|
GUIDEWIRE MICRO ACCESS .018 X 45CM STAINLESS STEEL 06507201
|
Facility
|
IP
|
$646.00
|
|
| Hospital Charge Code |
2962968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.54 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
GUIDEWIRE MICRO ACCESS .018 X 45CM STAINLESS STEEL 06507201
|
Facility
|
OP
|
$646.00
|
|
| Hospital Charge Code |
2962968
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.88 |
| Max. Negotiated Rate |
$2,584.00 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$180.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.50
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.50
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$419.90
|
| Rate for Payer: Quartz Medicare Advantage |
$387.60
|
| Rate for Payer: The Alliance Commercial |
$2,584.00
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
GUIDE WIRE NITINOL /PT 0.018x40CM MAK001N
|
Facility
|
IP
|
$583.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$285.67 |
| Max. Negotiated Rate |
$536.36 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$349.80
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
GUIDE WIRE NITINOL /PT 0.018x40CM MAK001N
|
Facility
|
OP
|
$583.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973406
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.24 |
| Max. Negotiated Rate |
$2,332.00 |
| Rate for Payer: Aetna Commercial |
$524.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$501.38
|
| Rate for Payer: Aetna Managed Medicare |
$163.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$378.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$291.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$279.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$308.99
|
| Rate for Payer: Cash Price |
$174.90
|
| Rate for Payer: Cigna Commercial |
$536.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$326.25
|
| Rate for Payer: Health EOS Commercial |
$518.87
|
| Rate for Payer: HFN Commercial |
$536.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$437.25
|
| Rate for Payer: Multiplan Commercial |
$466.40
|
| Rate for Payer: NAPHCARE Commercial |
$349.80
|
| Rate for Payer: Preferred Network Access Commercial |
$536.36
|
| Rate for Payer: Quartz Beloit One Network |
$285.67
|
| Rate for Payer: Quartz Commercial |
$378.95
|
| Rate for Payer: Quartz Medicare Advantage |
$349.80
|
| Rate for Payer: The Alliance Commercial |
$2,332.00
|
| Rate for Payer: WEA Trust Commercial |
$320.65
|
| Rate for Payer: WPS Commercial |
$431.83
|
|
|
GUIDE WIRE NITONOL 2 CM ST.TIP
|
Facility
|
IP
|
$1,282.00
|
|
| Hospital Charge Code |
2963047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$628.18 |
| Max. Negotiated Rate |
$1,179.44 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$769.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$769.20
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
GUIDE WIRE NITONOL 2 CM ST.TIP
|
Facility
|
OP
|
$1,282.00
|
|
| Hospital Charge Code |
2963047
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$358.96 |
| Max. Negotiated Rate |
$5,128.00 |
| Rate for Payer: Aetna Commercial |
$1,153.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,102.52
|
| Rate for Payer: Aetna Managed Medicare |
$358.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$833.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$641.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$615.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$679.46
|
| Rate for Payer: Cash Price |
$384.60
|
| Rate for Payer: Cigna Commercial |
$1,179.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$717.41
|
| Rate for Payer: Health EOS Commercial |
$1,140.98
|
| Rate for Payer: HFN Commercial |
$1,179.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$961.50
|
| Rate for Payer: Multiplan Commercial |
$1,025.60
|
| Rate for Payer: NAPHCARE Commercial |
$769.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,179.44
|
| Rate for Payer: Quartz Beloit One Network |
$628.18
|
| Rate for Payer: Quartz Commercial |
$833.30
|
| Rate for Payer: Quartz Medicare Advantage |
$769.20
|
| Rate for Payer: The Alliance Commercial |
$5,128.00
|
| Rate for Payer: WEA Trust Commercial |
$705.10
|
| Rate for Payer: WPS Commercial |
$949.58
|
|
|
GUIDE WIRE PLATINUM PLUS 0.018 X 180CM PTCA 1753
|
Facility
|
IP
|
$2,184.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,070.16 |
