|
GUIDE WIRE ALL-STAR .014 190cm J
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972528
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$690.90 |
| Max. Negotiated Rate |
$1,297.20 |
| Rate for Payer: Aetna Commercial |
$1,269.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,212.60
|
| 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: Health EOS Commercial |
$1,254.90
|
| Rate for Payer: HFN Commercial |
$1,297.20
|
| 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 |
$846.00
|
| Rate for Payer: WEA Trust Commercial |
$775.50
|
| Rate for Payer: WPS Commercial |
$1,044.39
|
|
|
GUIDE WIRE ALL STAR 300cm J #1001741J
|
Facility
|
IP
|
$2,115.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,036.35 |
| Max. Negotiated Rate |
$1,945.80 |
| Rate for Payer: Aetna Commercial |
$1,903.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.95
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,945.80
|
| Rate for Payer: Health EOS Commercial |
$1,882.35
|
| Rate for Payer: HFN Commercial |
$1,945.80
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.35
|
| Rate for Payer: Quartz Commercial |
$1,269.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.25
|
| Rate for Payer: WPS Commercial |
$1,566.58
|
|
|
GUIDE WIRE ALL STAR 300cm J #1001741J
|
Facility
|
OP
|
$2,115.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972962
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$592.20 |
| Max. Negotiated Rate |
$8,460.00 |
| Rate for Payer: Aetna Commercial |
$1,903.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,818.90
|
| Rate for Payer: Aetna Managed Medicare |
$592.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,374.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,057.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,015.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,120.95
|
| Rate for Payer: Cash Price |
$634.50
|
| Rate for Payer: Cigna Commercial |
$1,945.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,183.55
|
| Rate for Payer: Health EOS Commercial |
$1,882.35
|
| Rate for Payer: HFN Commercial |
$1,945.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,586.25
|
| Rate for Payer: Multiplan Commercial |
$1,692.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,269.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,945.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,036.35
|
| Rate for Payer: Quartz Commercial |
$1,374.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,269.00
|
| Rate for Payer: The Alliance Commercial |
$8,460.00
|
| Rate for Payer: WEA Trust Commercial |
$1,163.25
|
| Rate for Payer: WPS Commercial |
$1,566.58
|
|
|
GUIDE WIRE AMPLATZ 3MM J .035 X 145 SUPER STIFF M0066401050
|
Facility
|
IP
|
$514.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.86 |
| Max. Negotiated Rate |
$472.88 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$308.40
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
GUIDE WIRE AMPLATZ 3MM J .035 X 145 SUPER STIFF M0066401050
|
Facility
|
OP
|
$514.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685889
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.92 |
| Max. Negotiated Rate |
$2,056.00 |
| Rate for Payer: Aetna Commercial |
$462.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$442.04
|
| Rate for Payer: Aetna Managed Medicare |
$143.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$334.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$257.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$272.42
|
| Rate for Payer: Cash Price |
$154.20
|
| Rate for Payer: Cigna Commercial |
$472.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.63
|
| Rate for Payer: Health EOS Commercial |
$457.46
|
| Rate for Payer: HFN Commercial |
$472.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.50
|
| Rate for Payer: Multiplan Commercial |
$411.20
|
| Rate for Payer: NAPHCARE Commercial |
$308.40
|
| Rate for Payer: Preferred Network Access Commercial |
$472.88
|
| Rate for Payer: Quartz Beloit One Network |
$251.86
|
| Rate for Payer: Quartz Commercial |
$334.10
|
| Rate for Payer: Quartz Medicare Advantage |
$308.40
|
| Rate for Payer: The Alliance Commercial |
$2,056.00
|
| Rate for Payer: WEA Trust Commercial |
$282.70
|
| Rate for Payer: WPS Commercial |
$380.72
|
|
|
GUIDE WIRE AMPLATZ 3MM J-TIP .038 X 145 SUPER STIFF M0066401070
|
Facility
|
OP
|
$589.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5307083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.92 |
| Max. Negotiated Rate |
$2,356.00 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Aetna Managed Medicare |
$164.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$382.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$294.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$282.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.17
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$541.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.60
|
| Rate for Payer: Health EOS Commercial |
