|
GUIDE WIRE BMW J-TIP-190cm
|
Facility
|
IP
|
$1,464.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972529
|
|
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 CHOICE PT 182cm 12160-01J
|
Facility
|
IP
|
$2,103.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,030.47 |
| Max. Negotiated Rate |
$1,934.76 |
| Rate for Payer: Aetna Commercial |
$1,892.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.59
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cigna Commercial |
$1,934.76
|
| Rate for Payer: Health EOS Commercial |
$1,871.67
|
| Rate for Payer: HFN Commercial |
$1,934.76
|
| Rate for Payer: Multiplan Commercial |
$1,682.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.47
|
| Rate for Payer: Quartz Commercial |
$1,261.80
|
| Rate for Payer: WEA Trust Commercial |
$1,156.65
|
| Rate for Payer: WPS Commercial |
$1,557.69
|
|
|
GUIDE WIRE CHOICE PT 182cm 12160-01J
|
Facility
|
OP
|
$2,103.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973727
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$588.84 |
| Max. Negotiated Rate |
$8,412.00 |
| Rate for Payer: Aetna Commercial |
$1,892.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,808.58
|
| Rate for Payer: Aetna Managed Medicare |
$588.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,366.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,051.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,009.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,114.59
|
| Rate for Payer: Cash Price |
$630.90
|
| Rate for Payer: Cigna Commercial |
$1,934.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,176.84
|
| Rate for Payer: Health EOS Commercial |
$1,871.67
|
| Rate for Payer: HFN Commercial |
$1,934.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,577.25
|
| Rate for Payer: Multiplan Commercial |
$1,682.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,261.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,934.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,030.47
|
| Rate for Payer: Quartz Commercial |
$1,366.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,261.80
|
| Rate for Payer: The Alliance Commercial |
$8,412.00
|
| Rate for Payer: WEA Trust Commercial |
$1,156.65
|
| Rate for Payer: WPS Commercial |
$1,557.69
|
|
|
GUIDE WIRE CHOICE PT 300cm
|
Facility
|
OP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$693.28 |
| Max. Negotiated Rate |
$9,904.00 |
| Rate for Payer: Aetna Commercial |
$2,228.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,129.36
|
| Rate for Payer: Aetna Managed Medicare |
$693.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,609.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,238.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,188.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,312.28
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,277.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,385.57
|
| Rate for Payer: Health EOS Commercial |
$2,203.64
|
| Rate for Payer: HFN Commercial |
$2,277.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,857.00
|
| Rate for Payer: Multiplan Commercial |
$1,980.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,485.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,213.24
|
| Rate for Payer: Quartz Commercial |
$1,609.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,485.60
|
| Rate for Payer: The Alliance Commercial |
$9,904.00
|
| Rate for Payer: WEA Trust Commercial |
$1,361.80
|
| Rate for Payer: WPS Commercial |
$1,833.97
|
|
|
GUIDE WIRE CHOICE PT 300cm
|
Facility
|
IP
|
$2,476.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973728
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,213.24 |
| Max. Negotiated Rate |
$2,277.92 |
| Rate for Payer: Aetna Commercial |
$2,228.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,129.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,312.28
|
| Rate for Payer: Cash Price |
$742.80
|
| Rate for Payer: Cigna Commercial |
$2,277.92
|
| Rate for Payer: Health EOS Commercial |
$2,203.64
|
| Rate for Payer: HFN Commercial |
$2,277.92
|
| Rate for Payer: Multiplan Commercial |
$1,980.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,485.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,277.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,213.24
|
| Rate for Payer: Quartz Commercial |
$1,485.60
|
| Rate for Payer: WEA Trust Commercial |
$1,361.80
|
| Rate for Payer: WPS Commercial |
$1,833.97
|
|
|
GUIDEWIRE CLOSUREFAST .025IN X 150CM GW-025-150-DE1.5J
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
4069313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$153.86 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$188.40
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
GUIDEWIRE CLOSUREFAST .025IN X 150CM GW-025-150-DE1.5J
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
4069313
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.92 |
| Max. Negotiated Rate |
$1,256.00 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Aetna Managed Medicare |
$87.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.71
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$204.10
|
| Rate for Payer: Quartz Medicare Advantage |
$188.40
|
| Rate for Payer: The Alliance Commercial |
$1,256.00
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
GUIDEWIRE CLOSUREFAST .025IN X 260CM GW-025-260-1.5J
|
Facility
|
OP
|
$443.00
|
|
| Hospital Charge Code |
4069314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$124.04 |
| Max. Negotiated Rate |
