|
GUIDE WIRE 0.86 TROCAR TIP AR-8737-39
|
Facility
|
IP
|
$588.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.12 |
| Max. Negotiated Rate |
$540.96 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$352.80
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
GUIDE WIRE 0.86 TROCAR TIP AR-8737-39
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5547457
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.64 |
| Max. Negotiated Rate |
$2,352.00 |
| Rate for Payer: Aetna Commercial |
$529.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$505.68
|
| Rate for Payer: Aetna Managed Medicare |
$164.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$311.64
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$540.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.04
|
| Rate for Payer: Health EOS Commercial |
$523.32
|
| Rate for Payer: HFN Commercial |
$540.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Multiplan Commercial |
$470.40
|
| Rate for Payer: NAPHCARE Commercial |
$352.80
|
| Rate for Payer: Preferred Network Access Commercial |
$540.96
|
| Rate for Payer: Quartz Beloit One Network |
$288.12
|
| Rate for Payer: Quartz Commercial |
$382.20
|
| Rate for Payer: Quartz Medicare Advantage |
$352.80
|
| Rate for Payer: The Alliance Commercial |
$2,352.00
|
| Rate for Payer: WEA Trust Commercial |
$323.40
|
| Rate for Payer: WPS Commercial |
$435.53
|
|
|
GUIDE WIRE 0.8 X 100 TROCAR TIP 03.333.000
|
Facility
|
IP
|
$910.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6228137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.90 |
| Max. Negotiated Rate |
$837.20 |
| Rate for Payer: Aetna Commercial |
$819.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$782.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$482.30
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$837.20
|
| Rate for Payer: Health EOS Commercial |
$809.90
|
| Rate for Payer: HFN Commercial |
$837.20
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: NAPHCARE Commercial |
$546.00
|
| Rate for Payer: Preferred Network Access Commercial |
$837.20
|
| Rate for Payer: Quartz Beloit One Network |
$445.90
|
| Rate for Payer: Quartz Commercial |
$546.00
|
| Rate for Payer: WEA Trust Commercial |
$500.50
|
| Rate for Payer: WPS Commercial |
$674.04
|
|
|
GUIDE WIRE 0.8 X 100 TROCAR TIP 03.333.000
|
Facility
|
OP
|
$910.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6228137
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.80 |
| Max. Negotiated Rate |
$3,640.00 |
| Rate for Payer: Aetna Commercial |
$819.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$782.60
|
| Rate for Payer: Aetna Managed Medicare |
$254.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$591.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$455.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$436.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$482.30
|
| Rate for Payer: Cash Price |
$273.00
|
| Rate for Payer: Cigna Commercial |
$837.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$509.24
|
| Rate for Payer: Health EOS Commercial |
$809.90
|
| Rate for Payer: HFN Commercial |
$837.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$682.50
|
| Rate for Payer: Multiplan Commercial |
$728.00
|
| Rate for Payer: NAPHCARE Commercial |
$546.00
|
| Rate for Payer: Preferred Network Access Commercial |
$837.20
|
| Rate for Payer: Quartz Beloit One Network |
$445.90
|
| Rate for Payer: Quartz Commercial |
$591.50
|
| Rate for Payer: Quartz Medicare Advantage |
$546.00
|
| Rate for Payer: The Alliance Commercial |
$3,640.00
|
| Rate for Payer: WEA Trust Commercial |
$500.50
|
| Rate for Payer: WPS Commercial |
$674.04
|
|
|
GUIDE WIRE 1.1 X 150 TROCAR TIP 03.333.001
|
Facility
|
IP
|
$973.14
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6248162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$476.84 |
| Max. Negotiated Rate |
$895.29 |
| Rate for Payer: Aetna Commercial |
$875.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$836.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.76
|
| Rate for Payer: Cash Price |
$291.94
|
| Rate for Payer: Cigna Commercial |