$524.21
|
| Rate for Payer: HFN Commercial |
$541.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.75
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: NAPHCARE Commercial |
$353.40
|
| Rate for Payer: Preferred Network Access Commercial |
$541.88
|
| Rate for Payer: Quartz Beloit One Network |
$288.61
|
| Rate for Payer: Quartz Commercial |
$382.85
|
| Rate for Payer: Quartz Medicare Advantage |
$353.40
|
| Rate for Payer: The Alliance Commercial |
$2,356.00
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
GUIDE WIRE AMPLATZ 3MM J-TIP .038 X 145 SUPER STIFF M0066401070
|
Facility
|
IP
|
$589.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5307083
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.61 |
| Max. Negotiated Rate |
$541.88 |
| Rate for Payer: Aetna Commercial |
$530.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$312.17
|
| Rate for Payer: Cash Price |
$176.70
|
| Rate for Payer: Cigna Commercial |
$541.88
|
| Rate for Payer: Health EOS Commercial |
$524.21
|
| Rate for Payer: HFN Commercial |
$541.88
|
| Rate for Payer: Multiplan Commercial |
$471.20
|
| Rate for Payer: NAPHCARE Commercial |
$353.40
|
| Rate for Payer: Preferred Network Access Commercial |
$541.88
|
| Rate for Payer: Quartz Beloit One Network |
$288.61
|
| Rate for Payer: Quartz Commercial |
$353.40
|
| Rate for Payer: WEA Trust Commercial |
$323.95
|
| Rate for Payer: WPS Commercial |
$436.27
|
|
|
GUIDE WIRE AMPLATZ STRAIGHT .035 X 145 SUPER STIFF M0066401080
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.93 |
| Max. Negotiated Rate |
$420.44 |
| Rate for Payer: Aetna Commercial |
$411.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.21
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$420.44
|
| Rate for Payer: Health EOS Commercial |
$406.73
|
| Rate for Payer: HFN Commercial |
$420.44
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: NAPHCARE Commercial |
$274.20
|
| Rate for Payer: Preferred Network Access Commercial |
$420.44
|
| Rate for Payer: Quartz Beloit One Network |
$223.93
|
| Rate for Payer: Quartz Commercial |
$274.20
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
GUIDE WIRE AMPLATZ STRAIGHT .035 X 145 SUPER STIFF M0066401080
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.96 |
| Max. Negotiated Rate |
$1,828.00 |
| Rate for Payer: Aetna Commercial |
$411.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Aetna Managed Medicare |
$127.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$297.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.21
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$420.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.74
|
| Rate for Payer: Health EOS Commercial |
$406.73
|
| Rate for Payer: HFN Commercial |
$420.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.75
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: NAPHCARE Commercial |
$274.20
|
| Rate for Payer: Preferred Network Access Commercial |
$420.44
|
| Rate for Payer: Quartz Beloit One Network |
$223.93
|
| Rate for Payer: Quartz Commercial |
$297.05
|
| Rate for Payer: Quartz Medicare Advantage |
$274.20
|
| Rate for Payer: The Alliance Commercial |
$1,828.00
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
GUIDE WIRE AMPLATZ STRAIGHT TIP .038 X 145 SUPER STIFF M0066401090
|
Facility
|
IP
|
$457.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$223.93 |
| Max. Negotiated Rate |
$420.44 |
| Rate for Payer: Aetna Commercial |
$411.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.21
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$420.44
|
| Rate for Payer: Health EOS Commercial |
$406.73
|
| Rate for Payer: HFN Commercial |
$420.44
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: NAPHCARE Commercial |
$274.20
|
| Rate for Payer: Preferred Network Access Commercial |
$420.44
|
| Rate for Payer: Quartz Beloit One Network |
$223.93
|
| Rate for Payer: Quartz Commercial |
$274.20
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
GUIDE WIRE AMPLATZ STRAIGHT TIP .038 X 145 SUPER STIFF M0066401090
|
Facility
|
OP
|
$457.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5685891
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.96 |
| Max. Negotiated Rate |
$1,828.00 |
| Rate for Payer: Aetna Commercial |
$411.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$393.02
|
| Rate for Payer: Aetna Managed Medicare |
$127.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$297.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$242.21
|
| Rate for Payer: Cash Price |
$137.10
|
| Rate for Payer: Cigna Commercial |
$420.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.74
|
| Rate for Payer: Health EOS Commercial |
$406.73
|
| Rate for Payer: HFN Commercial |
$420.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$342.75
|
| Rate for Payer: Multiplan Commercial |
$365.60
|
| Rate for Payer: NAPHCARE Commercial |
$274.20
|
| Rate for Payer: Preferred Network Access Commercial |
$420.44
|
| Rate for Payer: Quartz Beloit One Network |
