|
GUIDE WIRE GWR419478 98CM
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973184
|
|
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
|
|
|
GUIDEWIRE HALO GW-002B
|
Facility
|
IP
|
$2,217.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,129.78 |
| Max. Negotiated Rate |
$2,121.23 |
| Rate for Payer: Aetna Commercial |
$2,075.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,222.01
|
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Cigna Commercial |
$2,121.23
|
| Rate for Payer: Health EOS Commercial |
$2,052.06
|
| Rate for Payer: HFN Commercial |
$2,121.23
|
| Rate for Payer: Multiplan Commercial |
$1,844.54
|
| Rate for Payer: Preferred Network Access Commercial |
$2,121.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.78
|
| Rate for Payer: Quartz Commercial |
$1,383.41
|
| Rate for Payer: WEA Trust Commercial |
$1,268.12
|
| Rate for Payer: WPS Commercial |
$1,707.76
|
|
|
GUIDEWIRE HALO GW-002B
|
Facility
|
OP
|
$2,217.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$645.59 |
| Max. Negotiated Rate |
$2,121.23 |
| Rate for Payer: Aetna Commercial |
$2,075.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,982.88
|
| Rate for Payer: Aetna Managed Medicare |
$645.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,498.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,152.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,106.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,222.01
|
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Cigna Commercial |
$2,121.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,290.29
|
| Rate for Payer: Health EOS Commercial |
$2,052.06
|
| Rate for Payer: HFN Commercial |
$2,121.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,729.26
|
| Rate for Payer: Multiplan Commercial |
$1,844.54
|
| Rate for Payer: NAPHCARE Commercial |
$1,383.41
|
| Rate for Payer: Preferred Network Access Commercial |
$2,121.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,129.78
|
| Rate for Payer: Quartz Commercial |
$1,498.69
|
| Rate for Payer: Quartz Medicare Advantage |
$1,383.41
|
| Rate for Payer: The Alliance Commercial |
$1,152.84
|
| Rate for Payer: WEA Trust Commercial |
$1,268.12
|
| Rate for Payer: WPS Commercial |
$1,707.76
|
|
|
GUIDEWIRE HI-TORQUE
|
Facility
|
OP
|
$1,647.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.61 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Aetna Managed Medicare |
$479.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,113.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$822.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.55
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.66
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,113.37
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.73
|
| Rate for Payer: The Alliance Commercial |
$856.44
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
GUIDEWIRE HI-TORQUE
|
Facility
|
IP
|
$1,647.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$839.31 |
| Max. Negotiated Rate |
$1,575.85 |
| Rate for Payer: Aetna Commercial |
$1,541.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.83
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,575.85
|
| Rate for Payer: Health EOS Commercial |
$1,524.46
|
| Rate for Payer: HFN Commercial |
$1,575.85
|
| Rate for Payer: Multiplan Commercial |
$1,370.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.85
|
| Rate for Payer: Quartz Beloit One Network |
$839.31
|
| Rate for Payer: Quartz Commercial |
$1,027.73
|
| Rate for Payer: WEA Trust Commercial |
$942.08
|
| Rate for Payer: WPS Commercial |
$1,268.68
|
|
|
GUIDE WIRE HORIZON SUBTALAR 17606
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2964801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
GUIDE WIRE HORIZON SUBTALAR 17606
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2964801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.79 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$155.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.30
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$333.84
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| Rate for Payer: Quartz Medicare Advantage |
$333.84
|
| Rate for Payer: The Alliance Commercial |
$278.20
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
GUIDEWIRE JAGTAIL
|
Facility
|
OP
|
$1,556.00
|
|
| Hospital Charge Code |
2973569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.11 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Aetna Managed Medicare |
$453.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,051.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$809.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$776.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$905.59
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,213.68
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: NAPHCARE Commercial |
$970.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$1,051.86
|
| Rate for Payer: Quartz Medicare Advantage |
$970.94
|
| Rate for Payer: The Alliance Commercial |
$809.12
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
GUIDEWIRE JAGTAIL
