|
GUIDE WIRE 2.8MM NON-THREAD 292.61
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4065112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.95 |
| Max. Negotiated Rate |
$694.60 |
| Rate for Payer: Aetna Commercial |
$679.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.15
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$694.60
|
| Rate for Payer: Health EOS Commercial |
$671.95
|
| Rate for Payer: HFN Commercial |
$694.60
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: NAPHCARE Commercial |
$453.00
|
| Rate for Payer: Preferred Network Access Commercial |
$694.60
|
| Rate for Payer: Quartz Beloit One Network |
$369.95
|
| Rate for Payer: Quartz Commercial |
$453.00
|
| Rate for Payer: WEA Trust Commercial |
$415.25
|
| Rate for Payer: WPS Commercial |
$559.23
|
|
|
GUIDE WIRE 2.8MM NON-THREAD 292.61
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4065112
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$3,020.00 |
| Rate for Payer: Aetna Commercial |
$679.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.30
|
| Rate for Payer: Aetna Managed Medicare |
$211.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$490.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$377.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$362.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.15
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$694.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$422.50
|
| Rate for Payer: Health EOS Commercial |
$671.95
|
| Rate for Payer: HFN Commercial |
$694.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$566.25
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: NAPHCARE Commercial |
$453.00
|
| Rate for Payer: Preferred Network Access Commercial |
$694.60
|
| Rate for Payer: Quartz Beloit One Network |
$369.95
|
| Rate for Payer: Quartz Commercial |
$490.75
|
| Rate for Payer: Quartz Medicare Advantage |
$453.00
|
| Rate for Payer: The Alliance Commercial |
$3,020.00
|
| Rate for Payer: WEA Trust Commercial |
$415.25
|
| Rate for Payer: WPS Commercial |
$559.23
|
|
|
GUIDE WIRE 2.8MM X 300MM TROCAR POINT THREADED 292.68
|
Facility
|
OP
|
$936.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.08 |
| Max. Negotiated Rate |
$3,744.00 |
| Rate for Payer: Aetna Commercial |
$842.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.96
|
| Rate for Payer: Aetna Managed Medicare |
$262.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$608.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$468.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$449.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.08
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$861.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$523.79
|
| Rate for Payer: Health EOS Commercial |
$833.04
|
| Rate for Payer: HFN Commercial |
$861.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$702.00
|
| Rate for Payer: Multiplan Commercial |
$748.80
|
| Rate for Payer: NAPHCARE Commercial |
$561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$861.12
|
| Rate for Payer: Quartz Beloit One Network |
$458.64
|
| Rate for Payer: Quartz Commercial |
$608.40
|
| Rate for Payer: Quartz Medicare Advantage |
$561.60
|
| Rate for Payer: The Alliance Commercial |
$3,744.00
|
| Rate for Payer: WEA Trust Commercial |
$514.80
|
| Rate for Payer: WPS Commercial |
$693.30
|
|
|
GUIDE WIRE 2.8MM X 300MM TROCAR POINT THREADED 292.68
|
Facility
|
IP
|
$936.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966244
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$458.64 |
| Max. Negotiated Rate |
$861.12 |
| Rate for Payer: Aetna Commercial |
$842.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$804.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$496.08
|
| Rate for Payer: Cash Price |
$280.80
|
| Rate for Payer: Cigna Commercial |
$861.12
|
| Rate for Payer: Health EOS Commercial |
$833.04
|
| Rate for Payer: HFN Commercial |
$861.12
|
| Rate for Payer: Multiplan Commercial |
$748.80
|
| Rate for Payer: NAPHCARE Commercial |
$561.60
|
| Rate for Payer: Preferred Network Access Commercial |
$861.12
|
| Rate for Payer: Quartz Beloit One Network |
$458.64
|
| Rate for Payer: Quartz Commercial |
$561.60
|
| Rate for Payer: WEA Trust Commercial |
$514.80
|
| Rate for Payer: WPS Commercial |
$693.30
|
|
|
GUIDE WIRE 2.8MM X 450MM THREADED 292.726