$895.29
|
| Rate for Payer: Health EOS Commercial |
$866.09
|
| Rate for Payer: HFN Commercial |
$895.29
|
| Rate for Payer: Multiplan Commercial |
$778.51
|
| Rate for Payer: NAPHCARE Commercial |
$583.88
|
| Rate for Payer: Preferred Network Access Commercial |
$895.29
|
| Rate for Payer: Quartz Beloit One Network |
$476.84
|
| Rate for Payer: Quartz Commercial |
$583.88
|
| Rate for Payer: WEA Trust Commercial |
$535.23
|
| Rate for Payer: WPS Commercial |
$720.80
|
|
|
GUIDE WIRE 1.1 X 150 TROCAR TIP 03.333.001
|
Facility
|
OP
|
$973.14
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6248162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.48 |
| Max. Negotiated Rate |
$3,892.56 |
| Rate for Payer: Aetna Commercial |
$875.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$836.90
|
| Rate for Payer: Aetna Managed Medicare |
$272.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$632.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$486.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$467.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$515.76
|
| Rate for Payer: Cash Price |
$291.94
|
| Rate for Payer: Cigna Commercial |
$895.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$544.57
|
| Rate for Payer: Health EOS Commercial |
$866.09
|
| Rate for Payer: HFN Commercial |
$895.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$729.86
|
| Rate for Payer: Multiplan Commercial |
$778.51
|
| Rate for Payer: NAPHCARE Commercial |
$583.88
|
| Rate for Payer: Preferred Network Access Commercial |
$895.29
|
| Rate for Payer: Quartz Beloit One Network |
$476.84
|
| Rate for Payer: Quartz Commercial |
$632.54
|
| Rate for Payer: Quartz Medicare Advantage |
$583.88
|
| Rate for Payer: The Alliance Commercial |
$3,892.56
|
| Rate for Payer: WEA Trust Commercial |
$535.23
|
| Rate for Payer: WPS Commercial |
$720.80
|
|
|
GUIDE WIRE 1.1X15 254514
|
Facility
|
OP
|
$695.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$194.60 |
| Max. Negotiated Rate |
$2,780.00 |
| Rate for Payer: Aetna Commercial |
$625.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.70
|
| Rate for Payer: Aetna Managed Medicare |
$194.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$451.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$347.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$333.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.35
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$639.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$388.92
|
| Rate for Payer: Health EOS Commercial |
$618.55
|
| Rate for Payer: HFN Commercial |
$639.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$521.25
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: NAPHCARE Commercial |
$417.00
|
| Rate for Payer: Preferred Network Access Commercial |
$639.40
|
| Rate for Payer: Quartz Beloit One Network |
$340.55
|
| Rate for Payer: Quartz Commercial |
$451.75
|
| Rate for Payer: Quartz Medicare Advantage |
$417.00
|
| Rate for Payer: The Alliance Commercial |
$2,780.00
|
| Rate for Payer: WEA Trust Commercial |
$382.25
|
| Rate for Payer: WPS Commercial |
$514.79
|
|
|
GUIDE WIRE 1.1X15 254514
|
Facility
|
IP
|
$695.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2965027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$340.55 |
| Max. Negotiated Rate |
$639.40 |
| Rate for Payer: Aetna Commercial |
$625.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$597.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$368.35
|
| Rate for Payer: Cash Price |
$208.50
|
| Rate for Payer: Cigna Commercial |
$639.40
|
| Rate for Payer: Health EOS Commercial |
$618.55
|
| Rate for Payer: HFN Commercial |
$639.40
|
| Rate for Payer: Multiplan Commercial |
$556.00
|
| Rate for Payer: NAPHCARE Commercial |
$417.00
|
| Rate for Payer: Preferred Network Access Commercial |
$639.40
|
| Rate for Payer: Quartz Beloit One Network |
$340.55
|
| Rate for Payer: Quartz Commercial |
$417.00
|
| Rate for Payer: WEA Trust Commercial |
$382.25
|
| Rate for Payer: WPS Commercial |
$514.79
|
|
|
GUIDE WIRE 1.35 ARTHREX AR-5050-01
|
Facility
|
IP
|
