: Aetna Commercial |
$2,193.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,095.82
|
| Rate for Payer: Aetna Managed Medicare |
$682.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,584.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,218.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,169.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,291.61
|
| Rate for Payer: Cash Price |
$731.10
|
| Rate for Payer: Cigna Commercial |
$2,242.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,363.75
|
| Rate for Payer: Health EOS Commercial |
$2,168.93
|
| Rate for Payer: HFN Commercial |
$2,242.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,827.75
|
| Rate for Payer: Multiplan Commercial |
$1,949.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,462.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,242.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,194.13
|
| Rate for Payer: Quartz Commercial |
$1,584.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,462.20
|
| Rate for Payer: The Alliance Commercial |
$9,748.00
|
| Rate for Payer: WEA Trust Commercial |
$1,340.35
|
| Rate for Payer: WPS Commercial |
$1,805.09
|
|
|
GUIDE WIRE .079 X 9 STERILE (2 PK) P06 S2292"
|
Facility
|
IP
|
$2,437.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6172202
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,194.13 |
| Max. Negotiated Rate |
$2,242.04 |
| Rate for Payer: Aetna Commercial |
$2,193.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,095.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,291.61
|
| Rate for Payer: Cash Price |
$731.10
|
| Rate for Payer: Cigna Commercial |
$2,242.04
|
| Rate for Payer: Health EOS Commercial |
$2,168.93
|
| Rate for Payer: HFN Commercial |
$2,242.04
|
| Rate for Payer: Multiplan Commercial |
$1,949.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,462.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,242.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,194.13
|
| Rate for Payer: Quartz Commercial |
$1,462.20
|
| Rate for Payer: WEA Trust Commercial |
$1,340.35
|
| Rate for Payer: WPS Commercial |
$1,805.09
|
|
|
GUIDEWIRE 0.86MM TROCAR TIP THREADED AR-8737-40
|
Facility
|
IP
|
$466.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5813660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.34 |
| Max. Negotiated Rate |
$428.72 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$279.60
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
GUIDEWIRE 0.86MM TROCAR TIP THREADED AR-8737-40
|
Facility
|
OP
|
$466.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5813660
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.48 |
| Max. Negotiated Rate |
$1,864.00 |
| Rate for Payer: Aetna Commercial |
$419.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$400.76
|
| Rate for Payer: Aetna Managed Medicare |
$130.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.98
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$428.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.77
|
| Rate for Payer: Health EOS Commercial |
$414.74
|
| Rate for Payer: HFN Commercial |
$428.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$349.50
|
| Rate for Payer: Multiplan Commercial |
$372.80
|
| Rate for Payer: NAPHCARE Commercial |
$279.60
|
| Rate for Payer: Preferred Network Access Commercial |
$428.72
|
| Rate for Payer: Quartz Beloit One Network |
$228.34
|
| Rate for Payer: Quartz Commercial |
$302.90
|
| Rate for Payer: Quartz Medicare Advantage |
$279.60
|
| Rate for Payer: The Alliance Commercial |
$1,864.00
|
| Rate for Payer: WEA Trust Commercial |
$256.30
|
| Rate for Payer: WPS Commercial |
$345.17
|
|
|
GUIDEWIRE 0.86MM WITH LASER LINE AR-8737-21
|
Facility
|
IP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.31 |
| Max. Negotiated Rate |
$293.48 |
| Rate for Payer: Aetna Commercial |
$287.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.07
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$293.48
|
| Rate for Payer: Health EOS Commercial |
$283.91
|
| Rate for Payer: HFN Commercial |
$293.48
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: NAPHCARE Commercial |
$191.40
|
| Rate for Payer: Preferred Network Access Commercial |
$293.48
|
| Rate for Payer: Quartz Beloit One Network |
$156.31
|
| Rate for Payer: Quartz Commercial |
$191.40
|
| Rate for Payer: WEA Trust Commercial |
$175.45
|
| Rate for Payer: WPS Commercial |
$236.28
|
|
|
GUIDEWIRE 0.86MM WITH LASER LINE AR-8737-21
|
Facility
|
OP
|
$319.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.32 |
| Max. Negotiated Rate |
$1,276.00 |
| Rate for Payer: Aetna Commercial |
$287.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.34
|
| Rate for Payer: Aetna Managed Medicare |
$89.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$207.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.07
|
| Rate for Payer: Cash Price |
$95.70
|
| Rate for Payer: Cigna Commercial |
$293.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.51
|
| Rate for Payer: Health EOS Commercial |
$283.91
|
| Rate for Payer: HFN Commercial |
$293.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.25
|
| Rate for Payer: Multiplan Commercial |
$255.20
|
| Rate for Payer: NAPHCARE Commercial |
$191.40
|
| Rate for Payer: Preferred Network Access Commercial |
$293.48
|
| Rate for Payer: Quartz Beloit One Network |
$156.31
|
| Rate for Payer: Quartz Commercial |
$207.35
|
| Rate for Payer: Quartz Medicare Advantage |
$191.40
|
| Rate for Payer: The Alliance Commercial |
$1,276.00
|
| Rate for Payer: WEA Trust Commercial |
$175.45
|
| Rate for Payer: WPS Commercial |
$236.28
|
|