|
Facility
|
OP
|
$755.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4065113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$211.40 |
| Max. Negotiated Rate |
$3,020.00 |
| Rate for Payer: Aetna Commercial |
$679.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.30
|
| Rate for Payer: Aetna Managed Medicare |
$211.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$490.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$377.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$362.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.15
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$694.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$422.50
|
| Rate for Payer: Health EOS Commercial |
$671.95
|
| Rate for Payer: HFN Commercial |
$694.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$566.25
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: NAPHCARE Commercial |
$453.00
|
| Rate for Payer: Preferred Network Access Commercial |
$694.60
|
| Rate for Payer: Quartz Beloit One Network |
$369.95
|
| Rate for Payer: Quartz Commercial |
$490.75
|
| Rate for Payer: Quartz Medicare Advantage |
$453.00
|
| Rate for Payer: The Alliance Commercial |
$3,020.00
|
| Rate for Payer: WEA Trust Commercial |
$415.25
|
| Rate for Payer: WPS Commercial |
$559.23
|
|
|
GUIDE WIRE 2.8MM X 450MM THREADED 292.726
|
Facility
|
IP
|
$755.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4065113
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$369.95 |
| Max. Negotiated Rate |
$694.60 |
| Rate for Payer: Aetna Commercial |
$679.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$649.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$400.15
|
| Rate for Payer: Cash Price |
$226.50
|
| Rate for Payer: Cigna Commercial |
$694.60
|
| Rate for Payer: Health EOS Commercial |
$671.95
|
| Rate for Payer: HFN Commercial |
$694.60
|
| Rate for Payer: Multiplan Commercial |
$604.00
|
| Rate for Payer: NAPHCARE Commercial |
$453.00
|
| Rate for Payer: Preferred Network Access Commercial |
$694.60
|
| Rate for Payer: Quartz Beloit One Network |
$369.95
|
| Rate for Payer: Quartz Commercial |
$453.00
|
| Rate for Payer: WEA Trust Commercial |
$415.25
|
| Rate for Payer: WPS Commercial |
$559.23
|
|
|
GUIDE WIRE 2.8x180 OLECRANON
|
Facility
|
OP
|
$1,266.00
|
|
| Hospital Charge Code |
2966245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$354.48 |
| Max. Negotiated Rate |
$5,064.00 |
| Rate for Payer: Aetna Commercial |
$1,139.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,088.76
|
| Rate for Payer: Aetna Managed Medicare |
$354.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$822.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$633.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$607.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.98
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,164.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$708.45
|
| Rate for Payer: Health EOS Commercial |
$1,126.74
|
| Rate for Payer: HFN Commercial |
$1,164.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$949.50
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$759.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,164.72
|
| Rate for Payer: Quartz Beloit One Network |
$620.34
|
| Rate for Payer: Quartz Commercial |
$822.90
|
| Rate for Payer: Quartz Medicare Advantage |
$759.60
|
| Rate for Payer: The Alliance Commercial |
$5,064.00
|
| Rate for Payer: WEA Trust Commercial |
$696.30
|
| Rate for Payer: WPS Commercial |
$937.73
|
|
|
GUIDE WIRE 2.8x180 OLECRANON
|
Facility
|
IP
|
$1,266.00
|
|
| Hospital Charge Code |
2966245
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.34 |
| Max. Negotiated Rate |
$1,164.72 |
| Rate for Payer: Aetna Commercial |
$1,139.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,088.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$670.98
|
| Rate for Payer: Cash Price |
$379.80
|
| Rate for Payer: Cigna Commercial |
$1,164.72
|
| Rate for Payer: Health EOS Commercial |
$1,126.74
|
| Rate for Payer: HFN Commercial |
$1,164.72
|
| Rate for Payer: Multiplan Commercial |
$1,012.80
|
| Rate for Payer: NAPHCARE Commercial |
$759.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,164.72
|
| Rate for Payer: Quartz Beloit One Network |
$620.34
|
| Rate for Payer: Quartz Commercial |
$759.60
|
| Rate for Payer: WEA Trust Commercial |