$943.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5459429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.07 |
| Max. Negotiated Rate |
$867.56 |
| Rate for Payer: Aetna Commercial |
$848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$810.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$499.79
|
| Rate for Payer: Cash Price |
$282.90
|
| Rate for Payer: Cigna Commercial |
$867.56
|
| Rate for Payer: Health EOS Commercial |
$839.27
|
| Rate for Payer: HFN Commercial |
$867.56
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: NAPHCARE Commercial |
$565.80
|
| Rate for Payer: Preferred Network Access Commercial |
$867.56
|
| Rate for Payer: Quartz Beloit One Network |
$462.07
|
| Rate for Payer: Quartz Commercial |
$565.80
|
| Rate for Payer: WEA Trust Commercial |
$518.65
|
| Rate for Payer: WPS Commercial |
$698.48
|
|
|
GUIDE WIRE 1.35 ARTHREX AR-5050-01
|
Facility
|
OP
|
$943.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5459429
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.04 |
| Max. Negotiated Rate |
$3,772.00 |
| Rate for Payer: Aetna Commercial |
$848.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$810.98
|
| Rate for Payer: Aetna Managed Medicare |
$264.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$612.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$471.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$452.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$499.79
|
| Rate for Payer: Cash Price |
$282.90
|
| Rate for Payer: Cigna Commercial |
$867.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$527.70
|
| Rate for Payer: Health EOS Commercial |
$839.27
|
| Rate for Payer: HFN Commercial |
$867.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$707.25
|
| Rate for Payer: Multiplan Commercial |
$754.40
|
| Rate for Payer: NAPHCARE Commercial |
$565.80
|
| Rate for Payer: Preferred Network Access Commercial |
$867.56
|
| Rate for Payer: Quartz Beloit One Network |
$462.07
|
| Rate for Payer: Quartz Commercial |
$612.95
|
| Rate for Payer: Quartz Medicare Advantage |
$565.80
|
| Rate for Payer: The Alliance Commercial |
$3,772.00
|
| Rate for Payer: WEA Trust Commercial |
$518.65
|
| Rate for Payer: WPS Commercial |
$698.48
|
|
|
GUIDE WIRE 1.35MM TROCAR TIP AR-8943-01
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.77 |
| Max. Negotiated Rate |
$343.16 |
| Rate for Payer: Aetna Commercial |
$335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.69
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$343.16
|
| Rate for Payer: Health EOS Commercial |
$331.97
|
| Rate for Payer: HFN Commercial |
$343.16
|
| Rate for Payer: Multiplan Commercial |
$298.40
|
| Rate for Payer: NAPHCARE Commercial |
$223.80
|
| Rate for Payer: Preferred Network Access Commercial |
$343.16
|
| Rate for Payer: Quartz Beloit One Network |
$182.77
|
| Rate for Payer: Quartz Commercial |
$223.80
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: WPS Commercial |
$276.28
|
|
|
GUIDE WIRE 1.35MM TROCAR TIP AR-8943-01
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384979
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$1,492.00 |
| Rate for Payer: Aetna Commercial |
$335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.78
|
| Rate for Payer: Aetna Managed Medicare |
$104.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$186.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$179.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.69
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$343.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.73
|
| Rate for Payer: Health EOS Commercial |
$331.97
|
| Rate for Payer: HFN Commercial |
$343.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.75
|
| Rate for Payer: Multiplan Commercial |
$298.40
|
| Rate for Payer: NAPHCARE Commercial |
$223.80
|
| Rate for Payer: Preferred Network Access Commercial |
$343.16
|
| Rate for Payer: Quartz Beloit One Network |
$182.77
|
| Rate for Payer: Quartz Commercial |
$242.45
|
| Rate for Payer: Quartz Medicare Advantage |
$223.80
|
| Rate for Payer: The Alliance Commercial |
$1,492.00
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: WPS Commercial |
