|
GUIDEWIRE ASAHI GRAND SLAM 180CM
|
Facility
|
IP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449503
|
|
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 GRAND SLAM 180CM
|
Facility
|
OP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449503
|
|
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 GRAND SLAM 300CM
|
Facility
|
OP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449506
|
|
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 GRAND SLAM 300CM
|
Facility
|
IP
|
$3,689.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3449506
|
|
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
|
|
|
GUIDE WIRE ASAHI PROWATERFLEX 180cm
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
GUIDE WIRE ASAHI PROWATERFLEX 180cm
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973018
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$717.36 |
| Max. Negotiated Rate |
$1,346.88 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$878.40
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
|
GUIDE WIRE ASAHI PROWATERFLEX 300cm #82358-02
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973601
|
|
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
|
|
|
GUIDE WIRE ASAHI PROWATERFLEX 300cm #82358-02
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973601
|
|
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
|
|
|
GUIDEWIRE ASNIS III DIA 3.2 X 300MM W/O THREAD 702463
|
Facility
|
IP
|
$1,221.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$598.29 |
| Max. Negotiated Rate |
$1,123.32 |
| Rate for Payer: Aetna Commercial |
$1,098.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,050.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$647.13
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna Commercial |
$1,123.32
|
| Rate for Payer: Health EOS Commercial |
$1,086.69
|
| Rate for Payer: HFN Commercial |
$1,123.32
|
| Rate for Payer: Multiplan Commercial |
$976.80
|
| Rate for Payer: NAPHCARE Commercial |
$732.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,123.32
|
| Rate for Payer: Quartz Beloit One Network |
$598.29
|
| Rate for Payer: Quartz Commercial |
$732.60
|
| Rate for Payer: WEA Trust Commercial |
$671.55
|
| Rate for Payer: WPS Commercial |
$904.39
|
|
|
GUIDEWIRE ASNIS III DIA 3.2 X 300MM W/O THREAD 702463
|
Facility
|
OP
|
$1,221.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6201055
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$341.88 |
| Max. Negotiated Rate |
$4,884.00 |
| Rate for Payer: Aetna Commercial |
$1,098.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,050.06
|
| Rate for Payer: Aetna Managed Medicare |
$341.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$793.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$610.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$586.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$647.13
|
| Rate for Payer: Cash Price |
$366.30
|
| Rate for Payer: Cigna Commercial |
$1,123.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$683.27
|
| Rate for Payer: Health EOS Commercial |
$1,086.69
|
| Rate for Payer: HFN Commercial |
$1,123.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$915.75
|
| Rate for Payer: Multiplan Commercial |
$976.80
|
| Rate for Payer: NAPHCARE Commercial |
$732.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,123.32
|
| Rate for Payer: Quartz Beloit One Network |
$598.29
|
| Rate for Payer: Quartz Commercial |
$793.65
|
| Rate for Payer: Quartz Medicare Advantage |
$732.60
|
| Rate for Payer: The Alliance Commercial |
$4,884.00
|
| Rate for Payer: WEA Trust Commercial |
$671.55
|
| Rate for Payer: WPS Commercial |
$904.39
|
|
|
GUIDEWIRE ATTAIN HYBRID
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$683.20 |
| Max. Negotiated Rate |
$9,760.00 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Aetna Managed Medicare |
$683.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,586.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,220.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,171.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,365.42
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,830.00
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,586.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,464.00
|
| Rate for Payer: The Alliance Commercial |
$9,760.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
GUIDEWIRE ATTAIN HYBRID
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,195.60 |
| Max. Negotiated Rate |
$2,244.80 |
| Rate for Payer: Aetna Commercial |
$2,196.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,098.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,293.20
|
| Rate for Payer: Cash Price |
$732.00
|
| Rate for Payer: Cigna Commercial |
$2,244.80
|
| Rate for Payer: Health EOS Commercial |
$2,171.60
|
| Rate for Payer: HFN Commercial |
$2,244.80
|
| Rate for Payer: Multiplan Commercial |