$696.30
|
| Rate for Payer: WPS Commercial |
$937.73
|
|
|
GUIDE WIRE 2.8 X 220 FLUTED TIP 03.333.004
|
Facility
|
IP
|
$1,351.81
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6248158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$662.39 |
| Max. Negotiated Rate |
$1,243.67 |
| Rate for Payer: Aetna Commercial |
$1,216.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,162.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$716.46
|
| Rate for Payer: Cash Price |
$405.54
|
| Rate for Payer: Cigna Commercial |
$1,243.67
|
| Rate for Payer: Health EOS Commercial |
$1,203.11
|
| Rate for Payer: HFN Commercial |
$1,243.67
|
| Rate for Payer: Multiplan Commercial |
$1,081.45
|
| Rate for Payer: NAPHCARE Commercial |
$811.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,243.67
|
| Rate for Payer: Quartz Beloit One Network |
$662.39
|
| Rate for Payer: Quartz Commercial |
$811.09
|
| Rate for Payer: WEA Trust Commercial |
$743.50
|
| Rate for Payer: WPS Commercial |
$1,001.29
|
|
|
GUIDE WIRE 2.8 X 220 FLUTED TIP 03.333.004
|
Facility
|
OP
|
$1,351.81
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6248158
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$378.51 |
| Max. Negotiated Rate |
$5,407.24 |
| Rate for Payer: Aetna Commercial |
$1,216.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,162.56
|
| Rate for Payer: Aetna Managed Medicare |
$378.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$878.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$675.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$648.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$716.46
|
| Rate for Payer: Cash Price |
$405.54
|
| Rate for Payer: Cigna Commercial |
$1,243.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$756.47
|
| Rate for Payer: Health EOS Commercial |
$1,203.11
|
| Rate for Payer: HFN Commercial |
$1,243.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,013.86
|
| Rate for Payer: Multiplan Commercial |
$1,081.45
|
| Rate for Payer: NAPHCARE Commercial |
$811.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,243.67
|
| Rate for Payer: Quartz Beloit One Network |
$662.39
|
| Rate for Payer: Quartz Commercial |
$878.68
|
| Rate for Payer: Quartz Medicare Advantage |
$811.09
|
| Rate for Payer: The Alliance Commercial |
$5,407.24
|
| Rate for Payer: WEA Trust Commercial |
$743.50
|
| Rate for Payer: WPS Commercial |
$1,001.29
|
|
|
GUIDE WIRE 2.8 X 300MM 292.81
|
Facility
|
OP
|
$1,616.00
|
|
| Hospital Charge Code |
2966246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.48 |
| Max. Negotiated Rate |
$6,464.00 |
| Rate for Payer: Aetna Commercial |
$1,454.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.76
|
| Rate for Payer: Aetna Managed Medicare |
$452.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,050.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$808.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$775.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.48
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$1,486.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$904.31
|
| Rate for Payer: Health EOS Commercial |
$1,438.24
|
| Rate for Payer: HFN Commercial |
$1,486.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,212.00
|
| Rate for Payer: Multiplan Commercial |
$1,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$791.84
|
| Rate for Payer: Quartz Commercial |
$1,050.40
|
| Rate for Payer: Quartz Medicare Advantage |
$969.60
|
| Rate for Payer: The Alliance Commercial |
$6,464.00
|
| Rate for Payer: WEA Trust Commercial |
$888.80
|
| Rate for Payer: WPS Commercial |
$1,196.97
|
|
|
GUIDE WIRE 2.8 X 300MM 292.81
|
Facility
|
IP
|
$1,616.00
|
|
| Hospital Charge Code |
2966246
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$791.84 |
| Max. Negotiated Rate |
$1,486.72 |
| Rate for Payer: Aetna Commercial |
$1,454.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,389.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$856.48
|
| Rate for Payer: Cash Price |
$484.80
|
| Rate for Payer: Cigna Commercial |
$1,486.72
|
| Rate for Payer: Health EOS Commercial |
$1,438.24
|
| Rate for Payer: HFN Commercial |
$1,486.72
|
| Rate for Payer: Multiplan Commercial |
$1,292.80
|
| Rate for Payer: NAPHCARE Commercial |
$969.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,486.72
|