$276.28
|
|
|
GUIDE WIRE 1.35MM TROCAR TIP THREADED AR-8943-38
|
Facility
|
IP
|
$373.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$182.77 |
| Max. Negotiated Rate |
$343.16 |
| Rate for Payer: Aetna Commercial |
$335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.69
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$343.16
|
| Rate for Payer: Health EOS Commercial |
$331.97
|
| Rate for Payer: HFN Commercial |
$343.16
|
| Rate for Payer: Multiplan Commercial |
$298.40
|
| Rate for Payer: NAPHCARE Commercial |
$223.80
|
| Rate for Payer: Preferred Network Access Commercial |
$343.16
|
| Rate for Payer: Quartz Beloit One Network |
$182.77
|
| Rate for Payer: Quartz Commercial |
$223.80
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: WPS Commercial |
$276.28
|
|
|
GUIDE WIRE 1.35MM TROCAR TIP THREADED AR-8943-38
|
Facility
|
OP
|
$373.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5415025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.44 |
| Max. Negotiated Rate |
$1,492.00 |
| Rate for Payer: Aetna Commercial |
$335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$320.78
|
| Rate for Payer: Aetna Managed Medicare |
$104.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$242.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$186.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$179.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$197.69
|
| Rate for Payer: Cash Price |
$111.90
|
| Rate for Payer: Cigna Commercial |
$343.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$208.73
|
| Rate for Payer: Health EOS Commercial |
$331.97
|
| Rate for Payer: HFN Commercial |
$343.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$279.75
|
| Rate for Payer: Multiplan Commercial |
$298.40
|
| Rate for Payer: NAPHCARE Commercial |
$223.80
|
| Rate for Payer: Preferred Network Access Commercial |
$343.16
|
| Rate for Payer: Quartz Beloit One Network |
$182.77
|
| Rate for Payer: Quartz Commercial |
$242.45
|
| Rate for Payer: Quartz Medicare Advantage |
$223.80
|
| Rate for Payer: The Alliance Commercial |
$1,492.00
|
| Rate for Payer: WEA Trust Commercial |
$205.15
|
| Rate for Payer: WPS Commercial |
$276.28
|
|
|
GUIDE WIRE 1.6MM CAT-040-16
|
Facility
|
IP
|
$412.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$201.88 |
| Max. Negotiated Rate |
$379.04 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.36
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$247.20
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
GUIDE WIRE 1.6MM CAT-040-16
|
Facility
|
OP
|
$412.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.36 |
| Max. Negotiated Rate |
$1,648.00 |
| Rate for Payer: Aetna Commercial |
$370.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.32
|
| Rate for Payer: Aetna Managed Medicare |
$115.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$267.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$197.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$218.36
|
| Rate for Payer: Cash Price |
$123.60
|
| Rate for Payer: Cigna Commercial |
$379.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$230.56
|
| Rate for Payer: Health EOS Commercial |
$366.68
|
| Rate for Payer: HFN Commercial |
$379.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.00
|
| Rate for Payer: Multiplan Commercial |
$329.60
|
| Rate for Payer: NAPHCARE Commercial |
$247.20
|
| Rate for Payer: Preferred Network Access Commercial |
$379.04
|
| Rate for Payer: Quartz Beloit One Network |
$201.88
|
| Rate for Payer: Quartz Commercial |
$267.80
|
| Rate for Payer: Quartz Medicare Advantage |
$247.20
|
| Rate for Payer: The Alliance Commercial |
$1,648.00
|
| Rate for Payer: WEA Trust Commercial |
$226.60
|
| Rate for Payer: WPS Commercial |
$305.17
|
|
|
GUIDE WIRE 1.6 X 200MM ARTHREX AR-5050K-1
|
Facility
|
IP
|
$690.00
|
|
| Hospital Charge Code |
6171769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$338.10 |
| Max. Negotiated Rate |
$634.80 |
| Rate for Payer: Aetna Commercial |
$621.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$365.70
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$634.80
