|
GUIDEWIRE BALL NOSE 3.0MM X 900MM 0101-900S
|
Facility
|
OP
|
$1,986.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6232138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$578.32 |
| Max. Negotiated Rate |
$1,900.20 |
| Rate for Payer: Aetna Commercial |
$1,858.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,776.28
|
| Rate for Payer: Aetna Managed Medicare |
$578.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,342.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,032.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$991.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,094.68
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,900.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,155.85
|
| Rate for Payer: Health EOS Commercial |
$1,838.24
|
| Rate for Payer: HFN Commercial |
$1,900.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,549.08
|
| Rate for Payer: Multiplan Commercial |
$1,652.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,239.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,900.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,012.07
|
| Rate for Payer: Quartz Commercial |
$1,342.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1,239.26
|
| Rate for Payer: The Alliance Commercial |
$1,032.72
|
| Rate for Payer: WEA Trust Commercial |
$1,135.99
|
| Rate for Payer: WPS Commercial |
$1,529.82
|
|
|
GUIDEWIRE BALL NOSE 3.0MM X 900MM 0101-900S
|
Facility
|
IP
|
$1,986.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6232138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,012.07 |
| Max. Negotiated Rate |
$1,900.20 |
| Rate for Payer: Aetna Commercial |
$1,858.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,776.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,094.68
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,900.20
|
| Rate for Payer: Health EOS Commercial |
$1,838.24
|
| Rate for Payer: HFN Commercial |
$1,900.20
|
| Rate for Payer: Multiplan Commercial |
$1,652.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,900.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,012.07
|
| Rate for Payer: Quartz Commercial |
$1,239.26
|
| Rate for Payer: WEA Trust Commercial |
$1,135.99
|
| Rate for Payer: WPS Commercial |
$1,529.82
|
|
|
GUIDE WIRE BALL TIP 2.5 X 800MM 1806-0083S
|
Facility
|
OP
|
$1,413.00
|
|
| Hospital Charge Code |
3127462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$411.47 |
| Max. Negotiated Rate |
$1,351.96 |
| Rate for Payer: Aetna Commercial |
$1,322.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,263.79
|
| Rate for Payer: Aetna Managed Medicare |
$411.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$955.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$734.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$705.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$778.85
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cigna Commercial |
$1,351.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$822.37
|
| Rate for Payer: Health EOS Commercial |
$1,307.87
|
| Rate for Payer: HFN Commercial |
$1,351.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,102.14
|
| Rate for Payer: Multiplan Commercial |
$1,175.62
|
| Rate for Payer: NAPHCARE Commercial |
$881.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,351.96
|
| Rate for Payer: Quartz Beloit One Network |
$720.06
|
| Rate for Payer: Quartz Commercial |
$955.19
|
| Rate for Payer: Quartz Medicare Advantage |
$881.71
|
| Rate for Payer: The Alliance Commercial |
$734.76
|
| Rate for Payer: WEA Trust Commercial |
$808.24
|
| Rate for Payer: WPS Commercial |
$1,088.43
|
|
|
GUIDE WIRE BALL TIP 2.5 X 800MM 1806-0083S
|
Facility
|
IP
|
$1,413.00
|
|
| Hospital Charge Code |
3127462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$720.06 |
| Max. Negotiated Rate |
$1,351.96 |
| Rate for Payer: Aetna Commercial |
$1,322.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,263.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$778.85
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cigna Commercial |
$1,351.96
|
| Rate for Payer: Health EOS Commercial |
$1,307.87
|
| Rate for Payer: HFN Commercial |
$1,351.96
|
| Rate for Payer: Multiplan Commercial |
$1,175.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,351.96
|
| Rate for Payer: Quartz Beloit One Network |
$720.06
|
| Rate for Payer: Quartz Commercial |
$881.71
|
| Rate for Payer: WEA Trust Commercial |
$808.24
|
| Rate for Payer: WPS Commercial |
$1,088.43
|
|
|
GUIDE WIRE BALL-TIP 3.0 X 800MM 1806-0080S
|
Facility
|
IP
|
$1,654.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4099051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$842.88 |
| Max. Negotiated Rate |
$1,582.55 |
| Rate for Payer: Aetna Commercial |
$1,548.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,479.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$911.68
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cigna Commercial |
$1,582.55
|
| Rate for Payer: Health EOS Commercial |
$1,530.94
|
| Rate for Payer: HFN Commercial |