| Max. Negotiated Rate |
$2,009.28 |
| Rate for Payer: Aetna Commercial |
$1,965.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,878.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,157.52
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$2,009.28
|
| Rate for Payer: Health EOS Commercial |
$1,943.76
|
| Rate for Payer: HFN Commercial |
$2,009.28
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,009.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,070.16
|
| Rate for Payer: Quartz Commercial |
$1,310.40
|
| Rate for Payer: WEA Trust Commercial |
$1,201.20
|
| Rate for Payer: WPS Commercial |
$1,617.69
|
|
|
GUIDE WIRE PLATINUM PLUS 0.018 X 180CM PTCA 1753
|
Facility
|
OP
|
$2,184.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$611.52 |
| Max. Negotiated Rate |
$8,736.00 |
| Rate for Payer: Aetna Commercial |
$1,965.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,878.24
|
| Rate for Payer: Aetna Managed Medicare |
$611.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,419.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,092.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,048.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,157.52
|
| Rate for Payer: Cash Price |
$655.20
|
| Rate for Payer: Cigna Commercial |
$2,009.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,222.17
|
| Rate for Payer: Health EOS Commercial |
$1,943.76
|
| Rate for Payer: HFN Commercial |
$2,009.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,638.00
|
| Rate for Payer: Multiplan Commercial |
$1,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,310.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,009.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,070.16
|
| Rate for Payer: Quartz Commercial |
$1,419.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,310.40
|
| Rate for Payer: The Alliance Commercial |
$8,736.00
|
| Rate for Payer: WEA Trust Commercial |
$1,201.20
|
| Rate for Payer: WPS Commercial |
$1,617.69
|
|
|
GUIDE WIRE PLATINUM PLUS .018 X 260CM M001467320
|
Facility
|
OP
|
$1,754.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$491.12 |
| Max. Negotiated Rate |
$7,016.00 |
| Rate for Payer: Aetna Commercial |
$1,578.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,508.44
|
| Rate for Payer: Aetna Managed Medicare |
$491.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,140.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$877.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.62
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,613.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$981.54
|
| Rate for Payer: Health EOS Commercial |
$1,561.06
|
| Rate for Payer: HFN Commercial |
$1,613.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,315.50
|
| Rate for Payer: Multiplan Commercial |
$1,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,052.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,613.68
|
| Rate for Payer: Quartz Beloit One Network |
$859.46
|
| Rate for Payer: Quartz Commercial |
$1,140.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,052.40
|
| Rate for Payer: The Alliance Commercial |
$7,016.00
|
| Rate for Payer: WEA Trust Commercial |
$964.70
|
| Rate for Payer: WPS Commercial |
$1,299.19
|
|
|
GUIDE WIRE PLATINUM PLUS .018 X 260CM M001467320
|
Facility
|
IP
|
$1,754.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972689
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$859.46 |
| Max. Negotiated Rate |
$1,613.68 |
| Rate for Payer: Aetna Commercial |
$1,578.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,508.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$929.62
|
| Rate for Payer: Cash Price |
$526.20
|
| Rate for Payer: Cigna Commercial |
$1,613.68
|
| Rate for Payer: Health EOS Commercial |
$1,561.06
|
| Rate for Payer: HFN Commercial |
$1,613.68
|
| Rate for Payer: Multiplan Commercial |
$1,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,052.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,613.68
|
| Rate for Payer: Quartz Beloit One Network |
$859.46
|
| Rate for Payer: Quartz Commercial |
$1,052.40
|
| Rate for Payer: WEA Trust Commercial |
$964.70
|
| Rate for Payer: WPS Commercial |
$1,299.19
|
|
|
GUIDE WIRE PROSTOP PLUS 0.054 IN AR-4206
|
Facility
|
OP
|
$1,459.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$408.52 |
| Max. Negotiated Rate |