|
| Rate for Payer: Health EOS Commercial |
$614.10
|
| Rate for Payer: HFN Commercial |
$634.80
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
| Rate for Payer: NAPHCARE Commercial |
$414.00
|
| Rate for Payer: Preferred Network Access Commercial |
$634.80
|
| Rate for Payer: Quartz Beloit One Network |
$338.10
|
| Rate for Payer: Quartz Commercial |
$414.00
|
| Rate for Payer: WEA Trust Commercial |
$379.50
|
| Rate for Payer: WPS Commercial |
$511.08
|
|
|
GUIDE WIRE 1.6 X 200MM ARTHREX AR-5050K-1
|
Facility
|
OP
|
$690.00
|
|
| Hospital Charge Code |
6171769
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$193.20 |
| Max. Negotiated Rate |
$2,760.00 |
| Rate for Payer: Aetna Commercial |
$621.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.40
|
| Rate for Payer: Aetna Managed Medicare |
$193.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$448.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$345.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$331.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$365.70
|
| Rate for Payer: Cash Price |
$207.00
|
| Rate for Payer: Cigna Commercial |
$634.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.12
|
| Rate for Payer: Health EOS Commercial |
$614.10
|
| Rate for Payer: HFN Commercial |
$634.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$517.50
|
| Rate for Payer: Multiplan Commercial |
$552.00
|
| Rate for Payer: NAPHCARE Commercial |
$414.00
|
| Rate for Payer: Preferred Network Access Commercial |
$634.80
|
| Rate for Payer: Quartz Beloit One Network |
$338.10
|
| Rate for Payer: Quartz Commercial |
$448.50
|
| Rate for Payer: Quartz Medicare Advantage |
$414.00
|
| Rate for Payer: The Alliance Commercial |
$2,760.00
|
| Rate for Payer: WEA Trust Commercial |
$379.50
|
| Rate for Payer: WPS Commercial |
$511.08
|
|
|
GUIDE WIRE 1.6 X 200MM DRILL TIP 02.113.001
|
Facility
|
OP
|
$533.27
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5106925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.32 |
| Max. Negotiated Rate |
$2,133.08 |
| Rate for Payer: Aetna Commercial |
$479.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.61
|
| Rate for Payer: Aetna Managed Medicare |
$149.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$346.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$266.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$282.63
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cigna Commercial |
$490.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.42
|
| Rate for Payer: Health EOS Commercial |
$474.61
|
| Rate for Payer: HFN Commercial |
$490.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$399.95
|
| Rate for Payer: Multiplan Commercial |
$426.62
|
| Rate for Payer: NAPHCARE Commercial |
$319.96
|
| Rate for Payer: Preferred Network Access Commercial |
$490.61
|
| Rate for Payer: Quartz Beloit One Network |
$261.30
|
| Rate for Payer: Quartz Commercial |
$346.63
|
| Rate for Payer: Quartz Medicare Advantage |
$319.96
|
| Rate for Payer: The Alliance Commercial |
$2,133.08
|
| Rate for Payer: WEA Trust Commercial |
$293.30
|
| Rate for Payer: WPS Commercial |
$394.99
|
|
|
GUIDE WIRE 1.6 X 200MM DRILL TIP 02.113.001
|
Facility
|
IP
|
$533.27
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5106925
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.30 |
| Max. Negotiated Rate |
$490.61 |
| Rate for Payer: Aetna Commercial |
$479.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$282.63
|
| Rate for Payer: Cash Price |
$159.98
|
| Rate for Payer: Cigna Commercial |
$490.61
|
| Rate for Payer: Health EOS Commercial |
$474.61
|
| Rate for Payer: HFN Commercial |
$490.61
|
| Rate for Payer: Multiplan Commercial |
$426.62
|
| Rate for Payer: NAPHCARE Commercial |
$319.96
|
| Rate for Payer: Preferred Network Access Commercial |
$490.61
|
| Rate for Payer: Quartz Beloit One Network |
$261.30
|
| Rate for Payer: Quartz Commercial |
$319.96
|
| Rate for Payer: WEA Trust Commercial |
$293.30
|
| Rate for Payer: WPS Commercial |
$394.99
|
|
|
GUIDE WIRE 1.6 X 220MM THREADED 03.333.013
|
Facility
|
OP
|
