|
Sheath Brite Tip 8Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550850
|
|
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 Brite Tip 8Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550850
|
|
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 Brite Tip 8Fr 23cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550892
|
|
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 Brite Tip 8Fr 23cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550892
|
|
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 Brite Tip 8Fr 23cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550892
|
|
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 BRITE TIP 8F X 5.5CM WITH 3MM-J .035 GW 401-805M
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Aetna Managed Medicare |
$98.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$229.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$176.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.30
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.42
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: NAPHCARE Commercial |
$211.54
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$229.16
|
| Rate for Payer: Quartz Medicare Advantage |
$211.54
|
| Rate for Payer: The Alliance Commercial |
$176.28
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
SHEATH BRITE TIP 8F X 5.5CM WITH 3MM-J .035 GW 401-805M
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$211.54
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
SHEATH & BULLET TIP VASCULAR TUNNELER SMALL GREEN (GRAFTS UP TO 8MM) 9009-18
|
Facility
|
IP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4520296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.72 |
| Max. Negotiated Rate |
$1,018.99 |
| Rate for Payer: Aetna Commercial |
$996.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$587.03
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$1,018.99
|
| Rate for Payer: Health EOS Commercial |
$985.76
|
| Rate for Payer: HFN Commercial |
$1,018.99
|
| Rate for Payer: Multiplan Commercial |
$886.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.99
|
| Rate for Payer: Quartz Beloit One Network |
$542.72
|
| Rate for Payer: Quartz Commercial |
$664.56
|
| Rate for Payer: WEA Trust Commercial |
$609.18
|
| Rate for Payer: WPS Commercial |
$820.37
|
|
|
SHEATH & BULLET TIP VASCULAR TUNNELER SMALL GREEN (GRAFTS UP TO 8MM) 9009-18
|
Facility
|
OP
|
$1,065.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4520296
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$310.13 |
| Max. Negotiated Rate |
$1,018.99 |
| Rate for Payer: Aetna Commercial |
$996.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.54
|
| Rate for Payer: Aetna Managed Medicare |
$310.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$719.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$553.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$531.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$587.03
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$1,018.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$619.83
|
| Rate for Payer: Health EOS Commercial |
$985.76
|
| Rate for Payer: HFN Commercial |
$1,018.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$830.70
|
| Rate for Payer: Multiplan Commercial |
$886.08
|
| Rate for Payer: NAPHCARE Commercial |
$664.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,018.99
|
| Rate for Payer: Quartz Beloit One Network |
$542.72
|
| Rate for Payer: Quartz Commercial |
$719.94
|
| Rate for Payer: Quartz Medicare Advantage |
$664.56
|
| Rate for Payer: The Alliance Commercial |
$553.80
|
| Rate for Payer: WEA Trust Commercial |
$609.18
|
| Rate for Payer: WPS Commercial |
$820.37
|
|
|
SHEATH CATHETER 8FR 55CM MIN ORDER 5 EA
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2971228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.63 |
| Max. Negotiated Rate |
$1,458.16 |
| Rate for Payer: Aetna Commercial |
$1,426.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.03
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,458.16
|
| Rate for Payer: Health EOS Commercial |
$1,410.61
|
| Rate for Payer: HFN Commercial |
$1,458.16
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.16
|
| Rate for Payer: Quartz Beloit One Network |
$776.63
|
| Rate for Payer: Quartz Commercial |
$950.98
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$1,173.94
|
|
|
SHEATH CATHETER 8FR 55CM MIN ORDER 5 EA
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2971228
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$443.79 |
| Max. Negotiated Rate |
$1,458.16 |
| Rate for Payer: Aetna Commercial |
$1,426.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Aetna Managed Medicare |
$443.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$792.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$760.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.03
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,458.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$886.97
|
| Rate for Payer: Health EOS Commercial |
$1,410.61
