|
GUIDEWIRE SENSOR DUAL-FLEX ANGLED .035 X 150 3CM FLEXIBLE M0066703010
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5306813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$264.41 |
| Max. Negotiated Rate |
$868.77 |
| Rate for Payer: Aetna Commercial |
$849.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$812.12
|
| Rate for Payer: Aetna Managed Medicare |
$264.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$613.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$472.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$453.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$500.49
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cigna Commercial |
$868.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$528.46
|
| Rate for Payer: Health EOS Commercial |
$840.44
|
| Rate for Payer: HFN Commercial |
$868.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$708.24
|
| Rate for Payer: Multiplan Commercial |
$755.46
|
| Rate for Payer: NAPHCARE Commercial |
$566.59
|
| Rate for Payer: Preferred Network Access Commercial |
$868.77
|
| Rate for Payer: Quartz Beloit One Network |
$462.72
|
| Rate for Payer: Quartz Commercial |
$613.81
|
| Rate for Payer: Quartz Medicare Advantage |
$566.59
|
| Rate for Payer: The Alliance Commercial |
$472.16
|
| Rate for Payer: WEA Trust Commercial |
$519.38
|
| Rate for Payer: WPS Commercial |
$699.43
|
|
|
GUIDEWIRE SENSOR DUAL-FLEX ANGLED .035 X 150 3CM FLEXIBLE M0066703010
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5306813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$462.72 |
| Max. Negotiated Rate |
$868.77 |
| Rate for Payer: Aetna Commercial |
$849.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$812.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$500.49
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cigna Commercial |
$868.77
|
| Rate for Payer: Health EOS Commercial |
$840.44
|
| Rate for Payer: HFN Commercial |
$868.77
|
| Rate for Payer: Multiplan Commercial |
$755.46
|
| Rate for Payer: Preferred Network Access Commercial |
$868.77
|
| Rate for Payer: Quartz Beloit One Network |
$462.72
|
| Rate for Payer: Quartz Commercial |
$566.59
|
| Rate for Payer: WEA Trust Commercial |
$519.38
|
| Rate for Payer: WPS Commercial |
$699.43
|
|
|
GUIDEWIRE SENSOR DUAL-FLEX STRAIGHT .035 X 150 3CM FLEXIBLE M0066703080
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5306923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.92 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Aetna Managed Medicare |
$260.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$605.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$465.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$447.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$521.47
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.88
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: NAPHCARE Commercial |
$559.10
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$605.70
|
| Rate for Payer: Quartz Medicare Advantage |
$559.10
|
| Rate for Payer: The Alliance Commercial |
$465.92
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
GUIDEWIRE SENSOR DUAL-FLEX STRAIGHT .035 X 150 3CM FLEXIBLE M0066703080
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5306923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.60 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$559.10
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
GUIDE WIRE SMOOTH DIGIFUSE 80 X 70MM DW2590
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$101.92 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Aetna Managed Medicare |
$101.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$236.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$182.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.70
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$273.00
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: NAPHCARE Commercial |
$218.40
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$236.60
|
| Rate for Payer: Quartz Medicare Advantage |
$218.40
|
| Rate for Payer: The Alliance Commercial |
$182.00
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
GUIDE WIRE SMOOTH DIGIFUSE 80 X 70MM DW2590
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.36 |
| Max. Negotiated Rate |
$334.88 |
| Rate for Payer: Aetna Commercial |
$327.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.92
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$334.88
|
| Rate for Payer: Health EOS Commercial |
$323.96
|
| Rate for Payer: HFN Commercial |
$334.88
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$334.88
|
| Rate for Payer: Quartz Beloit One Network |
$178.36
|
| Rate for Payer: Quartz Commercial |
$218.40
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
GUIDE WIRE SMOOTH-TIP 2.2 X 800MM 1806-0093S
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6204987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$389.33 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Aetna Managed Medicare |
$389.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$695.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$667.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$778.13
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.86
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: NAPHCARE Commercial |
$834.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$903.81
|
