|
Shaving of single lesion (scalp, hands, feet, genitalia) 0.6-1.0cm 11306
|
Professional
|
Both
|
$274.00
|
|
|
Service Code
|
CPT 11306
|
| Hospital Charge Code |
3013529
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$260.30 |
| Rate for Payer: Aetna Commercial |
$260.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$260.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$164.40
|
| Rate for Payer: Health EOS Commercial |
$249.34
|
| Rate for Payer: HFN Commercial |
$260.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.79
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: Preferred Network Access Commercial |
$260.30
|
| Rate for Payer: Quartz Beloit One Network |
$120.56
|
| Rate for Payer: Quartz Commercial |
$156.18
|
| Rate for Payer: The Alliance Commercial |
$137.00
|
| Rate for Payer: United Healthcare Medicaid |
$56.97
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
Shaving of single lesion (scalp, hands, feet, genitalia) 1.1-2.0cm 11307
|
Professional
|
Both
|
$242.00
|
|
|
Service Code
|
CPT 11307
|
| Hospital Charge Code |
3013530
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.97 |
| Max. Negotiated Rate |
$229.90 |
| Rate for Payer: Aetna Commercial |
$229.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$208.12
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cash Price |
$72.60
|
| Rate for Payer: Cigna Commercial |
$229.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.20
|
| Rate for Payer: Health EOS Commercial |
$220.22
|
| Rate for Payer: HFN Commercial |
$229.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$214.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$214.48
|
| Rate for Payer: Multiplan Commercial |
$193.60
|
| Rate for Payer: Preferred Network Access Commercial |
$229.90
|
| Rate for Payer: Quartz Beloit One Network |
$106.48
|
| Rate for Payer: Quartz Commercial |
$137.94
|
| Rate for Payer: The Alliance Commercial |
$121.00
|
| Rate for Payer: United Healthcare Medicaid |
$56.97
|
| Rate for Payer: WEA Trust Commercial |
$133.10
|
| Rate for Payer: WPS Commercial |
$179.25
|
|
|
Shaving of single lesion (scalp, hands, feet, genitalia) >2.0cm 11308
|
Professional
|
Both
|
$510.00
|
|
|
Service Code
|
CPT 11308
|
| Hospital Charge Code |
3013531
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.26 |
| Max. Negotiated Rate |
$484.50 |
| Rate for Payer: Aetna Commercial |
$484.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.60
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cash Price |
$153.00
|
| Rate for Payer: Cigna Commercial |
$484.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$306.00
|
| Rate for Payer: Health EOS Commercial |
$464.10
|
| Rate for Payer: HFN Commercial |
$484.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$243.75
|
| Rate for Payer: Multiplan Commercial |
$408.00
|
| Rate for Payer: Preferred Network Access Commercial |
$484.50
|
| Rate for Payer: Quartz Beloit One Network |
$224.40
|
| Rate for Payer: Quartz Commercial |
$290.70
|
| Rate for Payer: The Alliance Commercial |
$255.00
|
| Rate for Payer: United Healthcare Medicaid |
$131.26
|
| Rate for Payer: WEA Trust Commercial |
$280.50
|
| Rate for Payer: WPS Commercial |
$377.76
|
|
|
Shaving of single lesion (trunk, arm, legs) <=0.5cm 11300
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 11300
|
| Hospital Charge Code |
3013524
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.41 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$146.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$49.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.40
|
| Rate for Payer: Health EOS Commercial |
$140.14
|
| Rate for Payer: HFN Commercial |
$146.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.02
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$146.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.76
|
| Rate for Payer: Quartz Commercial |
$87.78
|
| Rate for Payer: The Alliance Commercial |
$77.00
|
| Rate for Payer: United Healthcare Medicaid |
$49.41
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
Shaving of single lesion (trunk, arm, legs) 0.6-1.0cm 11301
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
CPT 11301
|
| Hospital Charge Code |
3013525
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.91 |
| Max. Negotiated Rate |
$172.16 |
| Rate for Payer: Aetna Commercial |
$156.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.90
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$156.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99.00
