|
SHEATH INTRODUCER 6fr SUPER
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
2972709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$85.03 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Aetna Managed Medicare |
$85.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$197.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$145.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.94
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$227.76
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$197.39
|
| Rate for Payer: Quartz Medicare Advantage |
$182.21
|
| Rate for Payer: The Alliance Commercial |
$151.84
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
SHEATH INTRODUCER 6fr SUPER
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
2972709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$279.39 |
| Rate for Payer: Aetna Commercial |
$273.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$261.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.95
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$279.39
|
| Rate for Payer: Health EOS Commercial |
$270.28
|
| Rate for Payer: HFN Commercial |
$279.39
|
| Rate for Payer: Multiplan Commercial |
$242.94
|
| Rate for Payer: Preferred Network Access Commercial |
$279.39
|
| Rate for Payer: Quartz Beloit One Network |
$148.80
|
| Rate for Payer: Quartz Commercial |
$182.21
|
| Rate for Payer: WEA Trust Commercial |
$167.02
|
| Rate for Payer: WPS Commercial |
$224.93
|
|
|
SHEATH KIT MICRO PUNC 4fr S-MAK401N
|
Facility
|
OP
|
$1,054.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2969729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$306.92 |
| Max. Negotiated Rate |
$1,008.47 |
| Rate for Payer: Aetna Commercial |
$986.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$942.70
|
| Rate for Payer: Aetna Managed Medicare |
$306.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$712.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$548.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$526.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$580.96
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$1,008.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$613.43
|
| Rate for Payer: Health EOS Commercial |
$975.58
|
| Rate for Payer: HFN Commercial |
$1,008.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$822.12
|
| Rate for Payer: Multiplan Commercial |
$876.93
|
| Rate for Payer: NAPHCARE Commercial |
$657.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,008.47
|
| Rate for Payer: Quartz Beloit One Network |
$537.12
|
| Rate for Payer: Quartz Commercial |
$712.50
|
| Rate for Payer: Quartz Medicare Advantage |
$657.70
|
| Rate for Payer: The Alliance Commercial |
$548.08
|
| Rate for Payer: WEA Trust Commercial |
$602.89
|
| Rate for Payer: WPS Commercial |
$811.90
|
|
|
SHEATH KIT MICRO PUNC 4fr S-MAK401N
|
Facility
|
IP
|
$1,054.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2969729
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$537.12 |
| Max. Negotiated Rate |
$1,008.47 |
| Rate for Payer: Aetna Commercial |
$986.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$942.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$580.96
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$1,008.47
|
| Rate for Payer: Health EOS Commercial |
$975.58
|
| Rate for Payer: HFN Commercial |
$1,008.47
|
| Rate for Payer: Multiplan Commercial |
$876.93
|
| Rate for Payer: Preferred Network Access Commercial |
$1,008.47
|
| Rate for Payer: Quartz Beloit One Network |
$537.12
|
| Rate for Payer: Quartz Commercial |
$657.70
|
| Rate for Payer: WEA Trust Commercial |
$602.89
|
| Rate for Payer: WPS Commercial |
$811.90
|
|
|
SHEATH KIT MICRO-PUNTURCE 5FR 15CM
|
Facility
|
OP
|
$1,016.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2973605
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$295.86 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Aetna Managed Medicare |
$295.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$686.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$528.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$507.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$591.31
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$792.48
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: NAPHCARE Commercial |
$633.98
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$686.82
|
| Rate for Payer: Quartz Medicare Advantage |
$633.98
|
| Rate for Payer: The Alliance Commercial |
$528.32
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
SHEATH KIT MICRO-PUNTURCE 5FR 15CM
|
Facility
|
IP
|
$1,016.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2973605
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$517.75 |
| Max. Negotiated Rate |
$972.11 |
| Rate for Payer: Aetna Commercial |
$950.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$908.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$560.02
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$972.11
|
| Rate for Payer: Health EOS Commercial |
$940.41
|
| Rate for Payer: HFN Commercial |
$972.11
|
| Rate for Payer: Multiplan Commercial |
$845.31
|
| Rate for Payer: Preferred Network Access Commercial |
$972.11
