|
SHEAR HARMONIC FOCUS FCS9
|
Facility
|
OP
|
$5,601.00
|
|
| Hospital Charge Code |
2965114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,631.01 |
| Max. Negotiated Rate |
$5,359.04 |
| Rate for Payer: Aetna Commercial |
$5,242.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,009.53
|
| Rate for Payer: Aetna Managed Medicare |
$1,631.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,786.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,912.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,796.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,087.27
|
| Rate for Payer: Cash Price |
$1,680.30
|
| Rate for Payer: Cigna Commercial |
$5,359.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,259.78
|
| Rate for Payer: Health EOS Commercial |
$5,184.29
|
| Rate for Payer: HFN Commercial |
$5,359.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,368.78
|
| Rate for Payer: Multiplan Commercial |
$4,660.03
|
| Rate for Payer: NAPHCARE Commercial |
$3,495.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,359.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,854.27
|
| Rate for Payer: Quartz Commercial |
$3,786.28
|
| Rate for Payer: Quartz Medicare Advantage |
$3,495.02
|
| Rate for Payer: The Alliance Commercial |
$2,912.52
|
| Rate for Payer: WEA Trust Commercial |
$3,203.77
|
| Rate for Payer: WPS Commercial |
$4,314.45
|
|
|
SHEARS ENDO 5MM W/UNIPOLAR
|
Facility
|
OP
|
$1,552.00
|
|
| Hospital Charge Code |
2962931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$451.94 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Aetna Managed Medicare |
$451.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,049.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$807.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$774.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$903.26
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,210.56
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: NAPHCARE Commercial |
$968.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$1,049.15
|
| Rate for Payer: Quartz Medicare Advantage |
$968.45
|
| Rate for Payer: The Alliance Commercial |
$807.04
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SHEARS ENDO 5MM W/UNIPOLAR
|
Facility
|
IP
|
$1,552.00
|
|
| Hospital Charge Code |
2962931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$790.90 |
| Max. Negotiated Rate |
$1,484.95 |
| Rate for Payer: Aetna Commercial |
$1,452.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,388.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$855.46
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,484.95
|
| Rate for Payer: Health EOS Commercial |
$1,436.53
|
| Rate for Payer: HFN Commercial |
$1,484.95
|
| Rate for Payer: Multiplan Commercial |
$1,291.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,484.95
|
| Rate for Payer: Quartz Beloit One Network |
$790.90
|
| Rate for Payer: Quartz Commercial |
$968.45
|
| Rate for Payer: WEA Trust Commercial |
$887.74
|
| Rate for Payer: WPS Commercial |
$1,195.51
|
|
|
SHEATH 11CM 6 FR BRITE TIP
|
Facility
|
IP
|
$488.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$248.68 |
| Max. Negotiated Rate |
$466.92 |
| Rate for Payer: Aetna Commercial |
$456.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.99
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$466.92
|
| Rate for Payer: Health EOS Commercial |
$451.69
|
| Rate for Payer: HFN Commercial |
$466.92
|
| Rate for Payer: Multiplan Commercial |
$406.02
|
| Rate for Payer: Preferred Network Access Commercial |
$466.92
|
| Rate for Payer: Quartz Beloit One Network |
$248.68
|
| Rate for Payer: Quartz Commercial |
$304.51
|
| Rate for Payer: WEA Trust Commercial |
$279.14
|
| Rate for Payer: WPS Commercial |
$375.91
|
|
|
SHEATH 11CM 6 FR BRITE TIP
|
Facility
|
OP
|
$488.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971273
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$142.11 |
| Max. Negotiated Rate |
$466.92 |
| Rate for Payer: Aetna Commercial |
$456.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$436.47
|
| Rate for Payer: Aetna Managed Medicare |
$142.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$329.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$253.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$243.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$268.99
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$466.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$284.02
|
| Rate for Payer: Health EOS Commercial |
$451.69
|
| Rate for Payer: HFN Commercial |
$466.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$380.64
|
| Rate for Payer: Multiplan Commercial |
$406.02
|
| Rate for Payer: NAPHCARE Commercial |
$304.51
|
| Rate for Payer: Preferred Network Access Commercial |
$466.92
|
| Rate for Payer: Quartz Beloit One Network |
$248.68
|
| Rate for Payer: Quartz Commercial |
$329.89
|
| Rate for Payer: Quartz Medicare Advantage |
$304.51
|
| Rate for Payer: The Alliance Commercial |
$253.76
|
| Rate for Payer: WEA Trust Commercial |
$279.14
|
| Rate for Payer: WPS Commercial |
$375.91
|
|
|
SHEATH 12FR
|
Facility
|
OP
|
$1,556.00
|
|
| Hospital Charge Code |
2972331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$453.11 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Aetna Managed Medicare |
$453.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,051.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$809.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$776.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$905.59
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,213.68
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: NAPHCARE Commercial |
$970.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$1,051.86
|
| Rate for Payer: Quartz Medicare Advantage |
$970.94
|
| Rate for Payer: The Alliance Commercial |
$809.12
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
SHEATH 12FR
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
2972331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$792.94 |
| Max. Negotiated Rate |
$1,488.78 |
| Rate for Payer: Aetna Commercial |
$1,456.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,391.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$857.67