$1,952.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,464.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,244.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,195.60
|
| Rate for Payer: Quartz Commercial |
$1,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,342.00
|
| Rate for Payer: WPS Commercial |
$1,807.31
|
|
|
GUIDEWIRE BALL NOSE 3.0MM X 900MM 0101-900S
|
Facility
|
IP
|
$1,986.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6232138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$973.14 |
| Max. Negotiated Rate |
$1,827.12 |
| Rate for Payer: Aetna Commercial |
$1,787.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,707.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.58
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,827.12
|
| Rate for Payer: Health EOS Commercial |
$1,767.54
|
| Rate for Payer: HFN Commercial |
$1,827.12
|
| Rate for Payer: Multiplan Commercial |
$1,588.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,827.12
|
| Rate for Payer: Quartz Beloit One Network |
$973.14
|
| Rate for Payer: Quartz Commercial |
$1,191.60
|
| Rate for Payer: WEA Trust Commercial |
$1,092.30
|
| Rate for Payer: WPS Commercial |
$1,471.03
|
|
|
GUIDEWIRE BALL NOSE 3.0MM X 900MM 0101-900S
|
Facility
|
OP
|
$1,986.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6232138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$556.08 |
| Max. Negotiated Rate |
$7,944.00 |
| Rate for Payer: Aetna Commercial |
$1,787.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,707.96
|
| Rate for Payer: Aetna Managed Medicare |
$556.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,290.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$993.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$953.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,052.58
|
| Rate for Payer: Cash Price |
$595.80
|
| Rate for Payer: Cigna Commercial |
$1,827.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,111.37
|
| Rate for Payer: Health EOS Commercial |
$1,767.54
|
| Rate for Payer: HFN Commercial |
$1,827.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,489.50
|
| Rate for Payer: Multiplan Commercial |
$1,588.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,191.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,827.12
|
| Rate for Payer: Quartz Beloit One Network |
$973.14
|
| Rate for Payer: Quartz Commercial |
$1,290.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,191.60
|
| Rate for Payer: The Alliance Commercial |
$7,944.00
|
| Rate for Payer: WEA Trust Commercial |
$1,092.30
|
| Rate for Payer: WPS Commercial |
$1,471.03
|
|
|
GUIDE WIRE BALL TIP 2.5 X 800MM 1806-0083S
|
Facility
|
OP
|
$1,413.00
|
|
| Hospital Charge Code |
3127462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$395.64 |
| Max. Negotiated Rate |
$5,652.00 |
| Rate for Payer: Aetna Commercial |
$1,271.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,215.18
|
| Rate for Payer: Aetna Managed Medicare |
$395.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$918.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$706.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$678.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.89
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cigna Commercial |
$1,299.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$790.71
|
| Rate for Payer: Health EOS Commercial |
$1,257.57
|
| Rate for Payer: HFN Commercial |
$1,299.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,059.75
|
| Rate for Payer: Multiplan Commercial |
$1,130.40
|
| Rate for Payer: NAPHCARE Commercial |
$847.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.96
|
| Rate for Payer: Quartz Beloit One Network |
$692.37
|
| Rate for Payer: Quartz Commercial |
$918.45
|
| Rate for Payer: Quartz Medicare Advantage |
$847.80
|
| Rate for Payer: The Alliance Commercial |
$5,652.00
|
| Rate for Payer: WEA Trust Commercial |
$777.15
|
| Rate for Payer: WPS Commercial |
$1,046.61
|
|
|
GUIDE WIRE BALL TIP 2.5 X 800MM 1806-0083S
|
Facility
|
IP
|
$1,413.00
|
|
| Hospital Charge Code |
3127462
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$692.37 |
| Max. Negotiated Rate |
$1,299.96 |
| Rate for Payer: Aetna Commercial |
$1,271.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,215.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.89
|
| Rate for Payer: Cash Price |
$423.90
|
| Rate for Payer: Cigna Commercial |
$1,299.96
|
| Rate for Payer: Health EOS Commercial |
$1,257.57
|
| Rate for Payer: HFN Commercial |
$1,299.96
|
| Rate for Payer: Multiplan Commercial |
$1,130.40
|
| Rate for Payer: NAPHCARE Commercial |
$847.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.96
|
| Rate for Payer: Quartz Beloit One Network |
$692.37
|
| Rate for Payer: Quartz Commercial |
$847.80
|
| Rate for Payer: WEA Trust Commercial |
$777.15
|
| Rate for Payer: WPS Commercial |
$1,046.61
|
|
|
GUIDE WIRE BALL-TIP 3.0 X 800MM 1806-0080S