$1,582.55
|
| Rate for Payer: Multiplan Commercial |
$1,376.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,582.55
|
| Rate for Payer: Quartz Beloit One Network |
$842.88
|
| Rate for Payer: Quartz Commercial |
$1,032.10
|
| Rate for Payer: WEA Trust Commercial |
$946.09
|
| Rate for Payer: WPS Commercial |
$1,274.08
|
|
|
GUIDE WIRE BALL-TIP 3.0 X 800MM 1806-0080S
|
Facility
|
OP
|
$1,654.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4099051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$481.64 |
| Max. Negotiated Rate |
$1,582.55 |
| Rate for Payer: Aetna Commercial |
$1,548.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,479.34
|
| Rate for Payer: Aetna Managed Medicare |
$481.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,118.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$860.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$825.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$911.68
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cigna Commercial |
$1,582.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$962.63
|
| Rate for Payer: Health EOS Commercial |
$1,530.94
|
| Rate for Payer: HFN Commercial |
$1,582.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,290.12
|
| Rate for Payer: Multiplan Commercial |
$1,376.13
|
| Rate for Payer: NAPHCARE Commercial |
$1,032.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,582.55
|
| Rate for Payer: Quartz Beloit One Network |
$842.88
|
| Rate for Payer: Quartz Commercial |
$1,118.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,032.10
|
| Rate for Payer: The Alliance Commercial |
$860.08
|
| Rate for Payer: WEA Trust Commercial |
$946.09
|
| Rate for Payer: WPS Commercial |
$1,274.08
|
|
|
GUIDE WIRE BALL TIP 3 X 1000MM 1806-0085S
|
Facility
|
IP
|
$1,715.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$873.96 |
| Max. Negotiated Rate |
$1,640.91 |
| Rate for Payer: Aetna Commercial |
$1,605.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,533.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$945.31
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cigna Commercial |
$1,640.91
|
| Rate for Payer: Health EOS Commercial |
$1,587.40
|
| Rate for Payer: HFN Commercial |
$1,640.91
|
| Rate for Payer: Multiplan Commercial |
$1,426.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,640.91
|
| Rate for Payer: Quartz Beloit One Network |
$873.96
|
| Rate for Payer: Quartz Commercial |
$1,070.16
|
| Rate for Payer: WEA Trust Commercial |
$980.98
|
| Rate for Payer: WPS Commercial |
$1,321.06
|
|
|
GUIDE WIRE BALL TIP 3 X 1000MM 1806-0085S
|
Facility
|
OP
|
$1,715.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$499.41 |
| Max. Negotiated Rate |
$1,640.91 |
| Rate for Payer: Aetna Commercial |
$1,605.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,533.90
|
| Rate for Payer: Aetna Managed Medicare |
$499.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,159.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$891.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$856.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$945.31
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cigna Commercial |
$1,640.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$998.13
|
| Rate for Payer: Health EOS Commercial |
$1,587.40
|
| Rate for Payer: HFN Commercial |
$1,640.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,337.70
|
| Rate for Payer: Multiplan Commercial |
$1,426.88
|
| Rate for Payer: NAPHCARE Commercial |
$1,070.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,640.91
|
| Rate for Payer: Quartz Beloit One Network |
$873.96
|
| Rate for Payer: Quartz Commercial |
$1,159.34
|
| Rate for Payer: Quartz Medicare Advantage |
$1,070.16
|
| Rate for Payer: The Alliance Commercial |
$891.80
|
| Rate for Payer: WEA Trust Commercial |
$980.98
|
| Rate for Payer: WPS Commercial |
$1,321.06
|
|
|
GUIDE WIRE BIO-COMPOSITE SCREW AR-5025K
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5885647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.70 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Aetna Managed Medicare |
$59.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.31
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.90
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: NAPHCARE Commercial |
$127.92
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$138.58
|
| Rate for Payer: Quartz Medicare Advantage |
$127.92
|
| Rate for Payer: The Alliance Commercial |
$106.60
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
GUIDE WIRE BIO-COMPOSITE SCREW AR-5025K
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5885647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$104.47 |
| Max. Negotiated Rate |
$196.14 |
| Rate for Payer: Aetna Commercial |
$191.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.00
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$196.14
|
| Rate for Payer: Health EOS Commercial |
$189.75
|
| Rate for Payer: HFN Commercial |
$196.14
|
| Rate for Payer: Multiplan Commercial |
$170.56
|