|
| Rate for Payer: HFN Commercial |
$1,458.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.72
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: NAPHCARE Commercial |
$950.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.16
|
| Rate for Payer: Quartz Beloit One Network |
$776.63
|
| Rate for Payer: Quartz Commercial |
$1,030.22
|
| Rate for Payer: Quartz Medicare Advantage |
$950.98
|
| Rate for Payer: The Alliance Commercial |
$792.48
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$1,173.94
|
|
|
SHEATH DENNY 5.5 FR.***DEDE CHECKING W/SURGERY
|
Facility
|
IP
|
$1,021.00
|
|
| Hospital Charge Code |
2963476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$520.30 |
| Max. Negotiated Rate |
$976.89 |
| Rate for Payer: Aetna Commercial |
$955.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.78
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$976.89
|
| Rate for Payer: Health EOS Commercial |
$945.04
|
| Rate for Payer: HFN Commercial |
$976.89
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: Preferred Network Access Commercial |
$976.89
|
| Rate for Payer: Quartz Beloit One Network |
$520.30
|
| Rate for Payer: Quartz Commercial |
$637.10
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
SHEATH DENNY 5.5 FR.***DEDE CHECKING W/SURGERY
|
Facility
|
OP
|
$1,021.00
|
|
| Hospital Charge Code |
2963476
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$297.32 |
| Max. Negotiated Rate |
$976.89 |
| Rate for Payer: Aetna Commercial |
$955.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Aetna Managed Medicare |
$297.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$690.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.78
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$976.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.22
|
| Rate for Payer: Health EOS Commercial |
$945.04
|
| Rate for Payer: HFN Commercial |
$976.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$796.38
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: NAPHCARE Commercial |
$637.10
|
| Rate for Payer: Preferred Network Access Commercial |
$976.89
|
| Rate for Payer: Quartz Beloit One Network |
$520.30
|
| Rate for Payer: Quartz Commercial |
$690.20
|
| Rate for Payer: Quartz Medicare Advantage |
$637.10
|
| Rate for Payer: The Alliance Commercial |
$530.92
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
SHEATH DENNY 7.0 FR.***DEDE CHECKING W/SURGERY
|
Facility
|
IP
|
$1,031.00
|
|
| Hospital Charge Code |
2963475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$525.40 |
| Max. Negotiated Rate |
$986.46 |
| Rate for Payer: Aetna Commercial |
$965.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$922.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.29
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$986.46
|
| Rate for Payer: Health EOS Commercial |
$954.29
|
| Rate for Payer: HFN Commercial |
$986.46
|
| Rate for Payer: Multiplan Commercial |
$857.79
|
| Rate for Payer: Preferred Network Access Commercial |
$986.46
|
| Rate for Payer: Quartz Beloit One Network |
$525.40
|
| Rate for Payer: Quartz Commercial |
$643.34
|
| Rate for Payer: WEA Trust Commercial |
$589.73
|
| Rate for Payer: WPS Commercial |
$794.18
|
|
|
SHEATH DENNY 7.0 FR.***DEDE CHECKING W/SURGERY
|
Facility
|
OP
|
$1,031.00
|
|
| Hospital Charge Code |
2963475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.23 |
| Max. Negotiated Rate |
$986.46 |
| Rate for Payer: Aetna Commercial |
$965.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$922.13
|
| Rate for Payer: Aetna Managed Medicare |
$300.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$536.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$514.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$568.29
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$986.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$600.04
|
| Rate for Payer: Health EOS Commercial |
$954.29
|
| Rate for Payer: HFN Commercial |
$986.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$804.18
|
| Rate for Payer: Multiplan Commercial |
$857.79
|
| Rate for Payer: NAPHCARE Commercial |
$643.34
|
| Rate for Payer: Preferred Network Access Commercial |
$986.46
|
| Rate for Payer: Quartz Beloit One Network |
$525.40
|
| Rate for Payer: Quartz Commercial |
$696.96
|
| Rate for Payer: Quartz Medicare Advantage |
$643.34
|
| Rate for Payer: The Alliance Commercial |
$536.12
|
| Rate for Payer: WEA Trust Commercial |
$589.73
|
| Rate for Payer: WPS Commercial |
$794.18
|
|
|
SHEATH ENDO-SCRUB 4MM 0 DEG FOR K.STORZ 1912000
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2965312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.94 |
| Max. Negotiated Rate |
$1,061.09 |
| Rate for Payer: Aetna Commercial |
$1,038.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.89
|
| Rate for Payer: Aetna Managed Medicare |
$322.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$749.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$553.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.28
|
| Rate for Payer: Cash Price |
$332.70
