|
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 |
$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 S & N 1912004
|
Facility
|
OP
|
$1,109.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3157462
|
|
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
|
|
|
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 |
$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 30 DEG FOR S & N 1912014
|
Facility
|
OP
|
$1,109.00
|
|
| Hospital Charge Code |
2965316
|
|
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
|
|
|
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 |
$399.56 |
| Max. Negotiated Rate |
$5,708.00 |
| Rate for Payer: Aetna Commercial |
$1,284.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.22
|
| Rate for Payer: Aetna Managed Medicare |
$399.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$927.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$713.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$684.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.31
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,312.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$798.55
|
| Rate for Payer: Health EOS Commercial |
$1,270.03
|
| Rate for Payer: HFN Commercial |
$1,312.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,070.25
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: NAPHCARE Commercial |
$856.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,312.84
|
| Rate for Payer: Quartz Beloit One Network |
$699.23
|
| Rate for Payer: Quartz Commercial |
$927.55
|
| Rate for Payer: Quartz Medicare Advantage |
$856.20
|
| Rate for Payer: The Alliance Commercial |
$5,708.00
|
| Rate for Payer: WEA Trust Commercial |
$784.85
|
| Rate for Payer: WPS Commercial |
$1,056.98
|
|
|
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 |
$699.23 |
| Max. Negotiated Rate |
$1,312.84 |
| Rate for Payer: Aetna Commercial |
$1,284.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,227.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.31
|
| Rate for Payer: Cash Price |
$428.10
|
| Rate for Payer: Cigna Commercial |
$1,312.84
|
| Rate for Payer: Health EOS Commercial |
$1,270.03
|
| Rate for Payer: HFN Commercial |
$1,312.84
|
| Rate for Payer: Multiplan Commercial |
$1,141.60
|
| Rate for Payer: NAPHCARE Commercial |
$856.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,312.84
|
| Rate for Payer: Quartz Beloit One Network |
$699.23
|
| Rate for Payer: Quartz Commercial |
$856.20
|
| Rate for Payer: WEA Trust Commercial |
$784.85
|
| Rate for Payer: WPS Commercial |
$1,056.98
|
|
|
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 |
$460.11 |
| Max. Negotiated Rate |
$863.88 |
| Rate for Payer: Aetna Commercial |
$845.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$807.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.67
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$863.88
|
| Rate for Payer: Health EOS Commercial |
$835.71
|
| Rate for Payer: HFN Commercial |
$863.88
|
| Rate for Payer: Multiplan Commercial |
$751.20
|
| Rate for Payer: NAPHCARE Commercial |
$563.40
|
| Rate for Payer: Preferred Network Access Commercial |
$863.88
|
| Rate for Payer: Quartz Beloit One Network |
$460.11
|
| Rate for Payer: Quartz Commercial |
$563.40
|
| Rate for Payer: WEA Trust Commercial |
$516.45
|
| Rate for Payer: WPS Commercial |
$695.52
|
|
|
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 |
$262.92 |
| Max. Negotiated Rate |
$3,756.00 |
| Rate for Payer: Aetna Commercial |
$845.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$807.54
|
| Rate for Payer: Aetna Managed Medicare |
$262.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$610.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$469.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$450.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$497.67
|
| Rate for Payer: Cash Price |
$281.70
|
| Rate for Payer: Cigna Commercial |
$863.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$525.46
|
| Rate for Payer: Health EOS Commercial |
$835.71
|
| Rate for Payer: HFN Commercial |
$863.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$704.25
|
| Rate for Payer: Multiplan Commercial |
$751.20
|
| Rate for Payer: NAPHCARE Commercial |
$563.40
|
| Rate for Payer: Preferred Network Access Commercial |
$863.88
|
| Rate for Payer: Quartz Beloit One Network |
$460.11
|
| Rate for Payer: Quartz Commercial |
$610.35
|
| Rate for Payer: Quartz Medicare Advantage |
$563.40
|
| Rate for Payer: The Alliance Commercial |
$3,756.00
|
| Rate for Payer: WEA Trust Commercial |
$516.45
|
| Rate for Payer: WPS Commercial |
$695.52
|
|
|
SHEATH INTRODUCER 6fr SUPER
|
Facility
|
OP
|
$292.00
|
|
| Hospital Charge Code |
2972709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.76 |
| Max. Negotiated Rate |
$1,168.00 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Aetna Managed Medicare |
$81.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.40
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.00
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$189.80
|
| Rate for Payer: Quartz Medicare Advantage |
$175.20
|
| Rate for Payer: The Alliance Commercial |
$1,168.00
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
SHEATH INTRODUCER 6fr SUPER
|
Facility
|
IP
|
$292.00
|
|
| Hospital Charge Code |
2972709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$268.64 |
| Rate for Payer: Aetna Commercial |
$262.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.76
|
| Rate for Payer: Cash Price |
$87.60
|
| Rate for Payer: Cigna Commercial |
$268.64
|
| Rate for Payer: Health EOS Commercial |
$259.88
|
| Rate for Payer: HFN Commercial |
$268.64
|
| Rate for Payer: Multiplan Commercial |
$233.60
|
| Rate for Payer: NAPHCARE Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$268.64