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
2973569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$792.94 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$970.94
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
GUIDE WIRE J-TIP BMW .014 300CM 1009661J
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.20 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$240.24
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
GUIDE WIRE J-TIP BMW .014 300CM 1009661J
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$112.11 |
| Max. Negotiated Rate |
$368.37 |
| Rate for Payer: Aetna Commercial |
$360.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.34
|
| Rate for Payer: Aetna Managed Medicare |
$112.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$260.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$200.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$192.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$212.21
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$368.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$224.07
|
| Rate for Payer: Health EOS Commercial |
$356.36
|
| Rate for Payer: HFN Commercial |
$368.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$300.30
|
| Rate for Payer: Multiplan Commercial |
$320.32
|
| Rate for Payer: NAPHCARE Commercial |
$240.24
|
| Rate for Payer: Preferred Network Access Commercial |
$368.37
|
| Rate for Payer: Quartz Beloit One Network |
$196.20
|
| Rate for Payer: Quartz Commercial |
$260.26
|
| Rate for Payer: Quartz Medicare Advantage |
$240.24
|
| Rate for Payer: The Alliance Commercial |
$200.20
|
| Rate for Payer: WEA Trust Commercial |
$220.22
|
| Rate for Payer: WPS Commercial |
$296.57
|
|
|
GUIDEWIRE MARKED HALO RFA ENDOSCOPIC GW-005M
|
Facility
|
OP
|
$2,490.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5106628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$725.09 |
| Max. Negotiated Rate |
$2,382.43 |
| Rate for Payer: Aetna Commercial |
$2,330.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,227.06
|
| Rate for Payer: Aetna Managed Medicare |
$725.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,683.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,294.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,243.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,372.49
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$2,382.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,449.18
|
| Rate for Payer: Health EOS Commercial |
$2,304.74
|
| Rate for Payer: HFN Commercial |
$2,382.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,942.20
|
| Rate for Payer: Multiplan Commercial |
$2,071.68
|
| Rate for Payer: NAPHCARE Commercial |
$1,553.76
|
| Rate for Payer: Preferred Network Access Commercial |
$2,382.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.90
|
| Rate for Payer: Quartz Commercial |
$1,683.24
|
| Rate for Payer: Quartz Medicare Advantage |
$1,553.76
|
| Rate for Payer: The Alliance Commercial |
$1,294.80
|
| Rate for Payer: WEA Trust Commercial |
$1,424.28
|
| Rate for Payer: WPS Commercial |
$1,918.05
|
|
|
GUIDEWIRE MARKED HALO RFA ENDOSCOPIC GW-005M
|
Facility
|
IP
|
$2,490.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5106628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,268.90 |
| Max. Negotiated Rate |
$2,382.43 |
| Rate for Payer: Aetna Commercial |
$2,330.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,227.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,372.49
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$2,382.43
|
| Rate for Payer: Health EOS Commercial |
$2,304.74
|
| Rate for Payer: HFN Commercial |
$2,382.43
|
| Rate for Payer: Multiplan Commercial |
$2,071.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,382.43
|
| Rate for Payer: Quartz Beloit One Network |
$1,268.90
|
| Rate for Payer: Quartz Commercial |
$1,553.76
|
| Rate for Payer: WEA Trust Commercial |
$1,424.28
|
| Rate for Payer: WPS Commercial |
$1,918.05
|
|
|
GUIDEWIRE MICRO ACCESS .018 X 45CM STAINLESS STEEL 06507201
|
Facility
|
IP
|
$646.00
|
|
| Hospital Charge Code |
2962968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$329.20 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.08
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$403.10
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
GUIDEWIRE MICRO ACCESS .018 X 45CM STAINLESS STEEL 06507201
|
Facility
|
OP
|
$646.00
|
|
| Hospital Charge Code |
2962968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.12 |
| Max. Negotiated Rate |
$618.09 |
| Rate for Payer: Aetna Commercial |
$604.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$577.78
|
| Rate for Payer: Aetna Managed Medicare |
$188.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$436.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$335.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.08
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$618.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$375.97
|
| Rate for Payer: Health EOS Commercial |
$597.94
|
| Rate for Payer: HFN Commercial |
$618.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.88
|
| Rate for Payer: Multiplan Commercial |
