|
GUIDEWIRE 2.0
|
Facility
|
OP
|
$787.00
|
|
| Hospital Charge Code |
2966249
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.36 |
| Max. Negotiated Rate |
$3,148.00 |
| Rate for Payer: Aetna Commercial |
$708.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$676.82
|
| Rate for Payer: Aetna Managed Medicare |
$220.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$511.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$393.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$377.76
|
| 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: Dean Health DHI/DHP/ASO |
$440.41
|
| Rate for Payer: Health EOS Commercial |
$700.43
|
| Rate for Payer: HFN Commercial |
$724.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$590.25
|
| 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 |
$511.55
|
| Rate for Payer: Quartz Medicare Advantage |
$472.20
|
| Rate for Payer: The Alliance Commercial |
$3,148.00
|
| Rate for Payer: WEA Trust Commercial |
$432.85
|
| Rate for Payer: WPS Commercial |
$582.93
|
|
|
GUIDE WIRE 2.0 292.26
|
Facility
|
IP
|
$1,692.00
|
|
| Hospital Charge Code |
2966239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$829.08 |
| Max. Negotiated Rate |
$1,556.64 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,015.20
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
GUIDE WIRE 2.0 292.26
|
Facility
|
OP
|
$1,692.00
|
|
| Hospital Charge Code |
2966239
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$473.76 |
| Max. Negotiated Rate |
$6,768.00 |
| Rate for Payer: Aetna Commercial |
$1,522.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,455.12
|
| Rate for Payer: Aetna Managed Medicare |
$473.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,099.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$846.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$812.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$896.76
|
| Rate for Payer: Cash Price |
$507.60
|
| Rate for Payer: Cigna Commercial |
$1,556.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$946.84
|
| Rate for Payer: Health EOS Commercial |
$1,505.88
|
| Rate for Payer: HFN Commercial |
$1,556.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,269.00
|
| Rate for Payer: Multiplan Commercial |
$1,353.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,015.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,556.64
|
| Rate for Payer: Quartz Beloit One Network |
$829.08
|
| Rate for Payer: Quartz Commercial |
$1,099.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,015.20
|
| Rate for Payer: The Alliance Commercial |
$6,768.00
|
| Rate for Payer: WEA Trust Commercial |
$930.60
|
| Rate for Payer: WPS Commercial |
$1,253.26
|
|
|
GUIDE WIRE 2.0 292.656
|
Facility
|
IP
|
$808.00
|
|
| Hospital Charge Code |
2966240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.92 |
| Max. Negotiated Rate |
$743.36 |
| Rate for Payer: Aetna Commercial |
$727.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.24
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$743.36
|
| Rate for Payer: Health EOS Commercial |
$719.12
|
| Rate for Payer: HFN Commercial |
$743.36
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: NAPHCARE Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$743.36
|
| Rate for Payer: Quartz Beloit One Network |
$395.92
|
| Rate for Payer: Quartz Commercial |
$484.80
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
GUIDE WIRE 2.0 292.656
|
Facility
|
OP
|
$808.00
|
|
| Hospital Charge Code |
2966240
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$226.24 |
| Max. Negotiated Rate |
$3,232.00 |
| Rate for Payer: Aetna Commercial |
$727.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Aetna Managed Medicare |
$226.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$404.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$387.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$428.24
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$743.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$452.16
|
| Rate for Payer: Health EOS Commercial |
$719.12
|
| Rate for Payer: HFN Commercial |
$743.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$606.00
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: NAPHCARE Commercial |
$484.80
|
| Rate for Payer: Preferred Network Access Commercial |
$743.36
|
| Rate for Payer: Quartz Beloit One Network |
$395.92
|
| Rate for Payer: Quartz Commercial |
$525.20
|
| Rate for Payer: Quartz Medicare Advantage |
$484.80
|
| Rate for Payer: The Alliance Commercial |
$3,232.00
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
Guidewire 20G* - Guidewire Catheter Gauge
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
6179211
|
|
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 20G* - Guidewire Catheter Gauge