| Rate for Payer: Quartz Medicare Advantage |
$834.29
|
| Rate for Payer: The Alliance Commercial |
$695.24
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
GUIDE WIRE SMOOTH-TIP 2.2 X 800MM 1806-0093S
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6204987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$681.34 |
| Max. Negotiated Rate |
$1,279.24 |
| Rate for Payer: Aetna Commercial |
$1,251.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,195.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.95
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,279.24
|
| Rate for Payer: Health EOS Commercial |
$1,237.53
|
| Rate for Payer: HFN Commercial |
$1,279.24
|
| Rate for Payer: Multiplan Commercial |
$1,112.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,279.24
|
| Rate for Payer: Quartz Beloit One Network |
$681.34
|
| Rate for Payer: Quartz Commercial |
$834.29
|
| Rate for Payer: WEA Trust Commercial |
$764.76
|
| Rate for Payer: WPS Commercial |
$1,029.89
|
|
|
GUIDE WIRE SMOOTH-TIP 3.0 X 800MM 1806-0090S
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$676.75 |
| Max. Negotiated Rate |
$1,270.63 |
| Rate for Payer: Aetna Commercial |
$1,243.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,187.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.99
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cigna Commercial |
$1,270.63
|
| Rate for Payer: Health EOS Commercial |
$1,229.20
|
| Rate for Payer: HFN Commercial |
$1,270.63
|
| Rate for Payer: Multiplan Commercial |
$1,104.90
|
| Rate for Payer: Preferred Network Access Commercial |
$1,270.63
|
| Rate for Payer: Quartz Beloit One Network |
$676.75
|
| Rate for Payer: Quartz Commercial |
$828.67
|
| Rate for Payer: WEA Trust Commercial |
$759.62
|
| Rate for Payer: WPS Commercial |
$1,022.96
|
|
|
GUIDE WIRE SMOOTH-TIP 3.0 X 800MM 1806-0090S
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.71 |
| Max. Negotiated Rate |
$1,270.63 |
| Rate for Payer: Aetna Commercial |
$1,243.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,187.76
|
| Rate for Payer: Aetna Managed Medicare |
$386.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$897.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$690.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$662.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$731.99
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cigna Commercial |
$1,270.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$772.90
|
| Rate for Payer: Health EOS Commercial |
$1,229.20
|
| Rate for Payer: HFN Commercial |
$1,270.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,035.84
|
| Rate for Payer: Multiplan Commercial |
$1,104.90
|
| Rate for Payer: NAPHCARE Commercial |
$828.67
|
| Rate for Payer: Preferred Network Access Commercial |
$1,270.63
|
| Rate for Payer: Quartz Beloit One Network |
$676.75
|
| Rate for Payer: Quartz Commercial |
$897.73
|
| Rate for Payer: Quartz Medicare Advantage |
$828.67
|
| Rate for Payer: The Alliance Commercial |
$690.56
|
| Rate for Payer: WEA Trust Commercial |
$759.62
|
| Rate for Payer: WPS Commercial |
$1,022.96
|
|
|
GUIDE WIRE STORQ .035 180cm 503-356J
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.90 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$188.45
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
GUIDE WIRE STORQ .035 180cm 503-356J
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.94 |
| Max. Negotiated Rate |
$288.95 |
| Rate for Payer: Aetna Commercial |
$282.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.11
|
| Rate for Payer: Aetna Managed Medicare |
$87.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.46
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$288.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.76
|
| Rate for Payer: Health EOS Commercial |
$279.53
|
| Rate for Payer: HFN Commercial |
$288.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.56
|
| Rate for Payer: Multiplan Commercial |
$251.26
|
| Rate for Payer: NAPHCARE Commercial |
$188.45
|
| Rate for Payer: Preferred Network Access Commercial |
$288.95
|
| Rate for Payer: Quartz Beloit One Network |
$153.90
|
| Rate for Payer: Quartz Commercial |
$204.15
|
| Rate for Payer: Quartz Medicare Advantage |
$188.45
|
| Rate for Payer: The Alliance Commercial |
$157.04
|
| Rate for Payer: WEA Trust Commercial |
$172.74
|
| Rate for Payer: WPS Commercial |
$232.63
|
|
|
GUIDE WIRE STORQ .035 300cm (ORDER IS MULTIPLES OF FIVE) 503356Y
|
Facility
|
IP
|
$1,347.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$686.43 |
| Max. Negotiated Rate |
$1,288.81 |
| Rate for Payer: Aetna Commercial |
$1,260.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.47
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cigna Commercial |
$1,288.81
|
| Rate for Payer: Health EOS Commercial |
$1,246.78
|
| Rate for Payer: HFN Commercial |
$1,288.81
|
| Rate for Payer: Multiplan Commercial |
$1,120.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.81
|
| Rate for Payer: Quartz Beloit One Network |
$686.43
|
| Rate for Payer: Quartz Commercial |
$840.53
|
| Rate for Payer: WEA Trust Commercial |
$770.48
|
| Rate for Payer: WPS Commercial |
$1,037.59
|
|
|
GUIDE WIRE STORQ .035 300cm (ORDER IS MULTIPLES OF FIVE) 503356Y
|
Facility
|
OP
|
$1,347.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.25 |
| Max. Negotiated Rate |
$1,288.81 |
| Rate for Payer: Aetna Commercial |