$223.93
|
| Rate for Payer: Quartz Commercial |
$297.05
|
| Rate for Payer: Quartz Medicare Advantage |
$274.20
|
| Rate for Payer: The Alliance Commercial |
$1,828.00
|
| Rate for Payer: WEA Trust Commercial |
$251.35
|
| Rate for Payer: WPS Commercial |
$338.50
|
|
|
GUIDEWIRE ASAHI CONFIANZA PRO12 180CM
|
Facility
|
IP
|
$4,454.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,182.46 |
| Max. Negotiated Rate |
$4,097.68 |
| Rate for Payer: Aetna Commercial |
$4,008.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.62
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,097.68
|
| Rate for Payer: Health EOS Commercial |
$3,964.06
|
| Rate for Payer: HFN Commercial |
$4,097.68
|
| Rate for Payer: Multiplan Commercial |
$3,563.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,672.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.46
|
| Rate for Payer: Quartz Commercial |
$2,672.40
|
| Rate for Payer: WEA Trust Commercial |
$2,449.70
|
| Rate for Payer: WPS Commercial |
$3,299.08
|
|
|
GUIDEWIRE ASAHI CONFIANZA PRO12 180CM
|
Facility
|
OP
|
$4,454.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449514
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,247.12 |
| Max. Negotiated Rate |
$17,816.00 |
| Rate for Payer: Aetna Commercial |
$4,008.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,247.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,895.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,227.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,137.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.62
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,097.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,492.46
|
| Rate for Payer: Health EOS Commercial |
$3,964.06
|
| Rate for Payer: HFN Commercial |
$4,097.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,340.50
|
| Rate for Payer: Multiplan Commercial |
$3,563.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,672.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.46
|
| Rate for Payer: Quartz Commercial |
$2,895.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,672.40
|
| Rate for Payer: The Alliance Commercial |
$17,816.00
|
| Rate for Payer: WEA Trust Commercial |
$2,449.70
|
| Rate for Payer: WPS Commercial |
$3,299.08
|
|
|
GUIDEWIRE ASAHI CONFIANZA PRO9 180CM
|
Facility
|
IP
|
$3,552.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,740.48 |
| Max. Negotiated Rate |
$3,267.84 |
| Rate for Payer: Aetna Commercial |
$3,196.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,054.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,882.56
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$3,267.84
|
| Rate for Payer: Health EOS Commercial |
$3,161.28
|
| Rate for Payer: HFN Commercial |
$3,267.84
|
| Rate for Payer: Multiplan Commercial |
$2,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,131.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,267.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,740.48
|
| Rate for Payer: Quartz Commercial |
$2,131.20
|
| Rate for Payer: WEA Trust Commercial |
$1,953.60
|
| Rate for Payer: WPS Commercial |
$2,630.97
|
|
|
GUIDEWIRE ASAHI CONFIANZA PRO9 180CM
|
Facility
|
OP
|
$3,552.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449513
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$994.56 |
| Max. Negotiated Rate |
$14,208.00 |
| Rate for Payer: Aetna Commercial |
$3,196.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,054.72
|
| Rate for Payer: Aetna Managed Medicare |
$994.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,308.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,776.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,704.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,882.56
|
| Rate for Payer: Cash Price |
$1,065.60
|
| Rate for Payer: Cigna Commercial |
$3,267.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,987.70
|
| Rate for Payer: Health EOS Commercial |
$3,161.28
|
| Rate for Payer: HFN Commercial |
$3,267.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,664.00
|
| Rate for Payer: Multiplan Commercial |
$2,841.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,131.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,267.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,740.48
|
| Rate for Payer: Quartz Commercial |
$2,308.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,131.20
|
| Rate for Payer: The Alliance Commercial |
$14,208.00
|
| Rate for Payer: WEA Trust Commercial |
$1,953.60
|
| Rate for Payer: WPS Commercial |
$2,630.97
|
|
|
GUIDEWIRE ASAHI CONFIANZA ST 300CM
|
Facility
|
IP
|
$4,454.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,182.46 |
| Max. Negotiated Rate |
$4,097.68 |
| Rate for Payer: Aetna Commercial |
$4,008.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.62
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,097.68
|
| Rate for Payer: Health EOS Commercial |
$3,964.06
|
| Rate for Payer: HFN Commercial |
$4,097.68
|
| Rate for Payer: Multiplan Commercial |