$1,772.00 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Aetna Managed Medicare |
$124.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.90
|
| Rate for Payer: Health EOS Commercial |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$332.25
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$265.80
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$287.95
|
| Rate for Payer: Quartz Medicare Advantage |
$265.80
|
| Rate for Payer: The Alliance Commercial |
$1,772.00
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
GUIDEWIRE CLOSUREFAST .025IN X 260CM GW-025-260-1.5J
|
Facility
|
IP
|
$443.00
|
|
| Hospital Charge Code |
4069314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$217.07 |
| Max. Negotiated Rate |
$407.56 |
| Rate for Payer: Aetna Commercial |
$398.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.79
|
| Rate for Payer: Cash Price |
$132.90
|
| Rate for Payer: Cigna Commercial |
$407.56
|
| Rate for Payer: Health EOS Commercial |
$394.27
|
| Rate for Payer: HFN Commercial |
$407.56
|
| Rate for Payer: Multiplan Commercial |
$354.40
|
| Rate for Payer: NAPHCARE Commercial |
$265.80
|
| Rate for Payer: Preferred Network Access Commercial |
$407.56
|
| Rate for Payer: Quartz Beloit One Network |
$217.07
|
| Rate for Payer: Quartz Commercial |
$265.80
|
| Rate for Payer: WEA Trust Commercial |
$243.65
|
| Rate for Payer: WPS Commercial |
$328.13
|
|
|
GUIDE WIRE CROSS IT 300cm HJ
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972530
|
|
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 CROSS IT 300cm HJ
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972530
|
|
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 GWR419478 98CM
|
Facility
|
IP
|
$2,440.00
|
|
| Hospital Charge Code |
2973184
|
|
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
|
|
|
GUIDE WIRE GWR419478 98CM
|
Facility
|
OP
|
$2,440.00
|
|
| Hospital Charge Code |
2973184
|
|
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 HALO GW-002B
|
Facility
|
IP
|
$2,217.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,086.33 |
| Max. Negotiated Rate |
$2,039.64 |
| Rate for Payer: Aetna Commercial |
$1,995.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,906.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,175.01
|
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Cigna Commercial |
$2,039.64
|
| Rate for Payer: Health EOS Commercial |
$1,973.13
|
| Rate for Payer: HFN Commercial |
$2,039.64
|
| Rate for Payer: Multiplan Commercial |
$1,773.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,330.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,039.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,086.33
|
| Rate for Payer: Quartz Commercial |
$1,330.20
|
| Rate for Payer: WEA Trust Commercial |
$1,219.35
|
| Rate for Payer: WPS Commercial |
$1,642.13
|
|
|
GUIDEWIRE HALO GW-002B
|
Facility
|
OP
|
$2,217.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972883
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$620.76 |
| Max. Negotiated Rate |
$8,868.00 |
| Rate for Payer: Aetna Commercial |
$1,995.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,906.62
|
| Rate for Payer: Aetna Managed Medicare |
$620.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,441.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,108.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,064.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,175.01
|
| Rate for Payer: Cash Price |
$665.10
|
| Rate for Payer: Cigna Commercial |
$2,039.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,240.63
|
| Rate for Payer: Health EOS Commercial |
$1,973.13
|
| Rate for Payer: HFN Commercial |
$2,039.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,662.75
|
| Rate for Payer: Multiplan Commercial |
$1,773.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,330.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,039.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,086.33
|
| Rate for Payer: Quartz Commercial |
$1,441.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,330.20
|
| Rate for Payer: The Alliance Commercial |
$8,868.00
|
| Rate for Payer: WEA Trust Commercial |
$1,219.35
|
| Rate for Payer: WPS Commercial |
$1,642.13
|
|
|
GUIDEWIRE HI-TORQUE
|
Facility
|
OP
|
$1,647.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$461.16 |
| Max. Negotiated Rate |
$6,588.00 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Aetna Managed Medicare |
$461.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,070.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.66
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,235.25
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$1,070.55
|
| Rate for Payer: Quartz Medicare Advantage |
$988.20
|
| Rate for Payer: The Alliance Commercial |
$6,588.00
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
GUIDEWIRE HI-TORQUE
|
Facility
|
IP
|
$1,647.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972388
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$807.03 |
| Max. Negotiated Rate |
$1,515.24 |
| Rate for Payer: Aetna Commercial |
$1,482.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,416.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.91
|
| Rate for Payer: Cash Price |
$494.10
|
| Rate for Payer: Cigna Commercial |
$1,515.24
|
| Rate for Payer: Health EOS Commercial |
$1,465.83
|
| Rate for Payer: HFN Commercial |
$1,515.24
|
| Rate for Payer: Multiplan Commercial |
$1,317.60
|
| Rate for Payer: NAPHCARE Commercial |
$988.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,515.24