|
| Rate for Payer: Quartz Beloit One Network |
$143.08
|
| Rate for Payer: Quartz Commercial |
$175.20
|
| Rate for Payer: WEA Trust Commercial |
$160.60
|
| Rate for Payer: WPS Commercial |
$216.28
|
|
|
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 |
$295.12 |
| Max. Negotiated Rate |
$4,216.00 |
| Rate for Payer: Aetna Commercial |
$948.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$906.44
|
| Rate for Payer: Aetna Managed Medicare |
$295.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$685.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$527.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$505.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$558.62
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$969.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$589.82
|
| Rate for Payer: Health EOS Commercial |
$938.06
|
| Rate for Payer: HFN Commercial |
$969.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$790.50
|
| Rate for Payer: Multiplan Commercial |
$843.20
|
| Rate for Payer: NAPHCARE Commercial |
$632.40
|
| Rate for Payer: Preferred Network Access Commercial |
$969.68
|
| Rate for Payer: Quartz Beloit One Network |
$516.46
|
| Rate for Payer: Quartz Commercial |
$685.10
|
| Rate for Payer: Quartz Medicare Advantage |
$632.40
|
| Rate for Payer: The Alliance Commercial |
$4,216.00
|
| Rate for Payer: WEA Trust Commercial |
$579.70
|
| Rate for Payer: WPS Commercial |
$780.70
|
|
|
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 |
$516.46 |
| Max. Negotiated Rate |
$969.68 |
| Rate for Payer: Aetna Commercial |
$948.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$906.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$558.62
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$969.68
|
| Rate for Payer: Health EOS Commercial |
$938.06
|
| Rate for Payer: HFN Commercial |
$969.68
|
| Rate for Payer: Multiplan Commercial |
$843.20
|
| Rate for Payer: NAPHCARE Commercial |
$632.40
|
| Rate for Payer: Preferred Network Access Commercial |
$969.68
|
| Rate for Payer: Quartz Beloit One Network |
$516.46
|
| Rate for Payer: Quartz Commercial |
$632.40
|
| Rate for Payer: WEA Trust Commercial |
$579.70
|
| Rate for Payer: WPS Commercial |
$780.70
|
|
|
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 |
$497.84 |
| Max. Negotiated Rate |
$934.72 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$609.60
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
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 |
$284.48 |
| Max. Negotiated Rate |
$4,064.00 |
| Rate for Payer: Aetna Commercial |
$914.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$873.76
|
| Rate for Payer: Aetna Managed Medicare |
$284.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$660.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$508.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$487.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$538.48
|
| Rate for Payer: Cash Price |
$304.80
|
| Rate for Payer: Cigna Commercial |
$934.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$568.55
|
| Rate for Payer: Health EOS Commercial |
$904.24
|
| Rate for Payer: HFN Commercial |
$934.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$762.00
|
| Rate for Payer: Multiplan Commercial |
$812.80
|
| Rate for Payer: NAPHCARE Commercial |
$609.60
|
| Rate for Payer: Preferred Network Access Commercial |
$934.72
|
| Rate for Payer: Quartz Beloit One Network |
$497.84
|
| Rate for Payer: Quartz Commercial |
$660.40
|
| Rate for Payer: Quartz Medicare Advantage |
$609.60
|
| Rate for Payer: The Alliance Commercial |
$4,064.00
|
| Rate for Payer: WEA Trust Commercial |
$558.80
|
| Rate for Payer: WPS Commercial |
$752.55
|
|
|
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 |
$93.52 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Aetna Managed Medicare |
$93.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.91
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$217.10
|
| Rate for Payer: Quartz Medicare Advantage |
$200.40
|
| Rate for Payer: The Alliance Commercial |
$1,336.00
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
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 |
$163.66 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$200.40
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
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 |
$163.66 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$200.40
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
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 |
$93.52 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Aetna Managed Medicare |
$93.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.91
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$217.10
|
| Rate for Payer: Quartz Medicare Advantage |
$200.40
|
| Rate for Payer: The Alliance Commercial |
$1,336.00
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
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 |
$1,281.84 |
| Max. Negotiated Rate |
$2,406.72 |
| Rate for Payer: Aetna Commercial |
$2,354.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,249.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.48
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,406.72
|
| Rate for Payer: Health EOS Commercial |
$2,328.24
|
| Rate for Payer: HFN Commercial |
$2,406.72
|
| Rate for Payer: Multiplan Commercial |
$2,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,569.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,406.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.84
|
| Rate for Payer: Quartz Commercial |
$1,569.60
|
| Rate for Payer: WEA Trust Commercial |
$1,438.80
|
| Rate for Payer: WPS Commercial |
$1,937.67
|
|
|
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 |