|
| Rate for Payer: Quartz Beloit One Network |
$517.75
|
| Rate for Payer: Quartz Commercial |
$633.98
|
| Rate for Payer: WEA Trust Commercial |
$581.15
|
| Rate for Payer: WPS Commercial |
$782.62
|
|
|
SHEATH PRELUDE 7FR PRO-7F-11-038
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3107499
|
|
Hospital Revenue Code
|
278
|
| 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 PRELUDE 7FR PRO-7F-11-038
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3107499
|
|
Hospital Revenue Code
|
278
|
| 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 PRELUDE 8FR PSI-8F-11-038
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3107497
|
|
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 PRELUDE 8FR PSI-8F-11-038
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3107497
|
|
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 SAFE II 9 FR #559
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3449502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,333.11 |
| Max. Negotiated Rate |
$2,502.99 |
| Rate for Payer: Aetna Commercial |
$2,448.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,339.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.94
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,502.99
|
| Rate for Payer: Health EOS Commercial |
$2,421.37
|
| Rate for Payer: HFN Commercial |
$2,502.99
|
| Rate for Payer: Multiplan Commercial |
$2,176.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.11
|
| Rate for Payer: Quartz Commercial |
$1,632.38
|
| Rate for Payer: WEA Trust Commercial |
$1,496.35
|
| Rate for Payer: WPS Commercial |
$2,015.10
|
|
|
SHEATH SAFE II 9 FR #559
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3449502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.78 |
| Max. Negotiated Rate |
$2,502.99 |
| Rate for Payer: Aetna Commercial |
$2,448.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,339.75
|
| Rate for Payer: Aetna Managed Medicare |
$761.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,768.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,360.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,305.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.94
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,502.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.51
|
| Rate for Payer: Health EOS Commercial |
$2,421.37
|
| Rate for Payer: HFN Commercial |
$2,502.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,040.48
|
| Rate for Payer: Multiplan Commercial |
$2,176.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,632.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.11
|
| Rate for Payer: Quartz Commercial |
$1,768.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.38
|
| Rate for Payer: The Alliance Commercial |
$1,360.32
|
| Rate for Payer: WEA Trust Commercial |
$1,496.35
|
| Rate for Payer: WPS Commercial |
$2,015.10
|
|
|
SHEATH SAFESHEATH 7FR
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,333.11 |
| Max. Negotiated Rate |
$2,502.99 |
| Rate for Payer: Aetna Commercial |
$2,448.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,339.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.94
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,502.99
|
| Rate for Payer: Health EOS Commercial |
$2,421.37
|
| Rate for Payer: HFN Commercial |
$2,502.99
|
| Rate for Payer: Multiplan Commercial |
$2,176.51
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.11
|
| Rate for Payer: Quartz Commercial |
$1,632.38
|
| Rate for Payer: WEA Trust Commercial |
$1,496.35
|
| Rate for Payer: WPS Commercial |
$2,015.10
|
|
|
SHEATH SAFESHEATH 7FR
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$761.78 |
| Max. Negotiated Rate |
$2,502.99 |
| Rate for Payer: Aetna Commercial |
$2,448.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,339.75
|
| Rate for Payer: Aetna Managed Medicare |
$761.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,768.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,360.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,305.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,441.94
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,502.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,522.51
|
| Rate for Payer: Health EOS Commercial |
$2,421.37
|
| Rate for Payer: HFN Commercial |
$2,502.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,040.48
|
| Rate for Payer: Multiplan Commercial |
$2,176.51
|
| Rate for Payer: NAPHCARE Commercial |
$1,632.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,502.99
|
| Rate for Payer: Quartz Beloit One Network |
$1,333.11
|
| Rate for Payer: Quartz Commercial |
$1,768.42
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.38
|
| Rate for Payer: The Alliance Commercial |
$1,360.32
|
| Rate for Payer: WEA Trust Commercial |
$1,496.35
|
| Rate for Payer: WPS Commercial |
$2,015.10
|
|
|
SHEATH SAFESHEATH 9FR #HLS1009M
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
2972099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$161.54 |
| Max. Negotiated Rate |
$303.31 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$197.81
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
SHEATH SAFESHEATH 9FR #HLS1009M