|
Facility
|
IP
|
$1,654.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4099051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$810.46 |
| Max. Negotiated Rate |
$1,521.68 |
| Rate for Payer: Aetna Commercial |
$1,488.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,422.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$876.62
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cigna Commercial |
$1,521.68
|
| Rate for Payer: Health EOS Commercial |
$1,472.06
|
| Rate for Payer: HFN Commercial |
$1,521.68
|
| Rate for Payer: Multiplan Commercial |
$1,323.20
|
| Rate for Payer: NAPHCARE Commercial |
$992.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,521.68
|
| Rate for Payer: Quartz Beloit One Network |
$810.46
|
| Rate for Payer: Quartz Commercial |
$992.40
|
| Rate for Payer: WEA Trust Commercial |
$909.70
|
| Rate for Payer: WPS Commercial |
$1,225.12
|
|
|
GUIDE WIRE BALL-TIP 3.0 X 800MM 1806-0080S
|
Facility
|
OP
|
$1,654.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
4099051
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.12 |
| Max. Negotiated Rate |
$6,616.00 |
| Rate for Payer: Aetna Commercial |
$1,488.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,422.44
|
| Rate for Payer: Aetna Managed Medicare |
$463.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,075.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$827.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$793.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$876.62
|
| Rate for Payer: Cash Price |
$496.20
|
| Rate for Payer: Cigna Commercial |
$1,521.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$925.58
|
| Rate for Payer: Health EOS Commercial |
$1,472.06
|
| Rate for Payer: HFN Commercial |
$1,521.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,240.50
|
| Rate for Payer: Multiplan Commercial |
$1,323.20
|
| Rate for Payer: NAPHCARE Commercial |
$992.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,521.68
|
| Rate for Payer: Quartz Beloit One Network |
$810.46
|
| Rate for Payer: Quartz Commercial |
$1,075.10
|
| Rate for Payer: Quartz Medicare Advantage |
$992.40
|
| Rate for Payer: The Alliance Commercial |
$6,616.00
|
| Rate for Payer: WEA Trust Commercial |
$909.70
|
| Rate for Payer: WPS Commercial |
$1,225.12
|
|
|
GUIDE WIRE BALL TIP 3 X 1000MM 1806-0085S
|
Facility
|
IP
|
$1,715.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$840.35 |
| Max. Negotiated Rate |
$1,577.80 |
| Rate for Payer: Aetna Commercial |
$1,543.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,474.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$908.95
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cigna Commercial |
$1,577.80
|
| Rate for Payer: Health EOS Commercial |
$1,526.35
|
| Rate for Payer: HFN Commercial |
$1,577.80
|
| Rate for Payer: Multiplan Commercial |
$1,372.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,577.80
|
| Rate for Payer: Quartz Beloit One Network |
$840.35
|
| Rate for Payer: Quartz Commercial |
$1,029.00
|
| Rate for Payer: WEA Trust Commercial |
$943.25
|
| Rate for Payer: WPS Commercial |
$1,270.30
|
|
|
GUIDE WIRE BALL TIP 3 X 1000MM 1806-0085S
|
Facility
|
OP
|
$1,715.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$480.20 |
| Max. Negotiated Rate |
$6,860.00 |
| Rate for Payer: Aetna Commercial |
$1,543.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,474.90
|
| Rate for Payer: Aetna Managed Medicare |
$480.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,114.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$857.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$823.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$908.95
|
| Rate for Payer: Cash Price |
$514.50
|
| Rate for Payer: Cigna Commercial |
$1,577.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$959.71
|
| Rate for Payer: Health EOS Commercial |
$1,526.35
|
| Rate for Payer: HFN Commercial |
$1,577.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,286.25
|
| Rate for Payer: Multiplan Commercial |
$1,372.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,029.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,577.80
|
| Rate for Payer: Quartz Beloit One Network |
$840.35
|
| Rate for Payer: Quartz Commercial |
$1,114.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,029.00
|
| Rate for Payer: The Alliance Commercial |
$6,860.00
|
| Rate for Payer: WEA Trust Commercial |
$943.25
|
| Rate for Payer: WPS Commercial |
$1,270.30
|
|
|
GUIDE WIRE BIO-COMPOSITE SCREW AR-5025K
|
Facility
|
OP
|
$205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5885647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$57.40 |
| Max. Negotiated Rate |
$820.00 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Aetna Managed Medicare |
$57.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$98.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.65