$3,563.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,672.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.46
|
| Rate for Payer: Quartz Commercial |
$2,672.40
|
| Rate for Payer: WEA Trust Commercial |
$2,449.70
|
| Rate for Payer: WPS Commercial |
$3,299.08
|
|
|
GUIDEWIRE ASAHI CONFIANZA ST 300CM
|
Facility
|
OP
|
$4,454.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449512
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,247.12 |
| Max. Negotiated Rate |
$17,816.00 |
| Rate for Payer: Aetna Commercial |
$4,008.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,830.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,247.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,895.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,227.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,137.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,360.62
|
| Rate for Payer: Cash Price |
$1,336.20
|
| Rate for Payer: Cigna Commercial |
$4,097.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,492.46
|
| Rate for Payer: Health EOS Commercial |
$3,964.06
|
| Rate for Payer: HFN Commercial |
$4,097.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,340.50
|
| Rate for Payer: Multiplan Commercial |
$3,563.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,672.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,097.68
|
| Rate for Payer: Quartz Beloit One Network |
$2,182.46
|
| Rate for Payer: Quartz Commercial |
$2,895.10
|
| Rate for Payer: Quartz Medicare Advantage |
$2,672.40
|
| Rate for Payer: The Alliance Commercial |
$17,816.00
|
| Rate for Payer: WEA Trust Commercial |
$2,449.70
|
| Rate for Payer: WPS Commercial |
$3,299.08
|
|
|
GUIDEWIRE ASAHI CONFIANZA ST9 180CM
|
Facility
|
OP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,295.56 |
| Max. Negotiated Rate |
$18,508.00 |
| Rate for Payer: Aetna Commercial |
$4,164.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,295.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,007.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,313.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,220.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.31
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,256.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,589.27
|
| Rate for Payer: Health EOS Commercial |
$4,118.03
|
| Rate for Payer: HFN Commercial |
$4,256.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,470.25
|
| Rate for Payer: Multiplan Commercial |
$3,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,776.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.23
|
| Rate for Payer: Quartz Commercial |
$3,007.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,776.20
|
| Rate for Payer: The Alliance Commercial |
$18,508.00
|
| Rate for Payer: WEA Trust Commercial |
$2,544.85
|
| Rate for Payer: WPS Commercial |
$3,427.22
|
|
|
GUIDEWIRE ASAHI CONFIANZA ST9 180CM
|
Facility
|
IP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,267.23 |
| Max. Negotiated Rate |
$4,256.84 |
| Rate for Payer: Aetna Commercial |
$4,164.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.31
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,256.84
|
| Rate for Payer: Health EOS Commercial |
$4,118.03
|
| Rate for Payer: HFN Commercial |
$4,256.84
|
| Rate for Payer: Multiplan Commercial |
$3,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,776.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.23
|
| Rate for Payer: Quartz Commercial |
$2,776.20
|
| Rate for Payer: WEA Trust Commercial |
$2,544.85
|
| Rate for Payer: WPS Commercial |
$3,427.22
|
|
|
GUIDEWIRE ASAHI FIELDER FC 180CM
|
Facility
|
IP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,807.61 |
| Max. Negotiated Rate |
$3,393.88 |
| Rate for Payer: Aetna Commercial |
$3,320.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,172.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,955.17
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cigna Commercial |
$3,393.88
|
| Rate for Payer: Health EOS Commercial |
$3,283.21
|
| Rate for Payer: HFN Commercial |
$3,393.88
|
| Rate for Payer: Multiplan Commercial |
$2,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,213.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,393.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,807.61
|
| Rate for Payer: Quartz Commercial |
$2,213.40
|
| Rate for Payer: WEA Trust Commercial |
$2,028.95
|
| Rate for Payer: WPS Commercial |
$2,732.44
|
|
|
GUIDEWIRE ASAHI FIELDER FC 180CM
|
Facility
|
OP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,032.92 |
| Max. Negotiated Rate |
$14,756.00 |
| Rate for Payer: Aetna Commercial |
$3,320.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,172.54
|
| Rate for Payer: Aetna Managed Medicare |
$1,032.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,397.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,844.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,770.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,955.17
