|
Snare Kit 10mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2950270
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,039.42 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,497.25
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
SNARE KIT 10mm GOOSENECK
|
Facility
|
OP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,833.98 |
| Max. Negotiated Rate |
$6,025.93 |
| Rate for Payer: Aetna Commercial |
$5,894.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,833.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,257.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,274.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,143.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,471.46
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$6,025.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,665.44
|
| Rate for Payer: Health EOS Commercial |
$5,829.43
|
| Rate for Payer: HFN Commercial |
$6,025.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,912.44
|
| Rate for Payer: Multiplan Commercial |
$5,239.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,929.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.46
|
| Rate for Payer: Quartz Commercial |
$4,257.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,929.95
|
| Rate for Payer: The Alliance Commercial |
$3,274.96
|
| Rate for Payer: WEA Trust Commercial |
$3,602.46
|
| Rate for Payer: WPS Commercial |
$4,851.35
|
|
|
SNARE KIT 10mm GOOSENECK
|
Facility
|
IP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973399
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,209.46 |
| Max. Negotiated Rate |
$6,025.93 |
| Rate for Payer: Aetna Commercial |
$5,894.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,471.46
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$6,025.93
|
| Rate for Payer: Health EOS Commercial |
$5,829.43
|
| Rate for Payer: HFN Commercial |
$6,025.93
|
| Rate for Payer: Multiplan Commercial |
$5,239.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.46
|
| Rate for Payer: Quartz Commercial |
$3,929.95
|
| Rate for Payer: WEA Trust Commercial |
$3,602.46
|
| Rate for Payer: WPS Commercial |
$4,851.35
|
|
|
Snare Kit 15mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,831.32 |
| Max. Negotiated Rate |
$3,953.98 |
| Rate for Payer: Aetna Commercial |
$3,953.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,953.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,081.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,497.25
|
| Rate for Payer: Health EOS Commercial |
$3,787.49
|
| Rate for Payer: HFN Commercial |
$3,953.98
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,953.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,831.32
|
| Rate for Payer: Quartz Commercial |
$2,372.39
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Kit 15mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,039.42 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,497.25
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Kit 15mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549104
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.38 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,165.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,705.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,081.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,997.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,329.16
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,121.56
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,497.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,705.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,497.25
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
SNARE KIT 2mm GOOSENECK
|
Facility
|
OP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,833.98 |
| Max. Negotiated Rate |
$6,025.93 |
| Rate for Payer: Aetna Commercial |
$5,894.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,833.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,257.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,274.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,143.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,471.46
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$6,025.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,665.44
|
| Rate for Payer: Health EOS Commercial |
$5,829.43
|
| Rate for Payer: HFN Commercial |
$6,025.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,912.44
|
| Rate for Payer: Multiplan Commercial |
$5,239.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,929.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.46
|
| Rate for Payer: Quartz Commercial |
$4,257.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,929.95
|
| Rate for Payer: The Alliance Commercial |
$3,274.96
|
| Rate for Payer: WEA Trust Commercial |
$3,602.46
|
| Rate for Payer: WPS Commercial |
$4,851.35
|
|
|
SNARE KIT 2mm GOOSENECK
|
Facility
|
IP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973675
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,209.46 |
| Max. Negotiated Rate |
$6,025.93 |
| Rate for Payer: Aetna Commercial |
$5,894.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,471.46
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$6,025.93
|
| Rate for Payer: Health EOS Commercial |
$5,829.43
|
| Rate for Payer: HFN Commercial |
$6,025.93
|
| Rate for Payer: Multiplan Commercial |
$5,239.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.46
|
| Rate for Payer: Quartz Commercial |
$3,929.95
|
| Rate for Payer: WEA Trust Commercial |
$3,602.46
|
| Rate for Payer: WPS Commercial |
$4,851.35
|
|
|
SNARE KIT 4mm GOOSENECK #SK400
|
Facility
|
OP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,833.98 |
| Max. Negotiated Rate |
$6,025.93 |
| Rate for Payer: Aetna Commercial |