|
| Rate for Payer: Health EOS Commercial |
$150.15
|
| Rate for Payer: HFN Commercial |
$156.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.16
|
| Rate for Payer: Multiplan Commercial |
$132.00
|
| Rate for Payer: Preferred Network Access Commercial |
$156.75
|
| Rate for Payer: Quartz Beloit One Network |
$72.60
|
| Rate for Payer: Quartz Commercial |
$94.05
|
| Rate for Payer: The Alliance Commercial |
$82.50
|
| Rate for Payer: United Healthcare Medicaid |
$60.91
|
| Rate for Payer: WEA Trust Commercial |
$90.75
|
| Rate for Payer: WPS Commercial |
$122.22
|
|
|
Shaving of single lesion (trunk, arm, legs) 1.1-2.0cm 11302
|
Professional
|
Both
|
$200.00
|
|
|
Service Code
|
CPT 11302
|
| Hospital Charge Code |
3013526
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.91 |
| Max. Negotiated Rate |
$201.81 |
| Rate for Payer: Aetna Commercial |
$190.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cash Price |
$60.00
|
| Rate for Payer: Cigna Commercial |
$190.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.00
|
| Rate for Payer: Health EOS Commercial |
$182.00
|
| Rate for Payer: HFN Commercial |
$190.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$201.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$201.81
|
| Rate for Payer: Multiplan Commercial |
$160.00
|
| Rate for Payer: Preferred Network Access Commercial |
$190.00
|
| Rate for Payer: Quartz Beloit One Network |
$88.00
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$100.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.91
|
| Rate for Payer: WEA Trust Commercial |
$110.00
|
| Rate for Payer: WPS Commercial |
$148.14
|
|
|
Shaving of single lesion (trunk, arm, legs) >2.0cm 11303
|
Professional
|
Both
|
$478.00
|
|
|
Service Code
|
CPT 11303
|
| Hospital Charge Code |
3013527
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.51 |
| Max. Negotiated Rate |
$454.10 |
| Rate for Payer: Aetna Commercial |
$454.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$411.08
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cash Price |
$143.40
|
| Rate for Payer: Cigna Commercial |
$454.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$113.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.80
|
| Rate for Payer: Health EOS Commercial |
$434.98
|
| Rate for Payer: HFN Commercial |
$454.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$238.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$238.77
|
| Rate for Payer: Multiplan Commercial |
$382.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.10
|
| Rate for Payer: Quartz Beloit One Network |
$210.32
|
| Rate for Payer: Quartz Commercial |
$272.46
|
| Rate for Payer: The Alliance Commercial |
$239.00
|
| Rate for Payer: United Healthcare Medicaid |
$113.51
|
| Rate for Payer: WEA Trust Commercial |
$262.90
|
| Rate for Payer: WPS Commercial |
$354.05
|
|
|
SHEAR HARMONIC FOCUS FCS9
|
Facility
|
OP
|
$5,601.00
|
|
| Hospital Charge Code |
2965114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,568.28 |
| Max. Negotiated Rate |
$22,404.00 |
| Rate for Payer: Aetna Commercial |
$5,040.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,816.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,568.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,640.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,800.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,688.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,968.53
|
| Rate for Payer: Cash Price |
$1,680.30
|
| Rate for Payer: Cigna Commercial |
$5,152.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,134.32
|
| Rate for Payer: Health EOS Commercial |
$4,984.89
|
| Rate for Payer: HFN Commercial |
$5,152.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,200.75
|
| Rate for Payer: Multiplan Commercial |
$4,480.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,360.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,152.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,744.49
|
| Rate for Payer: Quartz Commercial |
$3,640.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,360.60
|
| Rate for Payer: The Alliance Commercial |
$22,404.00
|
| Rate for Payer: WEA Trust Commercial |
$3,080.55
|
| Rate for Payer: WPS Commercial |
$4,148.66
|
|
|
SHEAR HARMONIC FOCUS FCS9
|
Facility
|
IP
|
$5,601.00
|
|
| Hospital Charge Code |
2965114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,744.49 |
| Max. Negotiated Rate |