|
| Rate for Payer: Cigna Commercial |
$1,061.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$645.44
|
| Rate for Payer: Health EOS Commercial |
$1,026.49
|
| Rate for Payer: HFN Commercial |
$1,061.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$865.02
|
| Rate for Payer: Multiplan Commercial |
$922.69
|
| Rate for Payer: NAPHCARE Commercial |
$692.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.09
|
| Rate for Payer: Quartz Beloit One Network |
$565.15
|
| Rate for Payer: Quartz Commercial |
$749.68
|
| Rate for Payer: Quartz Medicare Advantage |
$692.02
|
| Rate for Payer: The Alliance Commercial |
$576.68
|
| Rate for Payer: WEA Trust Commercial |
$634.35
|
| Rate for Payer: WPS Commercial |
$854.26
|
|
|
SHEATH ENDO-SCRUB 4MM 0 DEG FOR K.STORZ 1912000
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2965312
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.15 |
| Max. Negotiated Rate |
$1,061.09 |
| Rate for Payer: Aetna Commercial |
$1,038.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.28
|
| Rate for Payer: Cash Price |
$332.70
|
| Rate for Payer: Cigna Commercial |
$1,061.09
|
| Rate for Payer: Health EOS Commercial |
$1,026.49
|
| Rate for Payer: HFN Commercial |
$1,061.09
|
| Rate for Payer: Multiplan Commercial |
$922.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.09
|
| Rate for Payer: Quartz Beloit One Network |
$565.15
|
| Rate for Payer: Quartz Commercial |
$692.02
|
| Rate for Payer: WEA Trust Commercial |
$634.35
|
| Rate for Payer: WPS Commercial |
$854.26
|
|
|
SHEATH ENDO-SCRUB 4MM 0 DEG FOR S & N 1912004
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3157462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.94 |
| Max. Negotiated Rate |
$1,061.09 |
| Rate for Payer: Aetna Commercial |
$1,038.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.89
|
| Rate for Payer: Aetna Managed Medicare |
$322.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$749.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$553.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.28
|
| Rate for Payer: Cash Price |
$332.70
|
| Rate for Payer: Cigna Commercial |
$1,061.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$645.44
|
| Rate for Payer: Health EOS Commercial |
$1,026.49
|
| Rate for Payer: HFN Commercial |
$1,061.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$865.02
|
| Rate for Payer: Multiplan Commercial |
$922.69
|
| Rate for Payer: NAPHCARE Commercial |
$692.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.09
|
| Rate for Payer: Quartz Beloit One Network |
$565.15
|
| Rate for Payer: Quartz Commercial |
$749.68
|
| Rate for Payer: Quartz Medicare Advantage |
$692.02
|
| Rate for Payer: The Alliance Commercial |
$576.68
|
| Rate for Payer: WEA Trust Commercial |
$634.35
|
| Rate for Payer: WPS Commercial |
$854.26
|
|
|
SHEATH ENDO-SCRUB 4MM 0 DEG FOR S & N 1912004
|
Facility
|
IP
|
$1,109.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3157462
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.15 |
| Max. Negotiated Rate |
$1,061.09 |
| Rate for Payer: Aetna Commercial |
$1,038.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.28
|
| Rate for Payer: Cash Price |
$332.70
|
| Rate for Payer: Cigna Commercial |
$1,061.09
|
| Rate for Payer: Health EOS Commercial |
$1,026.49
|
| Rate for Payer: HFN Commercial |
$1,061.09
|
| Rate for Payer: Multiplan Commercial |
$922.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.09
|
| Rate for Payer: Quartz Beloit One Network |
$565.15
|
| Rate for Payer: Quartz Commercial |
$692.02
|
| Rate for Payer: WEA Trust Commercial |
$634.35
|
| Rate for Payer: WPS Commercial |
$854.26
|
|
|
SHEATH ENDO-SCRUB 4MM 30 DEG FOR S & N 1912014
|
Facility
|
OP
|
$1,109.00
|
|
| Hospital Charge Code |
2965316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$322.94 |
| Max. Negotiated Rate |
$1,061.09 |
| Rate for Payer: Aetna Commercial |
$1,038.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.89
|
| Rate for Payer: Aetna Managed Medicare |
$322.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$749.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$553.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.28
|
| Rate for Payer: Cash Price |
$332.70
|
| Rate for Payer: Cigna Commercial |
$1,061.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$645.44
|
| Rate for Payer: Health EOS Commercial |
$1,026.49
|
| Rate for Payer: HFN Commercial |
$1,061.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$865.02
|
| Rate for Payer: Multiplan Commercial |
$922.69
|
| Rate for Payer: NAPHCARE Commercial |
$692.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.09
|
| Rate for Payer: Quartz Beloit One Network |
$565.15
|
| Rate for Payer: Quartz Commercial |
$749.68
|
| Rate for Payer: Quartz Medicare Advantage |
$692.02
|
| Rate for Payer: The Alliance Commercial |
$576.68
|
| Rate for Payer: WEA Trust Commercial |
$634.35
|
| Rate for Payer: WPS Commercial |
$854.26
|
|
|
SHEATH ENDO-SCRUB 4MM 30 DEG FOR S & N 1912014
|
Facility
|
IP
|
$1,109.00
|
|
| Hospital Charge Code |