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
6179211
|
|
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
|
|
|
GUIDE WIRE 2.0MM TROCAR TIP AR-8956K-01
|
Facility
|
IP
|
$466.00
|
|
| Hospital Charge Code |
5599719
|
|
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
|
|
|
GUIDE WIRE 2.0MM TROCAR TIP AR-8956K-01
|
Facility
|
OP
|
$466.00
|
|
| Hospital Charge Code |
5599719
|
|
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
|
|
|
GUIDE WIRE 2.0 X 150MM NON-THREADED ASNIS III 705234
|
Facility
|
IP
|
$1,557.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5582939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.93 |
| Max. Negotiated Rate |
$1,432.44 |
| Rate for Payer: Aetna Commercial |
$1,401.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,339.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.21
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cigna Commercial |
$1,432.44
|
| Rate for Payer: Health EOS Commercial |
$1,385.73
|
| Rate for Payer: HFN Commercial |
$1,432.44
|
| Rate for Payer: Multiplan Commercial |
$1,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$934.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,432.44
|
| Rate for Payer: Quartz Beloit One Network |
$762.93
|
| Rate for Payer: Quartz Commercial |
$934.20
|
| Rate for Payer: WEA Trust Commercial |
$856.35
|
| Rate for Payer: WPS Commercial |
$1,153.27
|
|
|
GUIDE WIRE 2.0 X 150MM NON-THREADED ASNIS III 705234
|
Facility
|
OP
|
$1,557.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5582939
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.96 |
| Max. Negotiated Rate |
$6,228.00 |
| Rate for Payer: Aetna Commercial |
$1,401.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,339.02
|
| Rate for Payer: Aetna Managed Medicare |
$435.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,012.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$747.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$825.21
|
| Rate for Payer: Cash Price |
$467.10
|
| Rate for Payer: Cigna Commercial |
$1,432.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$871.30
|
| Rate for Payer: Health EOS Commercial |
$1,385.73
|
| Rate for Payer: HFN Commercial |
$1,432.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.75
|
| Rate for Payer: Multiplan Commercial |
$1,245.60
|
| Rate for Payer: NAPHCARE Commercial |
$934.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,432.44
|
| Rate for Payer: Quartz Beloit One Network |
$762.93
|
| Rate for Payer: Quartz Commercial |
$1,012.05
|
| Rate for Payer: Quartz Medicare Advantage |
$934.20
|
| Rate for Payer: The Alliance Commercial |
$6,228.00
|
| Rate for Payer: WEA Trust Commercial |
$856.35
|
| Rate for Payer: WPS Commercial |
$1,153.27
|
|
|
GUIDE WIRE 2.0 X 150MM THREADED ASNIS III 702460
|
Facility
|
OP
|
$816.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5582938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.48 |
| Max. Negotiated Rate |
$3,264.00 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.76
|
| Rate for Payer: Aetna Managed Medicare |
$228.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$530.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$408.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$391.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.48
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$750.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$456.63
|
| Rate for Payer: Health EOS Commercial |
$726.24
|
| Rate for Payer: HFN Commercial |
$750.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$612.00
|
| Rate for Payer: Multiplan Commercial |
$652.80
|
| Rate for Payer: NAPHCARE Commercial |
$489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$750.72
|
| Rate for Payer: Quartz Beloit One Network |
$399.84
|
| Rate for Payer: Quartz Commercial |
$530.40
|
| Rate for Payer: Quartz Medicare Advantage |
$489.60
|
| Rate for Payer: The Alliance Commercial |
$3,264.00
|
| Rate for Payer: WEA Trust Commercial |
$448.80
|
| Rate for Payer: WPS Commercial |
$604.41
|
|
|
GUIDE WIRE 2.0 X 150MM THREADED ASNIS III 702460
|
Facility
|
IP
|
$816.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5582938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.84 |
| Max. Negotiated Rate |
$750.72 |
| Rate for Payer: Aetna Commercial |
$734.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$701.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$432.48
|
| Rate for Payer: Cash Price |
$244.80
|
| Rate for Payer: Cigna Commercial |
$750.72
|
| Rate for Payer: Health EOS Commercial |
$726.24
|
| Rate for Payer: HFN Commercial |
$750.72
|
| Rate for Payer: Multiplan Commercial |
$652.80
|
| Rate for Payer: NAPHCARE Commercial |
$489.60