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
2972099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$92.31 |
| Max. Negotiated Rate |
$303.31 |
| Rate for Payer: Aetna Commercial |
$296.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$283.52
|
| Rate for Payer: Aetna Managed Medicare |
$92.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$214.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$158.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$174.73
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$303.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.49
|
| Rate for Payer: Health EOS Commercial |
$293.42
|
| Rate for Payer: HFN Commercial |
$303.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$247.26
|
| Rate for Payer: Multiplan Commercial |
$263.74
|
| Rate for Payer: NAPHCARE Commercial |
$197.81
|
| Rate for Payer: Preferred Network Access Commercial |
$303.31
|
| Rate for Payer: Quartz Beloit One Network |
$161.54
|
| Rate for Payer: Quartz Commercial |
$214.29
|
| Rate for Payer: Quartz Medicare Advantage |
$197.81
|
| Rate for Payer: The Alliance Commercial |
$164.84
|
| Rate for Payer: WEA Trust Commercial |
$181.32
|
| Rate for Payer: WPS Commercial |
$244.19
|
|
|
SHEATH SAFESHEATH LONG
|
Facility
|
OP
|
$1,336.00
|
|
| Hospital Charge Code |
2972183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$389.04 |
| Max. Negotiated Rate |
$1,278.28 |
| Rate for Payer: Aetna Commercial |
$1,250.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,194.92
|
| Rate for Payer: Aetna Managed Medicare |
$389.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$903.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$694.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$666.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.40
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$1,278.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$777.55
|
| Rate for Payer: Health EOS Commercial |
$1,236.60
|
| Rate for Payer: HFN Commercial |
$1,278.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.08
|
| Rate for Payer: Multiplan Commercial |
$1,111.55
|
| Rate for Payer: NAPHCARE Commercial |
$833.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,278.28
|
| Rate for Payer: Quartz Beloit One Network |
$680.83
|
| Rate for Payer: Quartz Commercial |
$903.14
|
| Rate for Payer: Quartz Medicare Advantage |
$833.66
|
| Rate for Payer: The Alliance Commercial |
$694.72
|
| Rate for Payer: WEA Trust Commercial |
$764.19
|
| Rate for Payer: WPS Commercial |
$1,029.12
|
|
|
SHEATH SAFESHEATH LONG
|
Facility
|
IP
|
$1,336.00
|
|
| Hospital Charge Code |
2972183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$680.83 |
| Max. Negotiated Rate |
$1,278.28 |
| Rate for Payer: Aetna Commercial |
$1,250.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,194.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$736.40
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$1,278.28
|
| Rate for Payer: Health EOS Commercial |
$1,236.60
|
| Rate for Payer: HFN Commercial |
$1,278.28
|
| Rate for Payer: Multiplan Commercial |
$1,111.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,278.28
|
| Rate for Payer: Quartz Beloit One Network |
$680.83
|
| Rate for Payer: Quartz Commercial |
$833.66
|
| Rate for Payer: WEA Trust Commercial |
$764.19
|
| Rate for Payer: WPS Commercial |
$1,029.12
|
|
|
SHEATH SET MICROPUNCTURE PEDIATRIC
|
Facility
|
IP
|
$783.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2971632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$399.02 |
| Max. Negotiated Rate |
$749.17 |
| Rate for Payer: Aetna Commercial |
$732.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.59
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$749.17
|
| Rate for Payer: Health EOS Commercial |
$724.74
|
| Rate for Payer: HFN Commercial |
$749.17
|
| Rate for Payer: Multiplan Commercial |
$651.46
|
| Rate for Payer: Preferred Network Access Commercial |
$749.17
|
| Rate for Payer: Quartz Beloit One Network |
$399.02
|
| Rate for Payer: Quartz Commercial |
$488.59
|
| Rate for Payer: WEA Trust Commercial |
$447.88
|
| Rate for Payer: WPS Commercial |
$603.14
|
|
|
SHEATH SET MICROPUNCTURE PEDIATRIC
|
Facility
|
OP
|
$783.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2971632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.01 |
| Max. Negotiated Rate |
$749.17 |
| Rate for Payer: Aetna Commercial |
$732.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.32
|
| Rate for Payer: Aetna Managed Medicare |
$228.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$390.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.59
|
| Rate for Payer: Cash Price |
$234.90
|
| Rate for Payer: Cigna Commercial |
$749.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$455.71
|
| Rate for Payer: Health EOS Commercial |
$724.74
|
| Rate for Payer: HFN Commercial |
$749.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$610.74
|
| Rate for Payer: Multiplan Commercial |
$651.46
|
| Rate for Payer: NAPHCARE Commercial |
$488.59
|
| Rate for Payer: Preferred Network Access Commercial |
$749.17
|
| Rate for Payer: Quartz Beloit One Network |
$399.02
|
| Rate for Payer: Quartz Commercial |
$529.31
|