$5,152.92 |
| Rate for Payer: Aetna Commercial |
$5,040.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,816.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,968.53
|
| Rate for Payer: Cash Price |
$1,680.30
|
| Rate for Payer: Cigna Commercial |
$5,152.92
|
| Rate for Payer: Health EOS Commercial |
$4,984.89
|
| Rate for Payer: HFN Commercial |
$5,152.92
|
| Rate for Payer: Multiplan Commercial |
$4,480.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,360.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,152.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,744.49
|
| Rate for Payer: Quartz Commercial |
$3,360.60
|
| Rate for Payer: WEA Trust Commercial |
$3,080.55
|
| Rate for Payer: WPS Commercial |
$4,148.66
|
|
|
SHEARS ENDO 5MM W/UNIPOLAR
|
Facility
|
IP
|
$1,552.00
|
|
| Hospital Charge Code |
2962931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$760.48 |
| Max. Negotiated Rate |
$1,427.84 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$931.20
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
SHEARS ENDO 5MM W/UNIPOLAR
|
Facility
|
OP
|
$1,552.00
|
|
| Hospital Charge Code |
2962931
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$434.56 |
| Max. Negotiated Rate |
$6,208.00 |
| Rate for Payer: Aetna Commercial |
$1,396.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.72
|
| Rate for Payer: Aetna Managed Medicare |
$434.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,008.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$776.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$744.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$822.56
|
| Rate for Payer: Cash Price |
$465.60
|
| Rate for Payer: Cigna Commercial |
$1,427.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$868.50
|
| Rate for Payer: Health EOS Commercial |
$1,381.28
|
| Rate for Payer: HFN Commercial |
$1,427.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,164.00
|
| Rate for Payer: Multiplan Commercial |
$1,241.60
|
| Rate for Payer: NAPHCARE Commercial |
$931.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,427.84
|
| Rate for Payer: Quartz Beloit One Network |
$760.48
|
| Rate for Payer: Quartz Commercial |
$1,008.80
|
| Rate for Payer: Quartz Medicare Advantage |
$931.20
|
| Rate for Payer: The Alliance Commercial |
$6,208.00
|
| Rate for Payer: WEA Trust Commercial |
$853.60
|
| Rate for Payer: WPS Commercial |
$1,149.57
|
|
|
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 |
$136.64 |
| Max. Negotiated Rate |
$1,952.00 |
| Rate for Payer: Aetna Commercial |
$439.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$419.68
|
| Rate for Payer: Aetna Managed Medicare |
$136.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$258.64
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$448.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.08
|
| Rate for Payer: Health EOS Commercial |
$434.32
|
| Rate for Payer: HFN Commercial |
$448.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$366.00
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: NAPHCARE Commercial |
$292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$448.96
|
| Rate for Payer: Quartz Beloit One Network |
$239.12
|
| Rate for Payer: Quartz Commercial |
$317.20
|
| Rate for Payer: Quartz Medicare Advantage |
$292.80
|
| Rate for Payer: The Alliance Commercial |
$1,952.00
|
| Rate for Payer: WEA Trust Commercial |
$268.40
|
| Rate for Payer: WPS Commercial |
$361.46
|
|
|
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 |
$239.12 |
| Max. Negotiated Rate |
$448.96 |
| Rate for Payer: Aetna Commercial |
$439.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$419.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$258.64
|
| Rate for Payer: Cash Price |
$146.40
|
| Rate for Payer: Cigna Commercial |
$448.96
|
| Rate for Payer: Health EOS Commercial |
$434.32
|
| Rate for Payer: HFN Commercial |
$448.96
|
| Rate for Payer: Multiplan Commercial |
$390.40
|
| Rate for Payer: NAPHCARE Commercial |
$292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$448.96
|
| Rate for Payer: Quartz Beloit One Network |
$239.12
|
| Rate for Payer: Quartz Commercial |
$292.80
|
| Rate for Payer: WEA Trust Commercial |
$268.40
|
| Rate for Payer: WPS Commercial |
$361.46
|
|
|
SHEATH 12FR
|
Facility
|
OP
|
$1,556.00
|
|
| Hospital Charge Code |
2972331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$435.68 |
| Max. Negotiated Rate |
$6,224.00 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Aetna Managed Medicare |