$537.47
|
| Rate for Payer: NAPHCARE Commercial |
$403.10
|
| Rate for Payer: Preferred Network Access Commercial |
$618.09
|
| Rate for Payer: Quartz Beloit One Network |
$329.20
|
| Rate for Payer: Quartz Commercial |
$436.70
|
| Rate for Payer: Quartz Medicare Advantage |
$403.10
|
| Rate for Payer: The Alliance Commercial |
$335.92
|
| Rate for Payer: WEA Trust Commercial |
$369.51
|
| Rate for Payer: WPS Commercial |
$497.61
|
|
|
GUIDE WIRE NITINOL /PT 0.018x40CM MAK001N
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.77 |
| Max. Negotiated Rate |
$557.81 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.44
|
| Rate for Payer: Aetna Managed Medicare |
$169.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$394.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$303.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$291.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.35
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$557.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.31
|
| Rate for Payer: Health EOS Commercial |
$539.62
|
| Rate for Payer: HFN Commercial |
$557.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.74
|
| Rate for Payer: Multiplan Commercial |
$485.06
|
| Rate for Payer: NAPHCARE Commercial |
$363.79
|
| Rate for Payer: Preferred Network Access Commercial |
$557.81
|
| Rate for Payer: Quartz Beloit One Network |
$297.10
|
| Rate for Payer: Quartz Commercial |
$394.11
|
| Rate for Payer: Quartz Medicare Advantage |
$363.79
|
| Rate for Payer: The Alliance Commercial |
$303.16
|
| Rate for Payer: WEA Trust Commercial |
$333.48
|
| Rate for Payer: WPS Commercial |
$449.08
|
|
|
GUIDE WIRE NITINOL /PT 0.018x40CM MAK001N
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.10 |
| Max. Negotiated Rate |
$557.81 |
| Rate for Payer: Aetna Commercial |
$545.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$521.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$321.35
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$557.81
|
| Rate for Payer: Health EOS Commercial |
$539.62
|
| Rate for Payer: HFN Commercial |
$557.81
|
| Rate for Payer: Multiplan Commercial |
$485.06
|
| Rate for Payer: Preferred Network Access Commercial |
$557.81
|
| Rate for Payer: Quartz Beloit One Network |
$297.10
|
| Rate for Payer: Quartz Commercial |
$363.79
|
| Rate for Payer: WEA Trust Commercial |
$333.48
|
| Rate for Payer: WPS Commercial |
$449.08
|
|
|
GUIDE WIRE NITONOL 2 CM ST.TIP
|
Facility
|
IP
|
$1,282.00
|
|
| Hospital Charge Code |
2963047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$653.31 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$799.97
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
GUIDE WIRE NITONOL 2 CM ST.TIP
|
Facility
|
OP
|
$1,282.00
|
|
| Hospital Charge Code |
2963047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.32 |
| Max. Negotiated Rate |
$1,226.62 |
| Rate for Payer: Aetna Commercial |
$1,199.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,146.62
|
| Rate for Payer: Aetna Managed Medicare |
$373.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$866.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$666.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$639.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$706.64
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,226.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$746.12
|
| Rate for Payer: Health EOS Commercial |
$1,186.62
|
| Rate for Payer: HFN Commercial |
$1,226.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$999.96
|
| Rate for Payer: Multiplan Commercial |
$1,066.62
|
| Rate for Payer: NAPHCARE Commercial |
$799.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,226.62
|
| Rate for Payer: Quartz Beloit One Network |
$653.31
|
| Rate for Payer: Quartz Commercial |
$866.63
|
| Rate for Payer: Quartz Medicare Advantage |
$799.97
|
| Rate for Payer: The Alliance Commercial |
$666.64
|
| Rate for Payer: WEA Trust Commercial |
$733.30
|
| Rate for Payer: WPS Commercial |
$987.52
|
|
|
GUIDE WIRE PLATINUM PLUS 0.018 X 180CM PTCA 1753
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$635.98 |
| Max. Negotiated Rate |
$2,089.65 |
| Rate for Payer: Aetna Commercial |
$2,044.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,953.37
|
| Rate for Payer: Aetna Managed Medicare |
$635.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,476.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,135.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,090.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.82
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$2,089.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,271.09
|
| Rate for Payer: Health EOS Commercial |
$2,021.51
|
| Rate for Payer: HFN Commercial |
$2,089.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,703.52
|
| Rate for Payer: Multiplan Commercial |
$1,817.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,362.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,089.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.97
|
| Rate for Payer: Quartz Commercial |
$1,476.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,362.82