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,488.78
|
| Rate for Payer: Health EOS Commercial |
$1,440.23
|
| Rate for Payer: HFN Commercial |
$1,488.78
|
| Rate for Payer: Multiplan Commercial |
$1,294.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,488.78
|
| Rate for Payer: Quartz Beloit One Network |
$792.94
|
| Rate for Payer: Quartz Commercial |
$970.94
|
| Rate for Payer: WEA Trust Commercial |
$890.03
|
| Rate for Payer: WPS Commercial |
$1,198.59
|
|
|
SHEATH 12FX35 URETERAL ACCESS G19168
|
Facility
|
IP
|
$1,855.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2965866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$945.31 |
| Max. Negotiated Rate |
$1,774.86 |
| Rate for Payer: Aetna Commercial |
$1,736.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,659.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,022.48
|
| Rate for Payer: Cash Price |
$556.50
|
| Rate for Payer: Cigna Commercial |
$1,774.86
|
| Rate for Payer: Health EOS Commercial |
$1,716.99
|
| Rate for Payer: HFN Commercial |
$1,774.86
|
| Rate for Payer: Multiplan Commercial |
$1,543.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,774.86
|
| Rate for Payer: Quartz Beloit One Network |
$945.31
|
| Rate for Payer: Quartz Commercial |
$1,157.52
|
| Rate for Payer: WEA Trust Commercial |
$1,061.06
|
| Rate for Payer: WPS Commercial |
$1,428.91
|
|
|
SHEATH 12FX35 URETERAL ACCESS G19168
|
Facility
|
OP
|
$1,855.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2965866
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$540.18 |
| Max. Negotiated Rate |
$1,774.86 |
| Rate for Payer: Aetna Commercial |
$1,736.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,659.11
|
| Rate for Payer: Aetna Managed Medicare |
$540.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,253.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$964.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$926.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,022.48
|
| Rate for Payer: Cash Price |
$556.50
|
| Rate for Payer: Cigna Commercial |
$1,774.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,079.61
|
| Rate for Payer: Health EOS Commercial |
$1,716.99
|
| Rate for Payer: HFN Commercial |
$1,774.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,446.90
|
| Rate for Payer: Multiplan Commercial |
$1,543.36
|
| Rate for Payer: NAPHCARE Commercial |
$1,157.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,774.86
|
| Rate for Payer: Quartz Beloit One Network |
$945.31
|
| Rate for Payer: Quartz Commercial |
$1,253.98
|
| Rate for Payer: Quartz Medicare Advantage |
$1,157.52
|
| Rate for Payer: The Alliance Commercial |
$964.60
|
| Rate for Payer: WEA Trust Commercial |
$1,061.06
|
| Rate for Payer: WPS Commercial |
$1,428.91
|
|
|
SHEATH 18FR
|
Facility
|
IP
|
$1,983.00
|
|
| Hospital Charge Code |
2972790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,010.54 |
| Max. Negotiated Rate |
$1,897.33 |
| Rate for Payer: Aetna Commercial |
$1,856.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,093.03
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,897.33
|
| Rate for Payer: Health EOS Commercial |
$1,835.46
|
| Rate for Payer: HFN Commercial |
$1,897.33
|
| Rate for Payer: Multiplan Commercial |
$1,649.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.54
|
| Rate for Payer: Quartz Commercial |
$1,237.39
|
| Rate for Payer: WEA Trust Commercial |
$1,134.28
|
| Rate for Payer: WPS Commercial |
$1,527.50
|
|
|
SHEATH 18FR
|
Facility
|
OP
|
$1,983.00
|
|
| Hospital Charge Code |
2972790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$577.45 |
| Max. Negotiated Rate |
$1,897.33 |
| Rate for Payer: Aetna Commercial |
$1,856.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,773.60
|
| Rate for Payer: Aetna Managed Medicare |
$577.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,340.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,031.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$989.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,093.03
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,897.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,154.11
|
| Rate for Payer: Health EOS Commercial |
$1,835.46
|
| Rate for Payer: HFN Commercial |
$1,897.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,546.74
|
| Rate for Payer: Multiplan Commercial |
$1,649.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,237.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,897.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,010.54
|
| Rate for Payer: Quartz Commercial |
$1,340.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,237.39
|
| Rate for Payer: The Alliance Commercial |
$1,031.16
|
| Rate for Payer: WEA Trust Commercial |
$1,134.28
|
| Rate for Payer: WPS Commercial |
$1,527.50
|
|
|
SHEATH 20FR
|
Facility
|
IP
|
$2,884.00
|
|
| Hospital Charge Code |
2973276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,469.69 |
| Max. Negotiated Rate |
$2,759.41 |
| Rate for Payer: Aetna Commercial |
$2,699.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,579.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,589.66
|
| Rate for Payer: Cash Price |
$865.20
|
| Rate for Payer: Cigna Commercial |
$2,759.41
|
| Rate for Payer: Health EOS Commercial |
$2,669.43
|
| Rate for Payer: HFN Commercial |
$2,759.41
|
| Rate for Payer: Multiplan Commercial |
$2,399.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,759.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,469.69
|
| Rate for Payer: Quartz Commercial |
$1,799.62
|
| Rate for Payer: WEA Trust Commercial |
$1,649.65
|
| Rate for Payer: WPS Commercial |
$2,221.55
|
|
|
SHEATH 20FR
|
Facility
|
OP
|
$2,884.00
|
|
| Hospital Charge Code |
2973276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$839.82 |
| Max. Negotiated Rate |
$2,759.41 |
| Rate for Payer: Aetna Commercial |
$2,699.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,579.45
|
| Rate for Payer: Aetna Managed Medicare |
$839.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,949.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,499.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,439.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,589.66
|