$5,894.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,833.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,257.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,274.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,143.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,471.46
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$6,025.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,665.44
|
| Rate for Payer: Health EOS Commercial |
$5,829.43
|
| Rate for Payer: HFN Commercial |
$6,025.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,912.44
|
| Rate for Payer: Multiplan Commercial |
$5,239.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,929.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.46
|
| Rate for Payer: Quartz Commercial |
$4,257.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,929.95
|
| Rate for Payer: The Alliance Commercial |
$3,274.96
|
| Rate for Payer: WEA Trust Commercial |
$3,602.46
|
| Rate for Payer: WPS Commercial |
$4,851.35
|
|
|
SNARE KIT 4mm GOOSENECK #SK400
|
Facility
|
IP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973661
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,209.46 |
| Max. Negotiated Rate |
$6,025.93 |
| Rate for Payer: Aetna Commercial |
$5,894.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,471.46
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$6,025.93
|
| Rate for Payer: Health EOS Commercial |
$5,829.43
|
| Rate for Payer: HFN Commercial |
$6,025.93
|
| Rate for Payer: Multiplan Commercial |
$5,239.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.46
|
| Rate for Payer: Quartz Commercial |
$3,929.95
|
| Rate for Payer: WEA Trust Commercial |
$3,602.46
|
| Rate for Payer: WPS Commercial |
$4,851.35
|
|
|
Snare Kit 5mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,831.32 |
| Max. Negotiated Rate |
$3,953.98 |
| Rate for Payer: Aetna Commercial |
$3,953.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,953.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,081.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,497.25
|
| Rate for Payer: Health EOS Commercial |
$3,787.49
|
| Rate for Payer: HFN Commercial |
$3,953.98
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,953.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,831.32
|
| Rate for Payer: Quartz Commercial |
$2,372.39
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Kit 5mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,039.42 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,497.25
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Kit 5mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.38 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,165.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,705.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,081.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,997.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,329.16
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,121.56
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,497.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,705.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,497.25
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
SNARE KIT 5mm GOOSENECK #GN500
|
Facility
|
OP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,833.98 |
| Max. Negotiated Rate |
$6,025.93 |
| Rate for Payer: Aetna Commercial |
$5,894.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.93
|
| Rate for Payer: Aetna Managed Medicare |
$1,833.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,257.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,274.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,143.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,471.46
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$6,025.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,665.44
|
| Rate for Payer: Health EOS Commercial |
$5,829.43
|
| Rate for Payer: HFN Commercial |
$6,025.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,912.44
|
| Rate for Payer: Multiplan Commercial |
$5,239.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,929.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.46
|
| Rate for Payer: Quartz Commercial |
$4,257.45
|
| Rate for Payer: Quartz Medicare Advantage |
$3,929.95
|
| Rate for Payer: The Alliance Commercial |
$3,274.96
|
| Rate for Payer: WEA Trust Commercial |
$3,602.46
|
| Rate for Payer: WPS Commercial |
$4,851.35
|
|
|
SNARE KIT 5mm GOOSENECK #GN500
|
Facility
|
IP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973433
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,209.46 |
| Max. Negotiated Rate |
$6,025.93 |
| Rate for Payer: Aetna Commercial |
$5,894.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,632.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,471.46
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$6,025.93
|
| Rate for Payer: Health EOS Commercial |
$5,829.43
|
| Rate for Payer: HFN Commercial |
$6,025.93
|
| Rate for Payer: Multiplan Commercial |
$5,239.94
|
| Rate for Payer: Preferred Network Access Commercial |
$6,025.93
|
| Rate for Payer: Quartz Beloit One Network |
$3,209.46
|
| Rate for Payer: Quartz Commercial |
$3,929.95
|
| Rate for Payer: WEA Trust Commercial |
$3,602.46
|
| Rate for Payer: WPS Commercial |
$4,851.35
|
|
|
Snare Micro Kit 2mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.38 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,165.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,705.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,081.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,997.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,329.16
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,121.56
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,497.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,705.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,497.25