$435.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,011.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$778.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$746.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$870.74
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,167.00
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$1,011.40
|
| Rate for Payer: Quartz Medicare Advantage |
$933.60
|
| Rate for Payer: The Alliance Commercial |
$6,224.00
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
SHEATH 12FR
|
Facility
|
IP
|
$1,556.00
|
|
| Hospital Charge Code |
2972331
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$762.44 |
| Max. Negotiated Rate |
$1,431.52 |
| Rate for Payer: Aetna Commercial |
$1,400.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,338.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$824.68
|
| Rate for Payer: Cash Price |
$466.80
|
| Rate for Payer: Cigna Commercial |
$1,431.52
|
| Rate for Payer: Health EOS Commercial |
$1,384.84
|
| Rate for Payer: HFN Commercial |
$1,431.52
|
| Rate for Payer: Multiplan Commercial |
$1,244.80
|
| Rate for Payer: NAPHCARE Commercial |
$933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,431.52
|
| Rate for Payer: Quartz Beloit One Network |
$762.44
|
| Rate for Payer: Quartz Commercial |
$933.60
|
| Rate for Payer: WEA Trust Commercial |
$855.80
|
| Rate for Payer: WPS Commercial |
$1,152.53
|
|
|
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 |
$908.95 |
| Max. Negotiated Rate |
$1,706.60 |
| Rate for Payer: Aetna Commercial |
$1,669.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,595.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$983.15
|
| Rate for Payer: Cash Price |
$556.50
|
| Rate for Payer: Cigna Commercial |
$1,706.60
|
| Rate for Payer: Health EOS Commercial |
$1,650.95
|
| Rate for Payer: HFN Commercial |
$1,706.60
|
| Rate for Payer: Multiplan Commercial |
$1,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,113.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,706.60
|
| Rate for Payer: Quartz Beloit One Network |
$908.95
|
| Rate for Payer: Quartz Commercial |
$1,113.00
|
| Rate for Payer: WEA Trust Commercial |
$1,020.25
|
| Rate for Payer: WPS Commercial |
$1,374.00
|
|
|
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 |
$519.40 |
| Max. Negotiated Rate |
$7,420.00 |
| Rate for Payer: Aetna Commercial |
$1,669.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,595.30
|
| Rate for Payer: Aetna Managed Medicare |
$519.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,205.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$927.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$890.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$983.15
|
| Rate for Payer: Cash Price |
$556.50
|
| Rate for Payer: Cigna Commercial |
$1,706.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,038.06
|
| Rate for Payer: Health EOS Commercial |
$1,650.95
|
| Rate for Payer: HFN Commercial |
$1,706.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,391.25
|
| Rate for Payer: Multiplan Commercial |
$1,484.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,113.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,706.60
|
| Rate for Payer: Quartz Beloit One Network |
$908.95
|
| Rate for Payer: Quartz Commercial |
$1,205.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,113.00
|
| Rate for Payer: The Alliance Commercial |
$7,420.00
|
| Rate for Payer: WEA Trust Commercial |
$1,020.25
|
| Rate for Payer: WPS Commercial |
$1,374.00
|
|
|
SHEATH 18FR
|
Facility
|
IP
|
$1,983.00
|
|
| Hospital Charge Code |
2972790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$971.67 |
| Max. Negotiated Rate |
$1,824.36 |
| Rate for Payer: Aetna Commercial |
$1,784.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,050.99
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,824.36
|
| Rate for Payer: Health EOS Commercial |
$1,764.87
|
| Rate for Payer: HFN Commercial |
$1,824.36
|
| Rate for Payer: Multiplan Commercial |
$1,586.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,189.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.36
|
| Rate for Payer: Quartz Beloit One Network |
$971.67
|
| Rate for Payer: Quartz Commercial |
$1,189.80
|
| Rate for Payer: WEA Trust Commercial |
$1,090.65
|
| Rate for Payer: WPS Commercial |
$1,468.81
|
|
|
SHEATH 18FR
|
Facility
|
OP
|
$1,983.00
|
|
| Hospital Charge Code |
2972790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.24 |