|
| Rate for Payer: Cash Price |
$1,106.70
|
| Rate for Payer: Cigna Commercial |
$3,393.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,064.36
|
| Rate for Payer: Health EOS Commercial |
$3,283.21
|
| Rate for Payer: HFN Commercial |
$3,393.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,766.75
|
| Rate for Payer: Multiplan Commercial |
$2,951.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,213.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,393.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,807.61
|
| Rate for Payer: Quartz Commercial |
$2,397.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,213.40
|
| Rate for Payer: The Alliance Commercial |
$14,756.00
|
| Rate for Payer: WEA Trust Commercial |
$2,028.95
|
| Rate for Payer: WPS Commercial |
$2,732.44
|
|
|
GUIDEWIRE ASAHI FIELDER XT 190CM
|
Facility
|
OP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,295.56 |
| Max. Negotiated Rate |
$18,508.00 |
| Rate for Payer: Aetna Commercial |
$4,164.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,295.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,007.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,313.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,220.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.31
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,256.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,589.27
|
| Rate for Payer: Health EOS Commercial |
$4,118.03
|
| Rate for Payer: HFN Commercial |
$4,256.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,470.25
|
| Rate for Payer: Multiplan Commercial |
$3,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,776.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.23
|
| Rate for Payer: Quartz Commercial |
$3,007.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,776.20
|
| Rate for Payer: The Alliance Commercial |
$18,508.00
|
| Rate for Payer: WEA Trust Commercial |
$2,544.85
|
| Rate for Payer: WPS Commercial |
$3,427.22
|
|
|
GUIDEWIRE ASAHI FIELDER XT 190CM
|
Facility
|
IP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449509
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,267.23 |
| Max. Negotiated Rate |
$4,256.84 |
| Rate for Payer: Aetna Commercial |
$4,164.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.31
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,256.84
|
| Rate for Payer: Health EOS Commercial |
$4,118.03
|
| Rate for Payer: HFN Commercial |
$4,256.84
|
| Rate for Payer: Multiplan Commercial |
$3,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,776.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.23
|
| Rate for Payer: Quartz Commercial |
$2,776.20
|
| Rate for Payer: WEA Trust Commercial |
$2,544.85
|
| Rate for Payer: WPS Commercial |
$3,427.22
|
|
|
GUIDEWIRE ASAHI FIELDER XT 300CM
|
Facility
|
OP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,295.56 |
| Max. Negotiated Rate |
$18,508.00 |
| Rate for Payer: Aetna Commercial |
$4,164.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.22
|
| Rate for Payer: Aetna Managed Medicare |
$1,295.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,007.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,313.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,220.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.31
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,256.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,589.27
|
| Rate for Payer: Health EOS Commercial |
$4,118.03
|
| Rate for Payer: HFN Commercial |
$4,256.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,470.25
|
| Rate for Payer: Multiplan Commercial |
$3,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,776.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.23
|
| Rate for Payer: Quartz Commercial |
$3,007.55
|
| Rate for Payer: Quartz Medicare Advantage |
$2,776.20
|
| Rate for Payer: The Alliance Commercial |
$18,508.00
|
| Rate for Payer: WEA Trust Commercial |
$2,544.85
|
| Rate for Payer: WPS Commercial |
$3,427.22
|
|
|
GUIDEWIRE ASAHI FIELDER XT 300CM
|
Facility
|
IP
|
$4,627.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449510
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,267.23 |
| Max. Negotiated Rate |
$4,256.84 |
| Rate for Payer: Aetna Commercial |
$4,164.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,979.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,452.31
|
| Rate for Payer: Cash Price |
$1,388.10
|
| Rate for Payer: Cigna Commercial |
$4,256.84
|
| Rate for Payer: Health EOS Commercial |
$4,118.03
|
| Rate for Payer: HFN Commercial |
$4,256.84
|
| Rate for Payer: Multiplan Commercial |
$3,701.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,776.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,256.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,267.23
|
| Rate for Payer: Quartz Commercial |
$2,776.20
|
| Rate for Payer: WEA Trust Commercial |
$2,544.85
|
| Rate for Payer: WPS Commercial |
$3,427.22
|
|