2965316
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$565.15 |
| Max. Negotiated Rate |
$1,061.09 |
| Rate for Payer: Aetna Commercial |
$1,038.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.28
|
| Rate for Payer: Cash Price |
$332.70
|
| Rate for Payer: Cigna Commercial |
$1,061.09
|
| Rate for Payer: Health EOS Commercial |
$1,026.49
|
| Rate for Payer: HFN Commercial |
$1,061.09
|
| Rate for Payer: Multiplan Commercial |
$922.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,061.09
|
| Rate for Payer: Quartz Beloit One Network |
$565.15
|
| Rate for Payer: Quartz Commercial |
$692.02
|
| Rate for Payer: WEA Trust Commercial |
$634.35
|
| Rate for Payer: WPS Commercial |
$854.26
|
|
|
SHEATH FLEXOR ANLO 5FR 45CM G44153
|
Facility
|
IP
|
$1,427.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3613494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$727.20 |
| Max. Negotiated Rate |
$1,365.35 |
| Rate for Payer: Aetna Commercial |
$1,335.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.56
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,365.35
|
| Rate for Payer: Health EOS Commercial |
$1,320.83
|
| Rate for Payer: HFN Commercial |
$1,365.35
|
| Rate for Payer: Multiplan Commercial |
$1,187.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,365.35
|
| Rate for Payer: Quartz Beloit One Network |
$727.20
|
| Rate for Payer: Quartz Commercial |
$890.45
|
| Rate for Payer: WEA Trust Commercial |
$816.24
|
| Rate for Payer: WPS Commercial |
$1,099.22
|
|
|
SHEATH FLEXOR ANLO 5FR 45CM G44153
|
Facility
|
OP
|
$1,427.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3613494
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.54 |
| Max. Negotiated Rate |
$1,365.35 |
| Rate for Payer: Aetna Commercial |
$1,335.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,276.31
|
| Rate for Payer: Aetna Managed Medicare |
$415.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$964.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$742.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$712.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$786.56
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,365.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$830.51
|
| Rate for Payer: Health EOS Commercial |
$1,320.83
|
| Rate for Payer: HFN Commercial |
$1,365.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,113.06
|
| Rate for Payer: Multiplan Commercial |
$1,187.26
|
| Rate for Payer: NAPHCARE Commercial |
$890.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,365.35
|
| Rate for Payer: Quartz Beloit One Network |
$727.20
|
| Rate for Payer: Quartz Commercial |
$964.65
|
| Rate for Payer: Quartz Medicare Advantage |
$890.45
|
| Rate for Payer: The Alliance Commercial |
$742.04
|
| Rate for Payer: WEA Trust Commercial |
$816.24
|
| Rate for Payer: WPS Commercial |
$1,099.22
|
|
|
SHEATH GUIDE 6FR 10cm/.021 RM*BF6F10PA
|
Facility
|
IP
|
$939.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3477498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.51 |
| Max. Negotiated Rate |
$898.44 |
| Rate for Payer: Aetna Commercial |
$878.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$839.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.58
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$898.44
|
| Rate for Payer: Health EOS Commercial |
$869.14
|
| Rate for Payer: HFN Commercial |
$898.44
|
| Rate for Payer: Multiplan Commercial |
$781.25
|
| Rate for Payer: Preferred Network Access Commercial |
$898.44
|
| Rate for Payer: Quartz Beloit One Network |
$478.51
|
| Rate for Payer: Quartz Commercial |
$585.94
|
| Rate for Payer: WEA Trust Commercial |
$537.11
|
| Rate for Payer: WPS Commercial |
$723.31
|
|
|
SHEATH GUIDE 6FR 10cm/.021 RM*BF6F10PA
|
Facility
|
OP
|
$939.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3477498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$273.44 |
| Max. Negotiated Rate |
$898.44 |
| Rate for Payer: Aetna Commercial |
$878.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$839.84
|
| Rate for Payer: Aetna Managed Medicare |
$273.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$634.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$488.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$468.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.58
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$898.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$546.50
|
| Rate for Payer: Health EOS Commercial |
$869.14
|
| Rate for Payer: HFN Commercial |
$898.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$732.42
|
| Rate for Payer: Multiplan Commercial |
$781.25
|
| Rate for Payer: NAPHCARE Commercial |
$585.94
|
| Rate for Payer: Preferred Network Access Commercial |
$898.44
|
| Rate for Payer: Quartz Beloit One Network |
$478.51
|
| Rate for Payer: Quartz Commercial |
$634.76
|
| Rate for Payer: Quartz Medicare Advantage |
$585.94
|
| Rate for Payer: The Alliance Commercial |
$488.28
|
| Rate for Payer: WEA Trust Commercial |
$537.11
|
| Rate for Payer: WPS Commercial |
$723.31
|
|