| Rate for Payer: Preferred Network Access Commercial |
$196.14
|
| Rate for Payer: Quartz Beloit One Network |
$104.47
|
| Rate for Payer: Quartz Commercial |
$127.92
|
| Rate for Payer: WEA Trust Commercial |
$117.26
|
| Rate for Payer: WPS Commercial |
$157.91
|
|
|
GUIDE WIRE BIOTRACK
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.48 |
| Max. Negotiated Rate |
$397.07 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$258.96
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
|
GUIDE WIRE BIOTRACK
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.85 |
| Max. Negotiated Rate |
$397.07 |
| Rate for Payer: Aetna Commercial |
$388.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.18
|
| Rate for Payer: Aetna Managed Medicare |
$120.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$280.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$207.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$228.75
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$397.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.53
|
| Rate for Payer: Health EOS Commercial |
$384.12
|
| Rate for Payer: HFN Commercial |
$397.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$323.70
|
| Rate for Payer: Multiplan Commercial |
$345.28
|
| Rate for Payer: NAPHCARE Commercial |
$258.96
|
| Rate for Payer: Preferred Network Access Commercial |
$397.07
|
| Rate for Payer: Quartz Beloit One Network |
$211.48
|
| Rate for Payer: Quartz Commercial |
$280.54
|
| Rate for Payer: Quartz Medicare Advantage |
$258.96
|
| Rate for Payer: The Alliance Commercial |
$215.80
|
| Rate for Payer: WEA Trust Commercial |
$237.38
|
| Rate for Payer: WPS Commercial |
$319.67
|
|
|
GUIDE WIRE BMW J-TIP-190cm
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972529
|
|
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 BMW J-TIP-190cm
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972529
|
|
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 CHOICE PT 182cm 12160-01J
|
Facility
|
IP
|
$2,103.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,071.69 |
| Max. Negotiated Rate |
$2,012.15 |
| Rate for Payer: Aetna Commercial |
$1,968.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,159.17
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cigna Commercial |
$2,012.15
|
| Rate for Payer: Health EOS Commercial |
$1,946.54
|
| Rate for Payer: HFN Commercial |
$2,012.15
|
| Rate for Payer: Multiplan Commercial |
$1,749.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,012.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.69
|
| Rate for Payer: Quartz Commercial |
$1,312.27
|
| Rate for Payer: WEA Trust Commercial |
$1,202.92
|
| Rate for Payer: WPS Commercial |
$1,619.94
|
|
|
GUIDE WIRE CHOICE PT 182cm 12160-01J
|
Facility
|
OP
|
$2,103.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$612.39 |
| Max. Negotiated Rate |
$2,012.15 |
| Rate for Payer: Aetna Commercial |
$1,968.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,880.92
|
| Rate for Payer: Aetna Managed Medicare |
$612.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,421.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,093.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,049.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,159.17
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cigna Commercial |
$2,012.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,223.95
|
| Rate for Payer: Health EOS Commercial |
$1,946.54
|
| Rate for Payer: HFN Commercial |
$2,012.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,640.34
|
| Rate for Payer: Multiplan Commercial |
$1,749.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,312.27
|
| Rate for Payer: Preferred Network Access Commercial |
$2,012.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,071.69
|
| Rate for Payer: Quartz Commercial |
$1,421.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,312.27
|
| Rate for Payer: The Alliance Commercial |
$1,093.56
|
| Rate for Payer: WEA Trust Commercial |
$1,202.92
|
| Rate for Payer: WPS Commercial |
$1,619.94
|
|
|
GUIDE WIRE CHOICE PT 300cm
|
Facility
|
OP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$721.01 |
| Max. Negotiated Rate |
$2,369.04 |
| Rate for Payer: Aetna Commercial |
$2,317.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,214.53
|
| Rate for Payer: Aetna Managed Medicare |
$721.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,673.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,287.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,236.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,364.77
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,369.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,441.03
|
| Rate for Payer: Health EOS Commercial |
$2,291.79
|
| Rate for Payer: HFN Commercial |
$2,369.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,931.28
|
| Rate for Payer: Multiplan Commercial |
$2,060.03
|
| Rate for Payer: NAPHCARE Commercial |
$1,545.02
|
| Rate for Payer: Preferred Network Access Commercial |
$2,369.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.77