$5,836.00 |
| Rate for Payer: Aetna Commercial |
$1,313.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,254.74
|
| Rate for Payer: Aetna Managed Medicare |
$408.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$948.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$729.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$700.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$773.27
|
| Rate for Payer: Cash Price |
$437.70
|
| Rate for Payer: Cigna Commercial |
$1,342.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$816.46
|
| Rate for Payer: Health EOS Commercial |
$1,298.51
|
| Rate for Payer: HFN Commercial |
$1,342.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,094.25
|
| Rate for Payer: Multiplan Commercial |
$1,167.20
|
| Rate for Payer: NAPHCARE Commercial |
$875.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,342.28
|
| Rate for Payer: Quartz Beloit One Network |
$714.91
|
| Rate for Payer: Quartz Commercial |
$948.35
|
| Rate for Payer: Quartz Medicare Advantage |
$875.40
|
| Rate for Payer: The Alliance Commercial |
$5,836.00
|
| Rate for Payer: WEA Trust Commercial |
$802.45
|
| Rate for Payer: WPS Commercial |
$1,080.68
|
|
|
GUIDE WIRE PROSTOP PLUS 0.054 IN AR-4206
|
Facility
|
IP
|
$1,459.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729758
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$714.91 |
| Max. Negotiated Rate |
$1,342.28 |
| Rate for Payer: Aetna Commercial |
$1,313.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,254.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$773.27
|
| Rate for Payer: Cash Price |
$437.70
|
| Rate for Payer: Cigna Commercial |
$1,342.28
|
| Rate for Payer: Health EOS Commercial |
$1,298.51
|
| Rate for Payer: HFN Commercial |
$1,342.28
|
| Rate for Payer: Multiplan Commercial |
$1,167.20
|
| Rate for Payer: NAPHCARE Commercial |
$875.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,342.28
|
| Rate for Payer: Quartz Beloit One Network |
$714.91
|
| Rate for Payer: Quartz Commercial |
$875.40
|
| Rate for Payer: WEA Trust Commercial |
$802.45
|
| Rate for Payer: WPS Commercial |
$1,080.68
|
|
|
GUIDEWIRE SENSOR DUAL-FLEX ANGLED .035 X 150 3CM FLEXIBLE M0066703010
|
Facility
|
OP
|
$908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5306813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$254.24 |
| Max. Negotiated Rate |
$3,632.00 |
| Rate for Payer: Aetna Commercial |
$817.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$780.88
|
| Rate for Payer: Aetna Managed Medicare |
$254.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$590.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$454.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$435.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$481.24
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cigna Commercial |
$835.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$508.12
|
| Rate for Payer: Health EOS Commercial |
$808.12
|
| Rate for Payer: HFN Commercial |
$835.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$681.00
|
| Rate for Payer: Multiplan Commercial |
$726.40
|
| Rate for Payer: NAPHCARE Commercial |
$544.80
|
| Rate for Payer: Preferred Network Access Commercial |
$835.36
|
| Rate for Payer: Quartz Beloit One Network |
$444.92
|
| Rate for Payer: Quartz Commercial |
$590.20
|
| Rate for Payer: Quartz Medicare Advantage |
$544.80
|
| Rate for Payer: The Alliance Commercial |
$3,632.00
|
| Rate for Payer: WEA Trust Commercial |
$499.40
|
| Rate for Payer: WPS Commercial |
$672.56
|
|
|
GUIDEWIRE SENSOR DUAL-FLEX ANGLED .035 X 150 3CM FLEXIBLE M0066703010
|
Facility
|
IP
|
$908.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5306813
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$444.92 |
| Max. Negotiated Rate |
$835.36 |
| Rate for Payer: Aetna Commercial |
$817.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$780.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$481.24
|
| Rate for Payer: Cash Price |
$272.40
|
| Rate for Payer: Cigna Commercial |
$835.36
|
| Rate for Payer: Health EOS Commercial |
$808.12
|
| Rate for Payer: HFN Commercial |
$835.36
|
| Rate for Payer: Multiplan Commercial |
$726.40
|
| Rate for Payer: NAPHCARE Commercial |
$544.80
|
| Rate for Payer: Preferred Network Access Commercial |
$835.36
|
| Rate for Payer: Quartz Beloit One Network |
$444.92
|