|
| Rate for Payer: Preferred Network Access Commercial |
$750.72
|
| Rate for Payer: Quartz Beloit One Network |
$399.84
|
| Rate for Payer: Quartz Commercial |
$489.60
|
| Rate for Payer: WEA Trust Commercial |
$448.80
|
| Rate for Payer: WPS Commercial |
$604.41
|
|
|
GUIDE WIRE 2.0 X 200MM UNTHREADED 705355
|
Facility
|
IP
|
$724.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6166130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.76 |
| Max. Negotiated Rate |
$666.08 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$434.40
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
GUIDE WIRE 2.0 X 200MM UNTHREADED 705355
|
Facility
|
OP
|
$724.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6166130
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$202.72 |
| Max. Negotiated Rate |
$2,896.00 |
| Rate for Payer: Aetna Commercial |
$651.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$622.64
|
| Rate for Payer: Aetna Managed Medicare |
$202.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$470.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$362.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$347.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$383.72
|
| Rate for Payer: Cash Price |
$217.20
|
| Rate for Payer: Cigna Commercial |
$666.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$405.15
|
| Rate for Payer: Health EOS Commercial |
$644.36
|
| Rate for Payer: HFN Commercial |
$666.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.00
|
| Rate for Payer: Multiplan Commercial |
$579.20
|
| Rate for Payer: NAPHCARE Commercial |
$434.40
|
| Rate for Payer: Preferred Network Access Commercial |
$666.08
|
| Rate for Payer: Quartz Beloit One Network |
$354.76
|
| Rate for Payer: Quartz Commercial |
$470.60
|
| Rate for Payer: Quartz Medicare Advantage |
$434.40
|
| Rate for Payer: The Alliance Commercial |
$2,896.00
|
| Rate for Payer: WEA Trust Commercial |
$398.20
|
| Rate for Payer: WPS Commercial |
$536.27
|
|
|
GUIDE WIRE 2.0 X 230 THREADED SPADE POINT 292.652
|
Facility
|
OP
|
$946.00
|
|
| Hospital Charge Code |
2966241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.88 |
| Max. Negotiated Rate |
$3,784.00 |
| Rate for Payer: Aetna Commercial |
$851.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Aetna Managed Medicare |
$264.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$614.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$473.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$454.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.38
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$870.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$529.38
|
| Rate for Payer: Health EOS Commercial |
$841.94
|
| Rate for Payer: HFN Commercial |
$870.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$709.50
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: NAPHCARE Commercial |
$567.60
|
| Rate for Payer: Preferred Network Access Commercial |
$870.32
|
| Rate for Payer: Quartz Beloit One Network |
$463.54
|
| Rate for Payer: Quartz Commercial |
$614.90
|
| Rate for Payer: Quartz Medicare Advantage |
$567.60
|
| Rate for Payer: The Alliance Commercial |
$3,784.00
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
GUIDE WIRE 2.0 X 230 THREADED SPADE POINT 292.652
|
Facility
|
IP
|
$946.00
|
|
| Hospital Charge Code |
2966241
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.54 |
| Max. Negotiated Rate |
$870.32 |
| Rate for Payer: Aetna Commercial |
$851.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$813.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.38
|
| Rate for Payer: Cash Price |
$283.80
|
| Rate for Payer: Cigna Commercial |
$870.32
|
| Rate for Payer: Health EOS Commercial |
$841.94
|
| Rate for Payer: HFN Commercial |
$870.32
|
| Rate for Payer: Multiplan Commercial |
$756.80
|
| Rate for Payer: NAPHCARE Commercial |
$567.60
|
| Rate for Payer: Preferred Network Access Commercial |
$870.32
|
| Rate for Payer: Quartz Beloit One Network |
$463.54
|
| Rate for Payer: Quartz Commercial |
$567.60
|
| Rate for Payer: WEA Trust Commercial |
$520.30
|
| Rate for Payer: WPS Commercial |
$700.70
|
|
|
Guidewire 22G* - Guidewire Catheter Gauge
|
Facility
|
IP
|
$182.00
|
|
| Hospital Charge Code |
6179212
|
|
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 22G* - Guidewire Catheter Gauge
|
Facility
|
OP
|
$182.00
|
|
| Hospital Charge Code |
6179212
|
|
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
|
|
|
GUIDE WIRE 2.4MM X 9.25 IN TROCAR TIP AR-8770K
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.43 |
| Max. Negotiated Rate |
$282.44 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$184.20
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