|
| Rate for Payer: Quartz Commercial |
$1,673.78
|
| Rate for Payer: Quartz Medicare Advantage |
$1,545.02
|
| Rate for Payer: The Alliance Commercial |
$1,287.52
|
| Rate for Payer: WEA Trust Commercial |
$1,416.27
|
| Rate for Payer: WPS Commercial |
$1,907.26
|
|
|
GUIDE WIRE CHOICE PT 300cm
|
Facility
|
IP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,261.77 |
| Max. Negotiated Rate |
$2,369.04 |
| Rate for Payer: Aetna Commercial |
$2,317.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,214.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,364.77
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,369.04
|
| Rate for Payer: Health EOS Commercial |
$2,291.79
|
| Rate for Payer: HFN Commercial |
$2,369.04
|
| Rate for Payer: Multiplan Commercial |
$2,060.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,369.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.77
|
| Rate for Payer: Quartz Commercial |
$1,545.02
|
| Rate for Payer: WEA Trust Commercial |
$1,416.27
|
| Rate for Payer: WPS Commercial |
$1,907.26
|
|
|
GUIDEWIRE CLOSUREFAST .025IN X 150CM GW-025-150-DE1.5J
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
4069313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.44 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Aetna Managed Medicare |
$91.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.92
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: NAPHCARE Commercial |
$195.94
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$212.26
|
| Rate for Payer: Quartz Medicare Advantage |
$195.94
|
| Rate for Payer: The Alliance Commercial |
$163.28
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
GUIDEWIRE CLOSUREFAST .025IN X 150CM GW-025-150-DE1.5J
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
4069313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$195.94
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
GUIDEWIRE CLOSUREFAST .025IN X 260CM GW-025-260-1.5J
|
Facility
|
OP
|
$443.00
|
|
| Hospital Charge Code |
4069314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$129.00 |
| Max. Negotiated Rate |
$423.86 |
| Rate for Payer: Aetna Commercial |
$414.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Aetna Managed Medicare |
$129.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$299.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$230.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$221.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.18
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$423.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$257.83
|
| Rate for Payer: Health EOS Commercial |
$410.04
|
| Rate for Payer: HFN Commercial |
$423.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$345.54
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: NAPHCARE Commercial |
$276.43
|
| Rate for Payer: Preferred Network Access Commercial |
$423.86
|
| Rate for Payer: Quartz Beloit One Network |
$225.75
|
| Rate for Payer: Quartz Commercial |
$299.47
|
| Rate for Payer: Quartz Medicare Advantage |
$276.43
|
| Rate for Payer: The Alliance Commercial |
$230.36
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: WPS Commercial |
$341.24
|
|
|
GUIDEWIRE CLOSUREFAST .025IN X 260CM GW-025-260-1.5J
|
Facility
|
IP
|
$443.00
|
|
| Hospital Charge Code |
4069314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$225.75 |
| Max. Negotiated Rate |
$423.86 |
| Rate for Payer: Aetna Commercial |
$414.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$244.18
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$423.86
|
| Rate for Payer: Health EOS Commercial |
$410.04
|
| Rate for Payer: HFN Commercial |
$423.86
|
| Rate for Payer: Multiplan Commercial |
$368.58
|
| Rate for Payer: Preferred Network Access Commercial |
$423.86
|
| Rate for Payer: Quartz Beloit One Network |
$225.75
|
| Rate for Payer: Quartz Commercial |
$276.43
|
| Rate for Payer: WEA Trust Commercial |
$253.40
|
| Rate for Payer: WPS Commercial |
$341.24
|
|
|
GUIDE WIRE CROSS IT 300cm HJ
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$718.54 |
| Max. Negotiated Rate |
$1,349.09 |
| Rate for Payer: Aetna Commercial |
$1,319.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,261.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$777.19
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,349.09
|
| Rate for Payer: Health EOS Commercial |
$1,305.10
|
| Rate for Payer: HFN Commercial |
$1,349.09
|
| Rate for Payer: Multiplan Commercial |
$1,173.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,349.09
|
| Rate for Payer: Quartz Beloit One Network |
$718.54
|
| Rate for Payer: Quartz Commercial |
$879.84
|
| Rate for Payer: WEA Trust Commercial |
$806.52
|
| Rate for Payer: WPS Commercial |
$1,086.12
|
|
|
GUIDE WIRE CROSS IT 300cm HJ
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972530
|
|
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 GWR419478 98CM
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973184
|
|
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
|
|