| Rate for Payer: Quartz Commercial |
$544.80
|
| Rate for Payer: WEA Trust Commercial |
$499.40
|
| Rate for Payer: WPS Commercial |
$672.56
|
|
|
GUIDEWIRE SENSOR DUAL-FLEX STRAIGHT .035 X 150 3CM FLEXIBLE M0066703080
|
Facility
|
OP
|
$896.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5306923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.88 |
| Max. Negotiated Rate |
$3,584.00 |
| Rate for Payer: Aetna Commercial |
$806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Aetna Managed Medicare |
$250.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$430.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$824.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$501.40
|
| Rate for Payer: Health EOS Commercial |
$797.44
|
| Rate for Payer: HFN Commercial |
$824.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$672.00
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: NAPHCARE Commercial |
$537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$824.32
|
| Rate for Payer: Quartz Beloit One Network |
$439.04
|
| Rate for Payer: Quartz Commercial |
$582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$537.60
|
| Rate for Payer: The Alliance Commercial |
$3,584.00
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
GUIDEWIRE SENSOR DUAL-FLEX STRAIGHT .035 X 150 3CM FLEXIBLE M0066703080
|
Facility
|
IP
|
$896.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5306923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.04 |
| Max. Negotiated Rate |
$824.32 |
| Rate for Payer: Aetna Commercial |
$806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$824.32
|
| Rate for Payer: Health EOS Commercial |
$797.44
|
| Rate for Payer: HFN Commercial |
$824.32
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: NAPHCARE Commercial |
$537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$824.32
|
| Rate for Payer: Quartz Beloit One Network |
$439.04
|
| Rate for Payer: Quartz Commercial |
$537.60
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
GUIDE WIRE SMOOTH DIGIFUSE 80 X 70MM DW2590
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$98.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$210.00
|
| Rate for Payer: The Alliance Commercial |
$1,400.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
GUIDE WIRE SMOOTH DIGIFUSE 80 X 70MM DW2590
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5729624
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
GUIDE WIRE SMOOTH-TIP 2.2 X 800MM 1806-0093S
|
Facility
|
IP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6204987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$655.13 |
| Max. Negotiated Rate |
$1,230.04 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$802.20
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
GUIDE WIRE SMOOTH-TIP 2.2 X 800MM 1806-0093S
|
Facility
|
OP
|
$1,337.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
6204987
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$374.36 |
| Max. Negotiated Rate |
$5,348.00 |
| Rate for Payer: Aetna Commercial |
$1,203.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,149.82
|
| Rate for Payer: Aetna Managed Medicare |
$374.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$869.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$668.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$641.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.61
|
| Rate for Payer: Cash Price |
$401.10
|
| Rate for Payer: Cigna Commercial |
$1,230.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$748.19
|
| Rate for Payer: Health EOS Commercial |
$1,189.93
|
| Rate for Payer: HFN Commercial |
$1,230.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,002.75
|
| Rate for Payer: Multiplan Commercial |
$1,069.60
|
| Rate for Payer: NAPHCARE Commercial |
$802.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,230.04
|
| Rate for Payer: Quartz Beloit One Network |
$655.13
|
| Rate for Payer: Quartz Commercial |
$869.05
|
| Rate for Payer: Quartz Medicare Advantage |
$802.20
|
| Rate for Payer: The Alliance Commercial |
$5,348.00
|
| Rate for Payer: WEA Trust Commercial |
$735.35
|
| Rate for Payer: WPS Commercial |
$990.32
|
|
|
GUIDE WIRE SMOOTH-TIP 3.0 X 800MM 1806-0090S
|
Facility
|
IP
|
$1,328.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$650.72 |
| Max. Negotiated Rate |
$1,221.76 |
| Rate for Payer: Aetna Commercial |
