|
Sheath Brite Tip 7Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Sheath Brite Tip 7Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550848
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Sheath Brite Tip 7Fr 23cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Sheath Brite Tip 7Fr 23cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Sheath Brite Tip 7Fr 23cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550890
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
SHEATH BRITE TIP 7F X 11CM WITH 3MM-J .035 GW 401-711M
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
SHEATH BRITE TIP 7F X 11CM WITH 3MM-J .035 GW 401-711M
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201009
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.92 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$94.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$220.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.25
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$203.40
|
| Rate for Payer: The Alliance Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
Sheath Brite Tip 8Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Sheath Brite Tip 8Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Sheath Brite Tip 8Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550850
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Sheath Brite Tip 8Fr 23cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Sheath Brite Tip 8Fr 23cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.88 |
| Max. Negotiated Rate |
$1,284.00 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Aetna Managed Medicare |
$89.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.63
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.75
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$208.65
|
| Rate for Payer: Quartz Medicare Advantage |
$192.60
|
| Rate for Payer: The Alliance Commercial |
$1,284.00
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
Sheath Brite Tip 8Fr 23cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550892
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
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 |
$94.92 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$94.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$220.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.25
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$203.40
|
| Rate for Payer: The Alliance Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
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 |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
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 |
$521.85 |
| Max. Negotiated Rate |
$979.80 |
| Rate for Payer: Aetna Commercial |
$958.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$915.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.45
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$979.80
|
| Rate for Payer: Health EOS Commercial |
$947.85
|
| Rate for Payer: HFN Commercial |
$979.80
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: NAPHCARE Commercial |
$639.00
|
| Rate for Payer: Preferred Network Access Commercial |
$979.80
|
| Rate for Payer: Quartz Beloit One Network |
$521.85
|
| Rate for Payer: Quartz Commercial |
$639.00
|
| Rate for Payer: WEA Trust Commercial |
$585.75
|
| Rate for Payer: WPS Commercial |
$788.85
|
|
|
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 |
$298.20 |
| Max. Negotiated Rate |
$4,260.00 |
| Rate for Payer: Aetna Commercial |
$958.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$915.90
|
| Rate for Payer: Aetna Managed Medicare |
$298.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$692.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$532.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$511.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.45
|
| Rate for Payer: Cash Price |
$319.50
|
| Rate for Payer: Cigna Commercial |
$979.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$595.97
|
| Rate for Payer: Health EOS Commercial |
$947.85
|
| Rate for Payer: HFN Commercial |
$979.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$798.75
|
| Rate for Payer: Multiplan Commercial |
$852.00
|
| Rate for Payer: NAPHCARE Commercial |
$639.00
|
| Rate for Payer: Preferred Network Access Commercial |
$979.80
|
| Rate for Payer: Quartz Beloit One Network |
$521.85
|
| Rate for Payer: Quartz Commercial |
$692.25
|
| Rate for Payer: Quartz Medicare Advantage |
$639.00
|
| Rate for Payer: The Alliance Commercial |
$4,260.00
|
| Rate for Payer: WEA Trust Commercial |
$585.75
|
| Rate for Payer: WPS Commercial |
$788.85
|
|
|
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 |
$426.72 |
| Max. Negotiated Rate |
$6,096.00 |
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Aetna Managed Medicare |
$426.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$990.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$731.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$852.83
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.00
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$990.60
|
| Rate for Payer: Quartz Medicare Advantage |
$914.40
|
| Rate for Payer: The Alliance Commercial |
$6,096.00
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
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 |
$746.76 |
| Max. Negotiated Rate |
$1,402.08 |
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$914.40
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
|
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 |
$500.29 |
| Max. Negotiated Rate |
$939.32 |
| Rate for Payer: Aetna Commercial |
$918.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.13