$732.48 |
| Max. Negotiated Rate |
$10,464.00 |
| Rate for Payer: Aetna Commercial |
$2,354.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,249.76
|
| Rate for Payer: Aetna Managed Medicare |
$732.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,700.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,308.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,255.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.48
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,463.91
|
| Rate for Payer: Health EOS Commercial |
$2,328.24
|
| Rate for Payer: HFN Commercial |
$2,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,962.00
|
| Rate for Payer: Multiplan Commercial |
$2,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,569.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,406.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.84
|
| Rate for Payer: Quartz Commercial |
$1,700.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,569.60
|
| Rate for Payer: The Alliance Commercial |
$10,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,438.80
|
| Rate for Payer: WPS Commercial |
$1,937.67
|
|
|
SHEATH SAFESHEATH 7FR
|
Facility
|
OP
|
$2,616.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$732.48 |
| Max. Negotiated Rate |
$10,464.00 |
| Rate for Payer: Aetna Commercial |
$2,354.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,249.76
|
| Rate for Payer: Aetna Managed Medicare |
$732.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,700.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,308.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,255.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.48
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,463.91
|
| Rate for Payer: Health EOS Commercial |
$2,328.24
|
| Rate for Payer: HFN Commercial |
$2,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,962.00
|
| Rate for Payer: Multiplan Commercial |
$2,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,569.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,406.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.84
|
| Rate for Payer: Quartz Commercial |
$1,700.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,569.60
|
| Rate for Payer: The Alliance Commercial |
$10,464.00
|
| Rate for Payer: WEA Trust Commercial |
$1,438.80
|
| Rate for Payer: WPS Commercial |
$1,937.67
|
|
|
SHEATH SAFESHEATH 7FR
|
Facility
|
IP
|
$2,616.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,281.84 |
| Max. Negotiated Rate |
$2,406.72 |
| Rate for Payer: Aetna Commercial |
$2,354.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,249.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,386.48
|
| Rate for Payer: Cash Price |
$784.80
|
| Rate for Payer: Cigna Commercial |
$2,406.72
|
| Rate for Payer: Health EOS Commercial |
$2,328.24
|
| Rate for Payer: HFN Commercial |
$2,406.72
|
| Rate for Payer: Multiplan Commercial |
$2,092.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,569.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,406.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,281.84
|
| Rate for Payer: Quartz Commercial |
$1,569.60
|
| Rate for Payer: WEA Trust Commercial |
$1,438.80
|
| Rate for Payer: WPS Commercial |
$1,937.67
|
|
|
SHEATH SAFESHEATH 9FR #HLS1009M
|
Facility
|
IP
|
$317.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
2972099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$155.33 |
| Max. Negotiated Rate |
$291.64 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$190.20
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
SHEATH SAFESHEATH 9FR #HLS1009M
|
Facility
|
OP
|
$317.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
2972099
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$88.76 |
| Max. Negotiated Rate |
$1,268.00 |
| Rate for Payer: Aetna Commercial |
$285.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.62
|
| Rate for Payer: Aetna Managed Medicare |
$88.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$158.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$152.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.01
|
| Rate for Payer: Cash Price |
$95.10
|
| Rate for Payer: Cigna Commercial |
$291.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.39
|
| Rate for Payer: Health EOS Commercial |
$282.13
|
| Rate for Payer: HFN Commercial |
$291.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$237.75
|
| Rate for Payer: Multiplan Commercial |
$253.60
|
| Rate for Payer: NAPHCARE Commercial |
$190.20
|
| Rate for Payer: Preferred Network Access Commercial |
$291.64
|
| Rate for Payer: Quartz Beloit One Network |
$155.33
|
| Rate for Payer: Quartz Commercial |
$206.05
|
| Rate for Payer: Quartz Medicare Advantage |
$190.20
|
| Rate for Payer: The Alliance Commercial |
$1,268.00
|
| Rate for Payer: WEA Trust Commercial |
$174.35
|
| Rate for Payer: WPS Commercial |
$234.80
|
|
|
SHEATH SAFESHEATH LONG
|
Facility
|
IP
|
$1,336.00
|
|
| Hospital Charge Code |
2972183
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$654.64 |
| Max. Negotiated Rate |
$1,229.12 |
| Rate for Payer: Aetna Commercial |
$1,202.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,148.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$708.08
|
| Rate for Payer: Cash Price |
$400.80
|
| Rate for Payer: Cigna Commercial |
$1,229.12
|
| Rate for Payer: Health EOS Commercial |
$1,189.04
|
| Rate for Payer: HFN Commercial |
$1,229.12
|
| Rate for Payer: Multiplan Commercial |
$1,068.80
|
| Rate for Payer: NAPHCARE Commercial |
$801.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,229.12
|
| Rate for Payer: Quartz Beloit One Network |
$654.64
|
| Rate for Payer: Quartz Commercial |
$801.60
|
| Rate for Payer: WEA Trust Commercial |
$734.80
|
| Rate for Payer: WPS Commercial |
$989.58
|
|