$1,195.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,142.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.84
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cigna Commercial |
$1,221.76
|
| Rate for Payer: Health EOS Commercial |
$1,181.92
|
| Rate for Payer: HFN Commercial |
$1,221.76
|
| Rate for Payer: Multiplan Commercial |
$1,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$796.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,221.76
|
| Rate for Payer: Quartz Beloit One Network |
$650.72
|
| Rate for Payer: Quartz Commercial |
$796.80
|
| Rate for Payer: WEA Trust Commercial |
$730.40
|
| Rate for Payer: WPS Commercial |
$983.65
|
|
|
GUIDE WIRE SMOOTH-TIP 3.0 X 800MM 1806-0090S
|
Facility
|
OP
|
$1,328.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5384685
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$371.84 |
| Max. Negotiated Rate |
$5,312.00 |
| Rate for Payer: Aetna Commercial |
$1,195.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,142.08
|
| Rate for Payer: Aetna Managed Medicare |
$371.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$863.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$664.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$637.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$703.84
|
| Rate for Payer: Cash Price |
$398.40
|
| Rate for Payer: Cigna Commercial |
$1,221.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$743.15
|
| Rate for Payer: Health EOS Commercial |
$1,181.92
|
| Rate for Payer: HFN Commercial |
$1,221.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$996.00
|
| Rate for Payer: Multiplan Commercial |
$1,062.40
|
| Rate for Payer: NAPHCARE Commercial |
$796.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,221.76
|
| Rate for Payer: Quartz Beloit One Network |
$650.72
|
| Rate for Payer: Quartz Commercial |
$863.20
|
| Rate for Payer: Quartz Medicare Advantage |
$796.80
|
| Rate for Payer: The Alliance Commercial |
$5,312.00
|
| Rate for Payer: WEA Trust Commercial |
$730.40
|
| Rate for Payer: WPS Commercial |
$983.65
|
|
|
GUIDE WIRE STORQ .035 180cm 503-356J
|
Facility
|
OP
|
$302.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.56 |
| Max. Negotiated Rate |
$1,208.00 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Aetna Managed Medicare |
$84.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.00
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.50
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$196.30
|
| Rate for Payer: Quartz Medicare Advantage |
$181.20
|
| Rate for Payer: The Alliance Commercial |
$1,208.00
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
GUIDE WIRE STORQ .035 180cm 503-356J
|
Facility
|
IP
|
$302.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2972059
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.98 |
| Max. Negotiated Rate |
$277.84 |
| Rate for Payer: Aetna Commercial |
$271.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.06
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$277.84
|
| Rate for Payer: Health EOS Commercial |
$268.78
|
| Rate for Payer: HFN Commercial |
$277.84
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: NAPHCARE Commercial |
$181.20
|
| Rate for Payer: Preferred Network Access Commercial |
$277.84
|
| Rate for Payer: Quartz Beloit One Network |
$147.98
|
| Rate for Payer: Quartz Commercial |
$181.20
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
|
GUIDE WIRE STORQ .035 300cm (ORDER IS MULTIPLES OF FIVE) 503356Y
|
Facility
|
IP
|
$1,347.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973531
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$660.03 |
| Max. Negotiated Rate |
$1,239.24 |
| Rate for Payer: Aetna Commercial |
$1,212.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,158.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$713.91
|
| Rate for Payer: Cash Price |
$404.10
|
| Rate for Payer: Cigna Commercial |
$1,239.24
|
| Rate for Payer: Health EOS Commercial |
$1,198.83
|
| Rate for Payer: HFN Commercial |
$1,239.24
|
| Rate for Payer: Multiplan Commercial |
$1,077.60
|
| Rate for Payer: NAPHCARE Commercial |
$808.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,239.24
|
| Rate for Payer: Quartz Beloit One Network |
$660.03
|
| Rate for Payer: Quartz Commercial |
$808.20
|
| Rate for Payer: WEA Trust Commercial |
$740.85
|
| Rate for Payer: WPS Commercial |
$997.72
|
|