| Rate for Payer: Quartz Beloit One Network |
$791.84
|
| Rate for Payer: Quartz Commercial |
$969.60
|
| Rate for Payer: WEA Trust Commercial |
$888.80
|
| Rate for Payer: WPS Commercial |
$1,196.97
|
|
|
GUIDE WIRE 2.8 X 450MM TROCAR POINT THREADED 900.726
|
Facility
|
IP
|
$1,629.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$798.21 |
| Max. Negotiated Rate |
$1,498.68 |
| Rate for Payer: Aetna Commercial |
$1,466.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.37
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna Commercial |
$1,498.68
|
| Rate for Payer: Health EOS Commercial |
$1,449.81
|
| Rate for Payer: HFN Commercial |
$1,498.68
|
| Rate for Payer: Multiplan Commercial |
$1,303.20
|
| Rate for Payer: NAPHCARE Commercial |
$977.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.68
|
| Rate for Payer: Quartz Beloit One Network |
$798.21
|
| Rate for Payer: Quartz Commercial |
$977.40
|
| Rate for Payer: WEA Trust Commercial |
$895.95
|
| Rate for Payer: WPS Commercial |
$1,206.60
|
|
|
GUIDE WIRE 2.8 X 450MM TROCAR POINT THREADED 900.726
|
Facility
|
OP
|
$1,629.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2966247
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.12 |
| Max. Negotiated Rate |
$6,516.00 |
| Rate for Payer: Aetna Commercial |
$1,466.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.94
|
| Rate for Payer: Aetna Managed Medicare |
$456.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,058.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$814.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$781.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.37
|
| Rate for Payer: Cash Price |
$488.70
|
| Rate for Payer: Cigna Commercial |
$1,498.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$911.59
|
| Rate for Payer: Health EOS Commercial |
$1,449.81
|
| Rate for Payer: HFN Commercial |
$1,498.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,221.75
|
| Rate for Payer: Multiplan Commercial |
$1,303.20
|
| Rate for Payer: NAPHCARE Commercial |
$977.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.68
|
| Rate for Payer: Quartz Beloit One Network |
$798.21
|
| Rate for Payer: Quartz Commercial |
$1,058.85
|
| Rate for Payer: Quartz Medicare Advantage |
$977.40
|
| Rate for Payer: The Alliance Commercial |
$6,516.00
|
| Rate for Payer: WEA Trust Commercial |
$895.95
|
| Rate for Payer: WPS Commercial |
$1,206.60
|
|
|
GUIDE WIRE 3.2MM X 290MM 03.010.115
|
Facility
|
OP
|
$1,812.00
|
|
| Hospital Charge Code |
2966248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$507.36 |
| Max. Negotiated Rate |
$7,248.00 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.32
|
| Rate for Payer: Aetna Managed Medicare |
$507.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,177.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$906.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,014.00
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,359.00
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,177.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,087.20
|
| Rate for Payer: The Alliance Commercial |
$7,248.00
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
|
GUIDE WIRE 3.2MM X 290MM 03.010.115
|
Facility
|
IP
|
$1,812.00
|
|
| Hospital Charge Code |
2966248
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$887.88 |
| Max. Negotiated Rate |
$1,667.04 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,087.20
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
|
GUIDE WIRE 3.2MM X 400MM DRILL TIP 03.045.018
|
Facility
|
OP
|
$1,484.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6178980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.52 |
| Max. Negotiated Rate |
$5,936.00 |
| Rate for Payer: Aetna Commercial |
$1,335.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.24
|
| Rate for Payer: Aetna Managed Medicare |
$415.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$964.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$742.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$712.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.52
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,365.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$830.45
|
| Rate for Payer: Health EOS Commercial |
$1,320.76
|
| Rate for Payer: HFN Commercial |
$1,365.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,113.00