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$188.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.72
|
| Rate for Payer: Health EOS Commercial |
$182.45
|
| Rate for Payer: HFN Commercial |
$188.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.75
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: NAPHCARE Commercial |
$123.00
|
| Rate for Payer: Preferred Network Access Commercial |
$188.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.45
|
| Rate for Payer: Quartz Commercial |
$133.25
|
| Rate for Payer: Quartz Medicare Advantage |
$123.00
|
| Rate for Payer: The Alliance Commercial |
$820.00
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
GUIDE WIRE BIO-COMPOSITE SCREW AR-5025K
|
Facility
|
IP
|
$205.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5885647
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$100.45 |
| Max. Negotiated Rate |
$188.60 |
| Rate for Payer: Aetna Commercial |
$184.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$176.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$108.65
|
| Rate for Payer: Cash Price |
$61.50
|
| Rate for Payer: Cigna Commercial |
$188.60
|
| Rate for Payer: Health EOS Commercial |
$182.45
|
| Rate for Payer: HFN Commercial |
$188.60
|
| Rate for Payer: Multiplan Commercial |
$164.00
|
| Rate for Payer: NAPHCARE Commercial |
$123.00
|
| Rate for Payer: Preferred Network Access Commercial |
$188.60
|
| Rate for Payer: Quartz Beloit One Network |
$100.45
|
| Rate for Payer: Quartz Commercial |
$123.00
|
| Rate for Payer: WEA Trust Commercial |
$112.75
|
| Rate for Payer: WPS Commercial |
$151.84
|
|
|
GUIDE WIRE BIOTRACK
|
Facility
|
IP
|
$415.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$203.35 |
| Max. Negotiated Rate |
$381.80 |
| Rate for Payer: Aetna Commercial |
$373.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.95
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: Health EOS Commercial |
$369.35
|
| Rate for Payer: HFN Commercial |
$381.80
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: NAPHCARE Commercial |
$249.00
|
| Rate for Payer: Preferred Network Access Commercial |
$381.80
|
| Rate for Payer: Quartz Beloit One Network |
$203.35
|
| Rate for Payer: Quartz Commercial |
$249.00
|
| Rate for Payer: WEA Trust Commercial |
$228.25
|
| Rate for Payer: WPS Commercial |
$307.39
|
|
|
GUIDE WIRE BIOTRACK
|
Facility
|
OP
|
$415.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$116.20 |
| Max. Negotiated Rate |
$1,660.00 |
| Rate for Payer: Aetna Commercial |
$373.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$356.90
|
| Rate for Payer: Aetna Managed Medicare |
$116.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$269.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$207.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$199.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$219.95
|
| Rate for Payer: Cash Price |
$124.50
|
| Rate for Payer: Cigna Commercial |
$381.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$232.23
|
| Rate for Payer: Health EOS Commercial |
$369.35
|
| Rate for Payer: HFN Commercial |
$381.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$311.25
|
| Rate for Payer: Multiplan Commercial |
$332.00
|
| Rate for Payer: NAPHCARE Commercial |
$249.00
|
| Rate for Payer: Preferred Network Access Commercial |
$381.80
|
| Rate for Payer: Quartz Beloit One Network |
$203.35
|
| Rate for Payer: Quartz Commercial |
$269.75
|
| Rate for Payer: Quartz Medicare Advantage |
$249.00
|
| Rate for Payer: The Alliance Commercial |
$1,660.00
|
| Rate for Payer: WEA Trust Commercial |
$228.25
|
| Rate for Payer: WPS Commercial |
$307.39
|
|
|
GUIDE WIRE BMW J-TIP-190cm
|
Facility
|
OP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.92 |
| Max. Negotiated Rate |
$5,856.00 |
| Rate for Payer: Aetna Commercial |
$1,317.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,259.04
|
| Rate for Payer: Aetna Managed Medicare |
$409.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$951.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$732.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$702.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$775.92
|
| Rate for Payer: Cash Price |
$439.20
|
| Rate for Payer: Cigna Commercial |
$1,346.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$819.25
|
| Rate for Payer: Health EOS Commercial |
$1,302.96
|
| Rate for Payer: HFN Commercial |
$1,346.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,098.00
|
| Rate for Payer: Multiplan Commercial |
$1,171.20
|
| Rate for Payer: NAPHCARE Commercial |
$878.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,346.88
|
| Rate for Payer: Quartz Beloit One Network |
$717.36
|
| Rate for Payer: Quartz Commercial |
$951.60
|
| Rate for Payer: Quartz Medicare Advantage |
$878.40
|
| Rate for Payer: The Alliance Commercial |
$5,856.00
|
| Rate for Payer: WEA Trust Commercial |
$805.20
|
| Rate for Payer: WPS Commercial |
$1,084.38
|
|