|
| Rate for Payer: Quartz Beloit One Network |
$807.03
|
| Rate for Payer: Quartz Commercial |
$988.20
|
| Rate for Payer: WEA Trust Commercial |
$905.85
|
| Rate for Payer: WPS Commercial |
$1,219.93
|
|
|
GUIDE WIRE HORIZON SUBTALAR 17606
|
Facility
|
IP
|
$535.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2964801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
GUIDE WIRE HORIZON SUBTALAR 17606
|
Facility
|
OP
|
$535.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2964801
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: The Alliance Commercial |
$2,140.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
GUIDEWIRE JAGTAIL
|
Facility
|
OP
|
$1,556.00
|
|
| Hospital Charge Code |
2973569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.68 |
| Max. Negotiated Rate |
$6,224.00 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Aetna Managed Medicare |
$435.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,011.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$746.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$870.74
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.00
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$1,011.40
|
| Rate for Payer: Quartz Medicare Advantage |
$933.60
|
| Rate for Payer: The Alliance Commercial |
$6,224.00
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
GUIDEWIRE JAGTAIL
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
2973569
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.44 |
| Max. Negotiated Rate |
$1,431.52 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$933.60
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
GUIDE WIRE J-TIP BMW .014 300CM 1009661J
|
Facility
|
IP
|
$385.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.65 |
| Max. Negotiated Rate |
$354.20 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$231.00
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
GUIDE WIRE J-TIP BMW .014 300CM 1009661J
|
Facility
|
OP
|
$385.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3072555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.80 |
| Max. Negotiated Rate |
$1,540.00 |
| Rate for Payer: Aetna Commercial |
$346.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$331.10
|
| Rate for Payer: Aetna Managed Medicare |
$107.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$250.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$204.05
|
| Rate for Payer: Cash Price |
$115.50
|
| Rate for Payer: Cigna Commercial |
$354.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$215.45
|
| Rate for Payer: Health EOS Commercial |
$342.65
|
| Rate for Payer: HFN Commercial |
$354.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$288.75
|
| Rate for Payer: Multiplan Commercial |
$308.00
|
| Rate for Payer: NAPHCARE Commercial |
$231.00
|
| Rate for Payer: Preferred Network Access Commercial |
$354.20
|
| Rate for Payer: Quartz Beloit One Network |
$188.65
|
| Rate for Payer: Quartz Commercial |
$250.25
|
| Rate for Payer: Quartz Medicare Advantage |
$231.00
|
| Rate for Payer: The Alliance Commercial |
$1,540.00
|
| Rate for Payer: WEA Trust Commercial |
$211.75
|
| Rate for Payer: WPS Commercial |
$285.17
|
|
|
GUIDEWIRE MARKED HALO RFA ENDOSCOPIC GW-005M
|
Facility
|
OP
|
$2,490.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5106628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.20 |
| Max. Negotiated Rate |
$9,960.00 |
| Rate for Payer: Aetna Commercial |
$2,241.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,141.40
|
| Rate for Payer: Aetna Managed Medicare |
$697.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,618.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,245.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,195.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,319.70
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$2,290.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,393.40
|
| Rate for Payer: Health EOS Commercial |
$2,216.10
|
| Rate for Payer: HFN Commercial |
$2,290.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,867.50
|
| Rate for Payer: Multiplan Commercial |
$1,992.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,494.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,290.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,220.10
|
| Rate for Payer: Quartz Commercial |
$1,618.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,494.00
|
| Rate for Payer: The Alliance Commercial |
$9,960.00
|
| Rate for Payer: WEA Trust Commercial |
$1,369.50
|
| Rate for Payer: WPS Commercial |
$1,844.34
|
|
|
GUIDEWIRE MARKED HALO RFA ENDOSCOPIC GW-005M
|
Facility
|
IP
|
$2,490.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5106628
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,220.10 |
| Max. Negotiated Rate |
$2,290.80 |
| Rate for Payer: Aetna Commercial |
$2,241.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,141.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,319.70
|
| Rate for Payer: Cash Price |
$747.00
|
| Rate for Payer: Cigna Commercial |
$2,290.80
|
| Rate for Payer: Health EOS Commercial |
$2,216.10
|
| Rate for Payer: HFN Commercial |
$2,290.80
|
| Rate for Payer: Multiplan Commercial |
$1,992.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,494.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,290.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,220.10
|
| Rate for Payer: Quartz Commercial |
$1,494.00
|
| Rate for Payer: WEA Trust Commercial |
$1,369.50
|
| Rate for Payer: WPS Commercial |
$1,844.34
|
|