| Max. Negotiated Rate |
$7,932.00 |
| Rate for Payer: Aetna Commercial |
$1,784.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,705.38
|
| Rate for Payer: Aetna Managed Medicare |
$555.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,288.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$991.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$951.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,050.99
|
| Rate for Payer: Cash Price |
$594.90
|
| Rate for Payer: Cigna Commercial |
$1,824.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,109.69
|
| Rate for Payer: Health EOS Commercial |
$1,764.87
|
| Rate for Payer: HFN Commercial |
$1,824.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,487.25
|
| Rate for Payer: Multiplan Commercial |
$1,586.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,189.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,824.36
|
| Rate for Payer: Quartz Beloit One Network |
$971.67
|
| Rate for Payer: Quartz Commercial |
$1,288.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,189.80
|
| Rate for Payer: The Alliance Commercial |
$7,932.00
|
| Rate for Payer: WEA Trust Commercial |
$1,090.65
|
| Rate for Payer: WPS Commercial |
$1,468.81
|
|
|
SHEATH 20FR
|
Facility
|
IP
|
$2,884.00
|
|
| Hospital Charge Code |
2973276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,413.16 |
| Max. Negotiated Rate |
$2,653.28 |
| Rate for Payer: Aetna Commercial |
$2,595.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,480.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,528.52
|
| Rate for Payer: Cash Price |
$865.20
|
| Rate for Payer: Cigna Commercial |
$2,653.28
|
| Rate for Payer: Health EOS Commercial |
$2,566.76
|
| Rate for Payer: HFN Commercial |
$2,653.28
|
| Rate for Payer: Multiplan Commercial |
$2,307.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,730.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,653.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,413.16
|
| Rate for Payer: Quartz Commercial |
$1,730.40
|
| Rate for Payer: WEA Trust Commercial |
$1,586.20
|
| Rate for Payer: WPS Commercial |
$2,136.18
|
|
|
SHEATH 20FR
|
Facility
|
OP
|
$2,884.00
|
|
| Hospital Charge Code |
2973276
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$807.52 |
| Max. Negotiated Rate |
$11,536.00 |
| Rate for Payer: Aetna Commercial |
$2,595.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,480.24
|
| Rate for Payer: Aetna Managed Medicare |
$807.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,874.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,442.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,384.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,528.52
|
| Rate for Payer: Cash Price |
$865.20
|
| Rate for Payer: Cigna Commercial |
$2,653.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,613.89
|
| Rate for Payer: Health EOS Commercial |
$2,566.76
|
| Rate for Payer: HFN Commercial |
$2,653.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,163.00
|
| Rate for Payer: Multiplan Commercial |
$2,307.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,730.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,653.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,413.16
|
| Rate for Payer: Quartz Commercial |
$1,874.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,730.40
|
| Rate for Payer: The Alliance Commercial |
$11,536.00
|
| Rate for Payer: WEA Trust Commercial |
$1,586.20
|
| Rate for Payer: WPS Commercial |
$2,136.18
|
|
|
SHEATH 4fr SHUTTLE 110cm
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
2972831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SHEATH 4fr SHUTTLE 110cm
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
2972831
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
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 |
$160.72 |
| Max. Negotiated Rate |
$301.76 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$196.80
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
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 |
$91.84 |
| Max. Negotiated Rate |
$1,312.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Aetna Managed Medicare |
$91.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.55
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$213.20
|
| Rate for Payer: Quartz Medicare Advantage |
$196.80
|
| Rate for Payer: The Alliance Commercial |
$1,312.00
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