$1,757.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6210964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.96 |
| Max. Negotiated Rate |
$7,028.00 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Aetna Managed Medicare |
$491.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,142.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$878.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$843.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$983.22
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,317.75
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,142.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,054.20
|
| Rate for Payer: The Alliance Commercial |
$7,028.00
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
GUIDE WIRE 1.6 X 220MM THREADED 03.333.013
|
Facility
|
IP
|
$1,757.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6210964
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$860.93 |
| Max. Negotiated Rate |
$1,616.44 |
| Rate for Payer: Aetna Commercial |
$1,581.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,511.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$931.21
|
| Rate for Payer: Cash Price |
$527.10
|
| Rate for Payer: Cigna Commercial |
$1,616.44
|
| Rate for Payer: Health EOS Commercial |
$1,563.73
|
| Rate for Payer: HFN Commercial |
$1,616.44
|
| Rate for Payer: Multiplan Commercial |
$1,405.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,054.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,616.44
|
| Rate for Payer: Quartz Beloit One Network |
$860.93
|
| Rate for Payer: Quartz Commercial |
$1,054.20
|
| Rate for Payer: WEA Trust Commercial |
$966.35
|
| Rate for Payer: WPS Commercial |
$1,301.41
|
|
|
Guidewire 18G* - Guidewire Catheter Gauge
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
6179210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$728.00 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Aetna Managed Medicare |
$50.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$118.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$87.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.85
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$136.50
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$118.30
|
| Rate for Payer: Quartz Medicare Advantage |
$109.20
|
| Rate for Payer: The Alliance Commercial |
$728.00
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
Guidewire 18G* - Guidewire Catheter Gauge
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
6179210
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.18 |
| Max. Negotiated Rate |
$167.44 |
| Rate for Payer: Aetna Commercial |
$163.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$156.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$96.46
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$167.44
|
| Rate for Payer: Health EOS Commercial |
$161.98
|
| Rate for Payer: HFN Commercial |
$167.44
|
| Rate for Payer: Multiplan Commercial |
$145.60
|
| Rate for Payer: NAPHCARE Commercial |
$109.20
|
| Rate for Payer: Preferred Network Access Commercial |
$167.44
|
| Rate for Payer: Quartz Beloit One Network |
$89.18
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: WEA Trust Commercial |
$100.10
|
| Rate for Payer: WPS Commercial |
$134.81
|
|
|
GUIDEWIRE 2.0
|
Facility
|
IP
|
$787.00
|
|
| Hospital Charge Code |
2966249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$385.63 |
| Max. Negotiated Rate |
$724.04 |
| Rate for Payer: Aetna Commercial |
$708.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$676.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$417.11
|
| Rate for Payer: Cash Price |
$236.10
|
| Rate for Payer: Cigna Commercial |
$724.04
|
| Rate for Payer: Health EOS Commercial |
$700.43
|
| Rate for Payer: HFN Commercial |
$724.04
|
| Rate for Payer: Multiplan Commercial |
$629.60
|
| Rate for Payer: NAPHCARE Commercial |
$472.20
|
| Rate for Payer: Preferred Network Access Commercial |
$724.04
|
| Rate for Payer: Quartz Beloit One Network |
$385.63
|
| Rate for Payer: Quartz Commercial |
$472.20
|
| Rate for Payer: WEA Trust Commercial |
$432.85
|
| Rate for Payer: WPS Commercial |
$582.93
|
|