GUIDE WIRE 2.4MM X 9.25 IN TROCAR TIP AR-8770K
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729739
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$1,228.00 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Aetna Managed Medicare |
$85.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$199.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$153.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$147.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.80
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.25
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$199.55
|
| Rate for Payer: Quartz Medicare Advantage |
$184.20
|
| Rate for Payer: The Alliance Commercial |
$1,228.00
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
GUIDE WIRE 2.5MM DRILL TIP 310.243
|
Facility
|
IP
|
$1,280.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$627.20 |
| Max. Negotiated Rate |
$1,177.60 |
| Rate for Payer: Aetna Commercial |
$1,152.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,100.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.40
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$1,177.60
|
| Rate for Payer: Health EOS Commercial |
$1,139.20
|
| Rate for Payer: HFN Commercial |
$1,177.60
|
| Rate for Payer: Multiplan Commercial |
$1,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$768.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.60
|
| Rate for Payer: Quartz Beloit One Network |
$627.20
|
| Rate for Payer: Quartz Commercial |
$768.00
|
| Rate for Payer: WEA Trust Commercial |
$704.00
|
| Rate for Payer: WPS Commercial |
$948.10
|
|
|
GUIDE WIRE 2.5MM DRILL TIP 310.243
|
Facility
|
OP
|
$1,280.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966242
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.40 |
| Max. Negotiated Rate |
$5,120.00 |
| Rate for Payer: Aetna Commercial |
$1,152.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,100.80
|
| Rate for Payer: Aetna Managed Medicare |
$358.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$832.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$640.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$614.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$678.40
|
| Rate for Payer: Cash Price |
$384.00
|
| Rate for Payer: Cigna Commercial |
$1,177.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$716.29
|
| Rate for Payer: Health EOS Commercial |
$1,139.20
|
| Rate for Payer: HFN Commercial |
$1,177.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$960.00
|
| Rate for Payer: Multiplan Commercial |
$1,024.00
|
| Rate for Payer: NAPHCARE Commercial |
$768.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,177.60
|
| Rate for Payer: Quartz Beloit One Network |
$627.20
|
| Rate for Payer: Quartz Commercial |
$832.00
|
| Rate for Payer: Quartz Medicare Advantage |
$768.00
|
| Rate for Payer: The Alliance Commercial |
$5,120.00
|
| Rate for Payer: WEA Trust Commercial |
$704.00
|
| Rate for Payer: WPS Commercial |
$948.10
|
|
|
GUIDE WIRE 2.5 X 230MM WIDESPADE POINT THREADED 900.723
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$491.47 |
| Max. Negotiated Rate |
$922.76 |
| Rate for Payer: Aetna Commercial |
$902.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.59
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$922.76
|
| Rate for Payer: Health EOS Commercial |
$892.67
|
| Rate for Payer: HFN Commercial |
$922.76
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: NAPHCARE Commercial |
$601.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.76
|
| Rate for Payer: Quartz Beloit One Network |
$491.47
|
| Rate for Payer: Quartz Commercial |
$601.80
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
|
GUIDE WIRE 2.5 X 230MM WIDESPADE POINT THREADED 900.723
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966243
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.84 |
| Max. Negotiated Rate |
$4,012.00 |
| Rate for Payer: Aetna Commercial |
$902.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Aetna Managed Medicare |
$280.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.59
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$922.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$561.28
|
| Rate for Payer: Health EOS Commercial |
$892.67
|
| Rate for Payer: HFN Commercial |
$922.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$752.25
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: NAPHCARE Commercial |
$601.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.76
|
| Rate for Payer: Quartz Beloit One Network |
$491.47
|
| Rate for Payer: Quartz Commercial |
$651.95
|
| Rate for Payer: Quartz Medicare Advantage |
$601.80
|
| Rate for Payer: The Alliance Commercial |
$4,012.00
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