| Rate for Payer: Quartz Medicare Advantage |
$488.59
|
| Rate for Payer: The Alliance Commercial |
$407.16
|
| Rate for Payer: WEA Trust Commercial |
$447.88
|
| Rate for Payer: WPS Commercial |
$603.14
|
|
|
SHEATH STRAIGHT 7 FR 45CM
|
Facility
|
OP
|
$1,593.00
|
|
| Hospital Charge Code |
2972555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$463.88 |
| Max. Negotiated Rate |
$1,524.18 |
| Rate for Payer: Aetna Commercial |
$1,491.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| Rate for Payer: Aetna Managed Medicare |
$463.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,076.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$828.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$795.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$878.06
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,524.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$927.13
|
| Rate for Payer: Health EOS Commercial |
$1,474.48
|
| Rate for Payer: HFN Commercial |
$1,524.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,242.54
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: NAPHCARE Commercial |
$994.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,524.18
|
| Rate for Payer: Quartz Beloit One Network |
$811.79
|
| Rate for Payer: Quartz Commercial |
$1,076.87
|
| Rate for Payer: Quartz Medicare Advantage |
$994.03
|
| Rate for Payer: The Alliance Commercial |
$828.36
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$1,227.09
|
|
|
SHEATH STRAIGHT 7 FR 45CM
|
Facility
|
IP
|
$1,593.00
|
|
| Hospital Charge Code |
2972555
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$811.79 |
| Max. Negotiated Rate |
$1,524.18 |
| Rate for Payer: Aetna Commercial |
$1,491.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$878.06
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,524.18
|
| Rate for Payer: Health EOS Commercial |
$1,474.48
|
| Rate for Payer: HFN Commercial |
$1,524.18
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,524.18
|
| Rate for Payer: Quartz Beloit One Network |
$811.79
|
| Rate for Payer: Quartz Commercial |
$994.03
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$1,227.09
|
|
|
SHEATH URETERAL ACCESS 12FR (ID) 14FR (OD) X 20CM G19173
|
Facility
|
OP
|
$394.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2965867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$114.73 |
| Max. Negotiated Rate |
$376.98 |
| Rate for Payer: Aetna Commercial |
$368.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.39
|
| Rate for Payer: Aetna Managed Medicare |
$114.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$266.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$204.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$196.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.17
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$376.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.31
|
| Rate for Payer: Health EOS Commercial |
$364.69
|
| Rate for Payer: HFN Commercial |
$376.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$307.32
|
| Rate for Payer: Multiplan Commercial |
$327.81
|
| Rate for Payer: NAPHCARE Commercial |
$245.86
|
| Rate for Payer: Preferred Network Access Commercial |
$376.98
|
| Rate for Payer: Quartz Beloit One Network |
$200.78
|
| Rate for Payer: Quartz Commercial |
$266.34
|
| Rate for Payer: Quartz Medicare Advantage |
$245.86
|
| Rate for Payer: The Alliance Commercial |
$204.88
|
| Rate for Payer: WEA Trust Commercial |
$225.37
|
| Rate for Payer: WPS Commercial |
$303.50
|
|
|
SHEATH URETERAL ACCESS 12FR (ID) 14FR (OD) X 20CM G19173
|
Facility
|
IP
|
$394.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2965867
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$200.78 |
| Max. Negotiated Rate |
$376.98 |
| Rate for Payer: Aetna Commercial |
$368.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$352.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$217.17
|
| Rate for Payer: Cash Price |
$118.20
|
| Rate for Payer: Cigna Commercial |
$376.98
|
| Rate for Payer: Health EOS Commercial |
$364.69
|
| Rate for Payer: HFN Commercial |
$376.98
|
| Rate for Payer: Multiplan Commercial |
$327.81
|
| Rate for Payer: Preferred Network Access Commercial |
$376.98
|
| Rate for Payer: Quartz Beloit One Network |
$200.78
|
| Rate for Payer: Quartz Commercial |
$245.86
|
| Rate for Payer: WEA Trust Commercial |
$225.37
|
| Rate for Payer: WPS Commercial |
$303.50
|
|
|
SHEEPSKIN DECUBITIS PAD
|
Facility
|
IP
|
$222.00
|
|
| Hospital Charge Code |
2963957
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$113.13 |
| Max. Negotiated Rate |
$212.41 |
| Rate for Payer: Aetna Commercial |
$207.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.37
|
| Rate for Payer: Cash Price |
$66.60
|
| Rate for Payer: Cigna Commercial |
$212.41
|
| Rate for Payer: Health EOS Commercial |
$205.48
|
| Rate for Payer: HFN Commercial |
$212.41
|
| Rate for Payer: Multiplan Commercial |
$184.70
|
| Rate for Payer: Preferred Network Access Commercial |
$212.41
|
| Rate for Payer: Quartz Beloit One Network |
$113.13
|
| Rate for Payer: Quartz Commercial |
$138.53
|
| Rate for Payer: WEA Trust Commercial |
$126.98
|
| Rate for Payer: WPS Commercial |
$171.01
|
|