|
| Rate for Payer: Multiplan Commercial |
$1,187.20
|
| Rate for Payer: NAPHCARE Commercial |
$890.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,365.28
|
| Rate for Payer: Quartz Beloit One Network |
$727.16
|
| Rate for Payer: Quartz Commercial |
$964.60
|
| Rate for Payer: Quartz Medicare Advantage |
$890.40
|
| Rate for Payer: The Alliance Commercial |
$5,936.00
|
| Rate for Payer: WEA Trust Commercial |
$816.20
|
| Rate for Payer: WPS Commercial |
$1,099.20
|
|
|
GUIDE WIRE 3.2MM X 400MM DRILL TIP 03.045.018
|
Facility
|
IP
|
$1,484.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6178980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$727.16 |
| Max. Negotiated Rate |
$1,365.28 |
| Rate for Payer: Aetna Commercial |
$1,335.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.52
|
| Rate for Payer: Cash Price |
$445.20
|
| Rate for Payer: Cigna Commercial |
$1,365.28
|
| Rate for Payer: Health EOS Commercial |
$1,320.76
|
| Rate for Payer: HFN Commercial |
$1,365.28
|
| Rate for Payer: Multiplan Commercial |
$1,187.20
|
| Rate for Payer: NAPHCARE Commercial |
$890.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,365.28
|
| Rate for Payer: Quartz Beloit One Network |
$727.16
|
| Rate for Payer: Quartz Commercial |
$890.40
|
| Rate for Payer: WEA Trust Commercial |
$816.20
|
| Rate for Payer: WPS Commercial |
$1,099.20
|
|
|
GUIDE WIRE 3.2 X 230MM NON-THREADED 705235
|
Facility
|
IP
|
$1,497.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5641643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$733.53 |
| Max. Negotiated Rate |
$1,377.24 |
| Rate for Payer: Aetna Commercial |
$1,347.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.41
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cigna Commercial |
$1,377.24
|
| Rate for Payer: Health EOS Commercial |
$1,332.33
|
| Rate for Payer: HFN Commercial |
$1,377.24
|
| Rate for Payer: Multiplan Commercial |
$1,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$898.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,377.24
|
| Rate for Payer: Quartz Beloit One Network |
$733.53
|
| Rate for Payer: Quartz Commercial |
$898.20
|
| Rate for Payer: WEA Trust Commercial |
$823.35
|
| Rate for Payer: WPS Commercial |
$1,108.83
|
|
|
GUIDE WIRE 3.2 X 230MM NON-THREADED 705235
|
Facility
|
OP
|
$1,497.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5641643
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$419.16 |
| Max. Negotiated Rate |
$5,988.00 |
| Rate for Payer: Aetna Commercial |
$1,347.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,287.42
|
| Rate for Payer: Aetna Managed Medicare |
$419.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$973.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$748.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$718.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$793.41
|
| Rate for Payer: Cash Price |
$449.10
|
| Rate for Payer: Cigna Commercial |
$1,377.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$837.72
|
| Rate for Payer: Health EOS Commercial |
$1,332.33
|
| Rate for Payer: HFN Commercial |
$1,377.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,122.75
|
| Rate for Payer: Multiplan Commercial |
$1,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$898.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,377.24
|
| Rate for Payer: Quartz Beloit One Network |
$733.53
|
| Rate for Payer: Quartz Commercial |
$973.05
|
| Rate for Payer: Quartz Medicare Advantage |
$898.20
|
| Rate for Payer: The Alliance Commercial |
$5,988.00
|
| Rate for Payer: WEA Trust Commercial |
$823.35
|
| Rate for Payer: WPS Commercial |
$1,108.83
|
|
|
GUIDE WIRE 3.2 X 230MM THREADED 705236
|
Facility
|
IP
|
$923.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6217043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$452.27 |
| Max. Negotiated Rate |
$849.16 |
| Rate for Payer: Aetna Commercial |
$830.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$793.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.19
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$849.16
|
| Rate for Payer: Health EOS Commercial |
$821.47
|
| Rate for Payer: HFN Commercial |
$849.16
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: NAPHCARE Commercial |
$553.80
|
| Rate for Payer: Preferred Network Access Commercial |
$849.16
|