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$939.32
|
| Rate for Payer: Health EOS Commercial |
$908.69
|
| Rate for Payer: HFN Commercial |
$939.32
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: NAPHCARE Commercial |
$612.60
|
| Rate for Payer: Preferred Network Access Commercial |
$939.32
|
| Rate for Payer: Quartz Beloit One Network |
$500.29
|
| Rate for Payer: Quartz Commercial |
$612.60
|
| Rate for Payer: WEA Trust Commercial |
$561.55
|
| Rate for Payer: WPS Commercial |
$756.25
|
|
|
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 |
$285.88 |
| Max. Negotiated Rate |
$4,084.00 |
| Rate for Payer: Aetna Commercial |
$918.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$878.06
|
| Rate for Payer: Aetna Managed Medicare |
$285.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$663.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$510.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$490.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$541.13
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$939.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$571.35
|
| Rate for Payer: Health EOS Commercial |
$908.69
|
| Rate for Payer: HFN Commercial |
$939.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$765.75
|
| Rate for Payer: Multiplan Commercial |
$816.80
|
| Rate for Payer: NAPHCARE Commercial |
$612.60
|
| Rate for Payer: Preferred Network Access Commercial |
$939.32
|
| Rate for Payer: Quartz Beloit One Network |
$500.29
|
| Rate for Payer: Quartz Commercial |
$663.65
|
| Rate for Payer: Quartz Medicare Advantage |
$612.60
|
| Rate for Payer: The Alliance Commercial |
$4,084.00
|
| Rate for Payer: WEA Trust Commercial |
$561.55
|
| Rate for Payer: WPS Commercial |
$756.25
|
|
|
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 |
$288.68 |
| Max. Negotiated Rate |
$4,124.00 |
| Rate for Payer: Aetna Commercial |
$927.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.66
|
| Rate for Payer: Aetna Managed Medicare |
$288.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$670.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.43
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$948.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.95
|
| Rate for Payer: Health EOS Commercial |
$917.59
|
| Rate for Payer: HFN Commercial |
$948.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$773.25
|
| Rate for Payer: Multiplan Commercial |
$824.80
|
| Rate for Payer: NAPHCARE Commercial |
$618.60
|
| Rate for Payer: Preferred Network Access Commercial |
$948.52
|
| Rate for Payer: Quartz Beloit One Network |
$505.19
|
| Rate for Payer: Quartz Commercial |
$670.15
|
| Rate for Payer: Quartz Medicare Advantage |
$618.60
|
| Rate for Payer: The Alliance Commercial |
$4,124.00
|
| Rate for Payer: WEA Trust Commercial |
$567.05
|
| Rate for Payer: WPS Commercial |
$763.66
|
|
|
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 |
$505.19 |
| Max. Negotiated Rate |
$948.52 |
| Rate for Payer: Aetna Commercial |
$927.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.43
|
| Rate for Payer: Cash Price |
$309.30
|
| Rate for Payer: Cigna Commercial |
$948.52
|
| Rate for Payer: Health EOS Commercial |
$917.59
|
| Rate for Payer: HFN Commercial |
$948.52
|
| Rate for Payer: Multiplan Commercial |
$824.80
|
| Rate for Payer: NAPHCARE Commercial |
$618.60
|
| Rate for Payer: Preferred Network Access Commercial |
$948.52
|
| Rate for Payer: Quartz Beloit One Network |
$505.19
|
| Rate for Payer: Quartz Commercial |
$618.60
|
| Rate for Payer: WEA Trust Commercial |
$567.05
|
| Rate for Payer: WPS Commercial |
$763.66
|
|
|
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 |
$543.41 |
| Max. Negotiated Rate |
$1,020.28 |
| Rate for Payer: Aetna Commercial |
$998.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$953.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$587.77
|
| Rate for Payer: Cash Price |
$332.70
|
| Rate for Payer: Cigna Commercial |
$1,020.28
|
| Rate for Payer: Health EOS Commercial |
$987.01
|
| Rate for Payer: HFN Commercial |
$1,020.28
|
| Rate for Payer: Multiplan Commercial |
$887.20
|
| Rate for Payer: NAPHCARE Commercial |
$665.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,020.28
|
| Rate for Payer: Quartz Beloit One Network |
$543.41
|
| Rate for Payer: Quartz Commercial |
$665.40
|
| Rate for Payer: WEA Trust Commercial |
$609.95
|
| Rate for Payer: WPS Commercial |
$821.44
|
|
|
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 |
$310.52 |
| Max. Negotiated Rate |
$4,436.00 |
| Rate for Payer: Aetna Commercial |
$998.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$953.74
|
| Rate for Payer: Aetna Managed Medicare |
$310.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$720.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$554.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$532.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$587.77
|
| Rate for Payer: Cash Price |
$332.70
|
| Rate for Payer: Cigna Commercial |
$1,020.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$620.60
|
| Rate for Payer: Health EOS Commercial |
$987.01
|
| Rate for Payer: HFN Commercial |
$1,020.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$831.75
|
| Rate for Payer: Multiplan Commercial |
$887.20
|
| Rate for Payer: NAPHCARE Commercial |
$665.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,020.28
|
| Rate for Payer: Quartz Beloit One Network |
$543.41
|
| Rate for Payer: Quartz Commercial |
$720.85
|
| Rate for Payer: Quartz Medicare Advantage |
$665.40
|
| Rate for Payer: The Alliance Commercial |
$4,436.00
|
| Rate for Payer: WEA Trust Commercial |
$609.95
|
| Rate for Payer: WPS Commercial |
$821.44
|
|