|
| Rate for Payer: The Alliance Commercial |
$1,135.68
|
| Rate for Payer: WEA Trust Commercial |
$1,249.25
|
| Rate for Payer: WPS Commercial |
$1,682.34
|
|
|
GUIDE WIRE PLATINUM PLUS 0.018 X 180CM PTCA 1753
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,112.97 |
| Max. Negotiated Rate |
$2,089.65 |
| Rate for Payer: Aetna Commercial |
$2,044.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,953.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,203.82
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$2,089.65
|
| Rate for Payer: Health EOS Commercial |
$2,021.51
|
| Rate for Payer: HFN Commercial |
$2,089.65
|
| Rate for Payer: Multiplan Commercial |
$1,817.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,089.65
|
| Rate for Payer: Quartz Beloit One Network |
$1,112.97
|
| Rate for Payer: Quartz Commercial |
$1,362.82
|
| Rate for Payer: WEA Trust Commercial |
$1,249.25
|
| Rate for Payer: WPS Commercial |
$1,682.34
|
|
|
GUIDE WIRE PLATINUM PLUS .018 X 260CM M001467320
|
Facility
|
IP
|
$1,754.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$893.84 |
| Max. Negotiated Rate |
$1,678.23 |
| Rate for Payer: Aetna Commercial |
$1,641.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.80
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,678.23
|
| Rate for Payer: Health EOS Commercial |
$1,623.50
|
| Rate for Payer: HFN Commercial |
$1,678.23
|
| Rate for Payer: Multiplan Commercial |
$1,459.33
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.23
|
| Rate for Payer: Quartz Beloit One Network |
$893.84
|
| Rate for Payer: Quartz Commercial |
$1,094.50
|
| Rate for Payer: WEA Trust Commercial |
$1,003.29
|
| Rate for Payer: WPS Commercial |
$1,351.11
|
|
|
GUIDE WIRE PLATINUM PLUS .018 X 260CM M001467320
|
Facility
|
OP
|
$1,754.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$510.76 |
| Max. Negotiated Rate |
$1,678.23 |
| Rate for Payer: Aetna Commercial |
$1,641.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.78
|
| Rate for Payer: Aetna Managed Medicare |
$510.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,185.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$912.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$875.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.80
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,678.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,020.83
|
| Rate for Payer: Health EOS Commercial |
$1,623.50
|
| Rate for Payer: HFN Commercial |
$1,678.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,368.12
|
| Rate for Payer: Multiplan Commercial |
$1,459.33
|
| Rate for Payer: NAPHCARE Commercial |
$1,094.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.23
|
| Rate for Payer: Quartz Beloit One Network |
$893.84
|
| Rate for Payer: Quartz Commercial |
$1,185.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,094.50
|
| Rate for Payer: The Alliance Commercial |
$912.08
|
| Rate for Payer: WEA Trust Commercial |
$1,003.29
|
| Rate for Payer: WPS Commercial |
$1,351.11
|
|
|
GUIDE WIRE PROSTOP PLUS 0.054 IN AR-4206
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$743.51 |
| Max. Negotiated Rate |
$1,395.97 |
| Rate for Payer: Aetna Commercial |
$1,365.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,304.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$804.20
|
| Rate for Payer: Cash Price |
$437.70
|
| Rate for Payer: Cigna Commercial |
$1,395.97
|
| Rate for Payer: Health EOS Commercial |
$1,350.45
|
| Rate for Payer: HFN Commercial |
$1,395.97
|
| Rate for Payer: Multiplan Commercial |
$1,213.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,395.97
|
| Rate for Payer: Quartz Beloit One Network |
$743.51
|
| Rate for Payer: Quartz Commercial |
$910.42
|
| Rate for Payer: WEA Trust Commercial |
$834.55
|
| Rate for Payer: WPS Commercial |
$1,123.87
|
|
|
GUIDE WIRE PROSTOP PLUS 0.054 IN AR-4206
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$424.86 |
| Max. Negotiated Rate |
$1,395.97 |
| Rate for Payer: Aetna Commercial |
$1,365.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,304.93
|
| Rate for Payer: Aetna Managed Medicare |
$424.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$986.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$758.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$728.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$804.20
|
| Rate for Payer: Cash Price |
$437.70
|
| Rate for Payer: Cigna Commercial |
$1,395.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$849.14
|
| Rate for Payer: Health EOS Commercial |
$1,350.45
|
| Rate for Payer: HFN Commercial |
$1,395.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,138.02
|
| Rate for Payer: Multiplan Commercial |
$1,213.89
|
| Rate for Payer: NAPHCARE Commercial |
$910.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,395.97
|
| Rate for Payer: Quartz Beloit One Network |
$743.51
|
| Rate for Payer: Quartz Commercial |
$986.28
|
| Rate for Payer: Quartz Medicare Advantage |
$910.42
|
| Rate for Payer: The Alliance Commercial |
$758.68
|
| Rate for Payer: WEA Trust Commercial |
$834.55
|
| Rate for Payer: WPS Commercial |
$1,123.87
|
|