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Micro Kit 2mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,039.42 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,497.25
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Micro Kit 2mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,831.32 |
| Max. Negotiated Rate |
$3,953.98 |
| Rate for Payer: Aetna Commercial |
$3,953.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,953.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,081.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,497.25
|
| Rate for Payer: Health EOS Commercial |
$3,787.49
|
| Rate for Payer: HFN Commercial |
$3,953.98
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,953.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,831.32
|
| Rate for Payer: Quartz Commercial |
$2,372.39
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Micro Kit 4mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,831.32 |
| Max. Negotiated Rate |
$3,953.98 |
| Rate for Payer: Aetna Commercial |
$3,953.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,953.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,081.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,497.25
|
| Rate for Payer: Health EOS Commercial |
$3,787.49
|
| Rate for Payer: HFN Commercial |
$3,953.98
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,953.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,831.32
|
| Rate for Payer: Quartz Commercial |
$2,372.39
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Micro Kit 4mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,039.42 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,497.25
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Micro Kit 4mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.38 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,165.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,705.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,081.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,997.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,329.16
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,121.56
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,497.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,705.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,497.25
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Micro Kit 7mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,039.42 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,497.25
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Micro Kit 7mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,165.38 |
| Max. Negotiated Rate |
$3,829.11 |
| Rate for Payer: Aetna Commercial |
$3,745.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Aetna Managed Medicare |
$1,165.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,705.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,081.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,997.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,205.90
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,829.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,329.16
|
| Rate for Payer: Health EOS Commercial |
$3,704.25
|
| Rate for Payer: HFN Commercial |
$3,829.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,121.56
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,497.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,829.11
|
| Rate for Payer: Quartz Beloit One Network |
$2,039.42
|
| Rate for Payer: Quartz Commercial |
$2,705.35
|
| Rate for Payer: Quartz Medicare Advantage |
$2,497.25
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
Snare Micro Kit 7mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,831.32 |
| Max. Negotiated Rate |
$3,953.98 |
| Rate for Payer: Aetna Commercial |
$3,953.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,579.39
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,953.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,081.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,497.25
|
| Rate for Payer: Health EOS Commercial |
$3,787.49
|
| Rate for Payer: HFN Commercial |
$3,953.98
|
| Rate for Payer: Multiplan Commercial |
$3,329.66
|
| Rate for Payer: Preferred Network Access Commercial |
$3,953.98
|
| Rate for Payer: Quartz Beloit One Network |
$1,831.32
|
| Rate for Payer: Quartz Commercial |
$2,372.39
|
| Rate for Payer: The Alliance Commercial |
$2,081.04
|
| Rate for Payer: WEA Trust Commercial |
$2,289.14
|
| Rate for Payer: WPS Commercial |
$3,082.74
|
|
|
SNARE SENSATION M00562673
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
5591389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.86 |
| Max. Negotiated Rate |
$199.97 |
| Rate for Payer: Aetna Commercial |
$195.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$186.93
|
| Rate for Payer: Aetna Managed Medicare |
$60.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$141.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$108.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$115.20
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$199.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.64
|
| Rate for Payer: Health EOS Commercial |
$193.45
|
| Rate for Payer: HFN Commercial |
$199.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$163.02
|
| Rate for Payer: Multiplan Commercial |
$173.89
|
| Rate for Payer: NAPHCARE Commercial |
$130.42
|
| Rate for Payer: Preferred Network Access Commercial |
$199.97
|
| Rate for Payer: Quartz Beloit One Network |
$106.51
|
| Rate for Payer: Quartz Commercial |
$141.28
|
| Rate for Payer: Quartz Medicare Advantage |
$130.42
|
| Rate for Payer: The Alliance Commercial |
$108.68
|
| Rate for Payer: WEA Trust Commercial |
$119.55
|
| Rate for Payer: WPS Commercial |
$160.99
|
|