| Rate for Payer: Quartz Beloit One Network |
$452.27
|
| Rate for Payer: Quartz Commercial |
$553.80
|
| Rate for Payer: WEA Trust Commercial |
$507.65
|
| Rate for Payer: WPS Commercial |
$683.67
|
|
|
GUIDE WIRE 3.2 X 230MM THREADED 705236
|
Facility
|
OP
|
$923.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6217043
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$258.44 |
| Max. Negotiated Rate |
$3,692.00 |
| Rate for Payer: Aetna Commercial |
$830.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$793.78
|
| Rate for Payer: Aetna Managed Medicare |
$258.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$599.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$461.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$443.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$489.19
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$849.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$516.51
|
| Rate for Payer: Health EOS Commercial |
$821.47
|
| Rate for Payer: HFN Commercial |
$849.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$692.25
|
| Rate for Payer: Multiplan Commercial |
$738.40
|
| Rate for Payer: NAPHCARE Commercial |
$553.80
|
| Rate for Payer: Preferred Network Access Commercial |
$849.16
|
| Rate for Payer: Quartz Beloit One Network |
$452.27
|
| Rate for Payer: Quartz Commercial |
$599.95
|
| Rate for Payer: Quartz Medicare Advantage |
$553.80
|
| Rate for Payer: The Alliance Commercial |
$3,692.00
|
| Rate for Payer: WEA Trust Commercial |
$507.65
|
| Rate for Payer: WPS Commercial |
$683.67
|
|
|
GUIDE WIRE 3.2 X 400 TFN 357.399
|
Facility
|
IP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$857.99 |
| Max. Negotiated Rate |
$1,610.92 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,050.60
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
GUIDE WIRE 3.2 X 400 TFN 357.399
|
Facility
|
OP
|
$1,751.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2969344
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$490.28 |
| Max. Negotiated Rate |
$7,004.00 |
| Rate for Payer: Aetna Commercial |
$1,575.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.86
|
| Rate for Payer: Aetna Managed Medicare |
$490.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,138.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.03
|
| Rate for Payer: Cash Price |
$525.30
|
| Rate for Payer: Cigna Commercial |
$1,610.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.86
|
| Rate for Payer: Health EOS Commercial |
$1,558.39
|
| Rate for Payer: HFN Commercial |
$1,610.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,313.25
|
| Rate for Payer: Multiplan Commercial |
$1,400.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,050.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.92
|
| Rate for Payer: Quartz Beloit One Network |
$857.99
|
| Rate for Payer: Quartz Commercial |
$1,138.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,050.60
|
| Rate for Payer: The Alliance Commercial |
$7,004.00
|
| Rate for Payer: WEA Trust Commercial |
$963.05
|
| Rate for Payer: WPS Commercial |
$1,296.97
|
|
|
GUIDE WIRE ALL-STAR .014 190cm J
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$394.80 |
| Max. Negotiated Rate |
$5,640.00 |
| Rate for Payer: Aetna Commercial |
$1,269.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,212.60
|
| Rate for Payer: Aetna Managed Medicare |
$394.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$916.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$705.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$676.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$747.30
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,297.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$789.04
|
| Rate for Payer: Health EOS Commercial |
$1,254.90
|
| Rate for Payer: HFN Commercial |
$1,297.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,057.50
|
| Rate for Payer: Multiplan Commercial |
$1,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$846.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,297.20
|
| Rate for Payer: Quartz Beloit One Network |
$690.90
|
| Rate for Payer: Quartz Commercial |
$916.50
|
| Rate for Payer: Quartz Medicare Advantage |
$846.00
|
| Rate for Payer: The Alliance Commercial |
$5,640.00
|
| Rate for Payer: WEA Trust Commercial |
$775.50
|
| Rate for Payer: WPS Commercial |
$1,044.39
|
|