$1,260.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.76
|
| Rate for Payer: Aetna Managed Medicare |
$392.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$910.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$700.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.47
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cigna Commercial |
$1,288.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.95
|
| Rate for Payer: Health EOS Commercial |
$1,246.78
|
| Rate for Payer: HFN Commercial |
$1,288.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.66
|
| Rate for Payer: Multiplan Commercial |
$1,120.70
|
| Rate for Payer: NAPHCARE Commercial |
$840.53
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.81
|
| Rate for Payer: Quartz Beloit One Network |
$686.43
|
| Rate for Payer: Quartz Commercial |
$910.57
|
| Rate for Payer: Quartz Medicare Advantage |
$840.53
|
| Rate for Payer: The Alliance Commercial |
$700.44
|
| Rate for Payer: WEA Trust Commercial |
$770.48
|
| Rate for Payer: WPS Commercial |
$1,037.59
|
|
|
GUIDEWIRE STRAIGHT #M00551981
|
Facility
|
IP
|
$1,827.00
|
|
| Hospital Charge Code |
2973627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$931.04 |
| Max. Negotiated Rate |
$1,748.07 |
| Rate for Payer: Aetna Commercial |
$1,710.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,007.04
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cigna Commercial |
$1,748.07
|
| Rate for Payer: Health EOS Commercial |
$1,691.07
|
| Rate for Payer: HFN Commercial |
$1,748.07
|
| Rate for Payer: Multiplan Commercial |
$1,520.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,748.07
|
| Rate for Payer: Quartz Beloit One Network |
$931.04
|
| Rate for Payer: Quartz Commercial |
$1,140.05
|
| Rate for Payer: WEA Trust Commercial |
$1,045.04
|
| Rate for Payer: WPS Commercial |
$1,407.34
|
|
|
GUIDEWIRE STRAIGHT #M00551981
|
Facility
|
OP
|
$1,827.00
|
|
| Hospital Charge Code |
2973627
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$532.02 |
| Max. Negotiated Rate |
$1,748.07 |
| Rate for Payer: Aetna Commercial |
$1,710.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,634.07
|
| Rate for Payer: Aetna Managed Medicare |
$532.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,235.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$950.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$912.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,007.04
|
| Rate for Payer: Cash Price |
$548.10
|
| Rate for Payer: Cigna Commercial |
$1,748.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,063.31
|
| Rate for Payer: Health EOS Commercial |
$1,691.07
|
| Rate for Payer: HFN Commercial |
$1,748.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,425.06
|
| Rate for Payer: Multiplan Commercial |
$1,520.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,140.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,748.07
|
| Rate for Payer: Quartz Beloit One Network |
$931.04
|
| Rate for Payer: Quartz Commercial |
$1,235.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,140.05
|
| Rate for Payer: The Alliance Commercial |
$950.04
|
| Rate for Payer: WEA Trust Commercial |
$1,045.04
|
| Rate for Payer: WPS Commercial |
$1,407.34
|
|
|
GUIDE WIRE WHISPER .014 J 300CM
|
Facility
|
IP
|
$1,616.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$823.51 |
| Max. Negotiated Rate |
$1,546.19 |
| Rate for Payer: Aetna Commercial |
$1,512.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,445.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$890.74
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$1,546.19
|
| Rate for Payer: Health EOS Commercial |
$1,495.77
|
| Rate for Payer: HFN Commercial |
$1,546.19
|
| Rate for Payer: Multiplan Commercial |
$1,344.51
|
| Rate for Payer: Preferred Network Access Commercial |
$1,546.19
|
| Rate for Payer: Quartz Beloit One Network |
$823.51
|
| Rate for Payer: Quartz Commercial |
$1,008.38
|
| Rate for Payer: WEA Trust Commercial |
$924.35
|
| Rate for Payer: WPS Commercial |
$1,244.80
|
|
|
GUIDE WIRE WHISPER .014 J 300CM
|
Facility
|
OP
|
$1,616.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972404
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$470.58 |
| Max. Negotiated Rate |
$1,546.19 |
| Rate for Payer: Aetna Commercial |
$1,512.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,445.35
|
| Rate for Payer: Aetna Managed Medicare |
$470.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,092.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$840.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$806.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$890.74
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$1,546.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$940.51
|
| Rate for Payer: Health EOS Commercial |
$1,495.77
|
| Rate for Payer: HFN Commercial |
$1,546.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,260.48
|
| Rate for Payer: Multiplan Commercial |
$1,344.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,008.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,546.19
|
| Rate for Payer: Quartz Beloit One Network |
$823.51
|
| Rate for Payer: Quartz Commercial |
$1,092.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,008.38
|
| Rate for Payer: The Alliance Commercial |
$840.32
|
| Rate for Payer: WEA Trust Commercial |
$924.35
|
| Rate for Payer: WPS Commercial |
$1,244.80
|
|
|
GUIDE WIRE WHISPER MS .014 J 190cm