| Rate for Payer: Cash Price |
$865.20
|
| Rate for Payer: Cigna Commercial |
$2,759.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,678.49
|
| Rate for Payer: Health EOS Commercial |
$2,669.43
|
| Rate for Payer: HFN Commercial |
$2,759.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,249.52
|
| Rate for Payer: Multiplan Commercial |
$2,399.49
|
| Rate for Payer: NAPHCARE Commercial |
$1,799.62
|
| Rate for Payer: Preferred Network Access Commercial |
$2,759.41
|
| Rate for Payer: Quartz Beloit One Network |
$1,469.69
|
| Rate for Payer: Quartz Commercial |
$1,949.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,799.62
|
| Rate for Payer: The Alliance Commercial |
$1,499.68
|
| Rate for Payer: WEA Trust Commercial |
$1,649.65
|
| Rate for Payer: WPS Commercial |
$2,221.55
|
|
|
SHEATH 4fr SHUTTLE 110cm
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
2972831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SHEATH 4fr SHUTTLE 110cm
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
2972831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$599.58 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Aetna Managed Medicare |
$599.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.34
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.02
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,391.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.82
|
| Rate for Payer: The Alliance Commercial |
$1,070.68
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SHEATH 5F PRELUDE SHORT PSS-5F-4-038MT
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3417500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$204.67
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
SHEATH 5F PRELUDE SHORT PSS-5F-4-038MT
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3417500
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.51 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$95.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.90
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.84
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$221.73
|
| Rate for Payer: Quartz Medicare Advantage |
$204.67
|
| Rate for Payer: The Alliance Commercial |
$170.56
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
Sheath 5Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2549138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.89 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.30
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Sheath 5Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2549138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.48 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.82
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.38
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$200.30
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$217.00
|
| Rate for Payer: Quartz Medicare Advantage |
$200.30
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Sheath 5Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2549138
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$200.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
SHEATH 5FR PRO-5F-11-038
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$208.42
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
SHEATH 5FR PRO-5F-11-038
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.26 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Aetna Managed Medicare |
$97.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.39
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.52
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: NAPHCARE Commercial |
$208.42
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$225.78
|
| Rate for Payer: Quartz Medicare Advantage |
$208.42
|
| Rate for Payer: The Alliance Commercial |
$173.68
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
SHEATH 5fr SHUTTLE 110cm
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
2972832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,049.27 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,284.82
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SHEATH 5fr SHUTTLE 110cm
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
2972832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$599.58 |
| Max. Negotiated Rate |
$1,970.05 |
| Rate for Payer: Aetna Commercial |
$1,927.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,841.57
|
| Rate for Payer: Aetna Managed Medicare |
$599.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,391.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,070.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,027.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,134.92
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,970.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,198.34
|
| Rate for Payer: Health EOS Commercial |
$1,905.81
|
| Rate for Payer: HFN Commercial |
$1,970.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,606.02
|
| Rate for Payer: Multiplan Commercial |
$1,713.09
|
| Rate for Payer: NAPHCARE Commercial |
$1,284.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,970.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,049.27
|
| Rate for Payer: Quartz Commercial |
$1,391.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,284.82
|
| Rate for Payer: The Alliance Commercial |
$1,070.68
|
| Rate for Payer: WEA Trust Commercial |
$1,177.75
|
| Rate for Payer: WPS Commercial |
$1,586.05
|
|
|
SHEATH 6.0fr ANL0 FLEXOR ANSEL
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$697.64 |
| Max. Negotiated Rate |
$1,309.86 |
| Rate for Payer: Aetna Commercial |
$1,281.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,224.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.59
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cigna Commercial |
$1,309.86
|
| Rate for Payer: Health EOS Commercial |
$1,267.15
|
| Rate for Payer: HFN Commercial |
$1,309.86
|
| Rate for Payer: Multiplan Commercial |
$1,139.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,309.86
|
| Rate for Payer: Quartz Beloit One Network |
$697.64
|
| Rate for Payer: Quartz Commercial |
$854.26
|
| Rate for Payer: WEA Trust Commercial |
$783.07
|
| Rate for Payer: WPS Commercial |
$1,054.54
|
|