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972527
|
|
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 WHISPER MS .014 J 190cm
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972527
|
|
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
|
|
|
GUIDING CATHETER 7FR MP 77827055
|
Facility
|
OP
|
$1,862.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.21 |
| Max. Negotiated Rate |
$1,781.56 |
| Rate for Payer: Aetna Commercial |
$1,742.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,665.37
|
| Rate for Payer: Aetna Managed Medicare |
$542.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,258.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$968.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$929.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.33
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,781.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,083.68
|
| Rate for Payer: Health EOS Commercial |
$1,723.47
|
| Rate for Payer: HFN Commercial |
$1,781.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,452.36
|
| Rate for Payer: Multiplan Commercial |
$1,549.18
|
| Rate for Payer: NAPHCARE Commercial |
$1,161.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.56
|
| Rate for Payer: Quartz Beloit One Network |
$948.88
|
| Rate for Payer: Quartz Commercial |
$1,258.71
|
| Rate for Payer: Quartz Medicare Advantage |
$1,161.89
|
| Rate for Payer: The Alliance Commercial |
$968.24
|
| Rate for Payer: WEA Trust Commercial |
$1,065.06
|
| Rate for Payer: WPS Commercial |
$1,434.30
|
|
|
GUIDING CATHETER 7FR MP 77827055
|
Facility
|
IP
|
$1,862.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972162
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$948.88 |
| Max. Negotiated Rate |
$1,781.56 |
| Rate for Payer: Aetna Commercial |
$1,742.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,665.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.33
|
| Rate for Payer: Cash Price |
$558.60
|
| Rate for Payer: Cigna Commercial |
$1,781.56
|
| Rate for Payer: Health EOS Commercial |
$1,723.47
|
| Rate for Payer: HFN Commercial |
$1,781.56
|
| Rate for Payer: Multiplan Commercial |
$1,549.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.56
|
| Rate for Payer: Quartz Beloit One Network |
$948.88
|
| Rate for Payer: Quartz Commercial |
$1,161.89
|
| Rate for Payer: WEA Trust Commercial |
$1,065.06
|
| Rate for Payer: WPS Commercial |
$1,434.30
|
|
|
GUYON'S CANAL RELEASE
|
Facility
|
OP
|
$1,242.00
|
|
| Hospital Charge Code |
2960093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$361.67 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Aetna Managed Medicare |
$361.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$839.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$645.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$620.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$722.84
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.76
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: NAPHCARE Commercial |
$775.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$839.59
|
| Rate for Payer: Quartz Medicare Advantage |
$775.01
|
| Rate for Payer: The Alliance Commercial |
$645.84
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
GUYON'S CANAL RELEASE
|
Facility
|
IP
|
$1,242.00
|
|
| Hospital Charge Code |
2960093
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$632.92 |
| Max. Negotiated Rate |
$1,188.35 |
| Rate for Payer: Aetna Commercial |
$1,162.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.59
|
| Rate for Payer: Cash Price |
$372.60
|
| Rate for Payer: Cigna Commercial |
$1,188.35
|
| Rate for Payer: Health EOS Commercial |
$1,149.60
|
| Rate for Payer: HFN Commercial |
$1,188.35
|
| Rate for Payer: Multiplan Commercial |
$1,033.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,188.35
|
| Rate for Payer: Quartz Beloit One Network |
$632.92
|
| Rate for Payer: Quartz Commercial |
$775.01
|
| Rate for Payer: WEA Trust Commercial |
$710.42
|
| Rate for Payer: WPS Commercial |
$956.71
|
|
|
Gynecological Exam
|
Professional
|
Both
|
$62.00
|
|
|
Service Code
|
HCPCS G0101
|
| Hospital Charge Code |
1122843
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.69 |
| Max. Negotiated Rate |
$135.95 |
| Rate for Payer: Aetna Commercial |
$61.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.69
|
| Rate for Payer: Anthem Medicare Advantage |
$23.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.69
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cash Price |
$18.60
|
| Rate for Payer: Cigna Commercial |
$61.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$34.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.69
|
| Rate for Payer: Health EOS Commercial |
$58.68
|
| Rate for Payer: HFN Commercial |
$61.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.69
|
| Rate for Payer: Multiplan Commercial |
$51.58
|
| Rate for Payer: NAPHCARE Commercial |
$35.54
|
| Rate for Payer: Preferred Network Access Commercial |
$61.26
|
| Rate for Payer: Quartz Beloit One Network |
$28.37
|
| Rate for Payer: Quartz Commercial |
$36.75
|
| Rate for Payer: Quartz Medicare Advantage |
$23.69
|
| Rate for Payer: The Alliance Commercial |
$65.15
|
| Rate for Payer: United Healthcare Medicaid |
$34.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.69
|
| Rate for Payer: WEA Trust Commercial |
$35.46
|
| Rate for Payer: WPS Commercial |
$41.46
|
|
