|
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 |
$1,763.44 |
| Max. Negotiated Rate |
$25,192.00 |
| Rate for Payer: Aetna Commercial |
$5,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,416.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,763.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,093.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,023.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,337.94
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$5,794.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,524.36
|
| Rate for Payer: Health EOS Commercial |
$5,605.22
|
| Rate for Payer: HFN Commercial |
$5,794.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,723.50
|
| Rate for Payer: Multiplan Commercial |
$5,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,794.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,086.02
|
| Rate for Payer: Quartz Commercial |
$4,093.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,778.80
|
| Rate for Payer: The Alliance Commercial |
$25,192.00
|
| Rate for Payer: WEA Trust Commercial |
$3,463.90
|
| Rate for Payer: WPS Commercial |
$4,664.93
|
|
|
Snare Kit 5mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.56 |
| Max. Negotiated Rate |
$16,008.00 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,601.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,920.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,239.52
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,001.50
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,601.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,401.20
|
| Rate for Payer: The Alliance Commercial |
$16,008.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
Snare Kit 5mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,960.98 |
| Max. Negotiated Rate |
$3,681.84 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,401.20
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
Snare Kit 5mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,760.88 |
| Max. Negotiated Rate |
$3,801.90 |
| Rate for Payer: Aetna Commercial |
$3,801.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,801.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,001.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,401.20
|
| Rate for Payer: Health EOS Commercial |
$3,641.82
|
| Rate for Payer: HFN Commercial |
$3,801.90
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,801.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,760.88
|
| Rate for Payer: Quartz Commercial |
$2,281.14
|
| Rate for Payer: The Alliance Commercial |
$2,001.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
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 |
$3,086.02 |
| Max. Negotiated Rate |
$5,794.16 |
| Rate for Payer: Aetna Commercial |
$5,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,416.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,337.94
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$5,794.16
|
| Rate for Payer: Health EOS Commercial |
$5,605.22
|
| Rate for Payer: HFN Commercial |
$5,794.16
|
| Rate for Payer: Multiplan Commercial |
$5,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,794.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,086.02
|
| Rate for Payer: Quartz Commercial |
$3,778.80
|
| Rate for Payer: WEA Trust Commercial |
$3,463.90
|
| Rate for Payer: WPS Commercial |
$4,664.93
|
|
|
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 |
$1,763.44 |
| Max. Negotiated Rate |
$25,192.00 |
| Rate for Payer: Aetna Commercial |
$5,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,416.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,763.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,093.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,023.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,337.94
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$5,794.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,524.36
|
| Rate for Payer: Health EOS Commercial |
$5,605.22
|
| Rate for Payer: HFN Commercial |
$5,794.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,723.50
|
| Rate for Payer: Multiplan Commercial |
$5,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,794.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,086.02
|
| Rate for Payer: Quartz Commercial |
$4,093.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,778.80
|
| Rate for Payer: The Alliance Commercial |
$25,192.00
|
| Rate for Payer: WEA Trust Commercial |
$3,463.90
|
| Rate for Payer: WPS Commercial |
$4,664.93
|
|
|
Snare Micro Kit 2mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,960.98 |
| Max. Negotiated Rate |
$3,681.84 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,401.20
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
Snare Micro Kit 2mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,760.88 |
| Max. Negotiated Rate |
$3,801.90 |
| Rate for Payer: Aetna Commercial |
$3,801.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,801.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,001.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,401.20
|
| Rate for Payer: Health EOS Commercial |
$3,641.82
|
| Rate for Payer: HFN Commercial |
$3,801.90
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,801.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,760.88
|
| Rate for Payer: Quartz Commercial |
$2,281.14
|
| Rate for Payer: The Alliance Commercial |
$2,001.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
Snare Micro Kit 2mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549096
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.56 |
| Max. Negotiated Rate |
$16,008.00 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,601.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,920.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,239.52
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,001.50
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,601.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,401.20
|
| Rate for Payer: The Alliance Commercial |
$16,008.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
Snare Micro Kit 4mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,960.98 |
| Max. Negotiated Rate |
$3,681.84 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,401.20
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
Snare Micro Kit 4mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,760.88 |
| Max. Negotiated Rate |
$3,801.90 |
| Rate for Payer: Aetna Commercial |
$3,801.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,801.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,001.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,401.20
|
| Rate for Payer: Health EOS Commercial |
$3,641.82
|
| Rate for Payer: HFN Commercial |
$3,801.90
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,801.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,760.88
|
| Rate for Payer: Quartz Commercial |
$2,281.14
|
| Rate for Payer: The Alliance Commercial |
$2,001.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
Snare Micro Kit 4mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549098
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.56 |
| Max. Negotiated Rate |
$16,008.00 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,601.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,920.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,239.52
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,001.50
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,601.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,401.20
|
| Rate for Payer: The Alliance Commercial |
$16,008.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
Snare Micro Kit 7mm
|
Facility
|
IP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,960.98 |
| Max. Negotiated Rate |
$3,681.84 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,401.20
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
Snare Micro Kit 7mm
|
Facility
|
OP
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,120.56 |
| Max. Negotiated Rate |
$16,008.00 |
| Rate for Payer: Aetna Commercial |
$3,601.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,120.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,601.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,001.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,920.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,121.06
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,681.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,239.52
|
| Rate for Payer: Health EOS Commercial |
$3,561.78
|
| Rate for Payer: HFN Commercial |
$3,681.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,001.50
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,401.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,681.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,960.98
|
| Rate for Payer: Quartz Commercial |
$2,601.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,401.20
|
| Rate for Payer: The Alliance Commercial |
$16,008.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
Snare Micro Kit 7mm
|
Professional
|
Both
|
$4,002.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2549100
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,760.88 |
| Max. Negotiated Rate |
$3,801.90 |
| Rate for Payer: Aetna Commercial |
$3,801.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,441.72
|
| Rate for Payer: Cash Price |
$1,200.60
|
| Rate for Payer: Cigna Commercial |
$3,801.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,001.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,401.20
|
| Rate for Payer: Health EOS Commercial |
$3,641.82
|
| Rate for Payer: HFN Commercial |
$3,801.90
|
| Rate for Payer: Multiplan Commercial |
$3,201.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,801.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,760.88
|
| Rate for Payer: Quartz Commercial |
$2,281.14
|
| Rate for Payer: The Alliance Commercial |
$2,001.00
|
| Rate for Payer: WEA Trust Commercial |
$2,201.10
|
| Rate for Payer: WPS Commercial |
$2,964.28
|
|
|
SNARE SENSATION M00562673
|
Facility
|
IP
|
$209.00
|
|
| Hospital Charge Code |
5591389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$102.41 |
| Max. Negotiated Rate |
$192.28 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.77
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$192.28
|
| Rate for Payer: Health EOS Commercial |
$186.01
|
| Rate for Payer: HFN Commercial |
$192.28
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: NAPHCARE Commercial |
$125.40
|
| Rate for Payer: Preferred Network Access Commercial |
$192.28
|
| Rate for Payer: Quartz Beloit One Network |
$102.41
|
| Rate for Payer: Quartz Commercial |
$125.40
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: WPS Commercial |
$154.81
|
|
|
SNARE SENSATION M00562673
|
Facility
|
OP
|
$209.00
|
|
| Hospital Charge Code |
5591389
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$58.52 |
| Max. Negotiated Rate |
$836.00 |
| Rate for Payer: Aetna Commercial |
$188.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.74
|
| Rate for Payer: Aetna Managed Medicare |
$58.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.77
|
| Rate for Payer: Cash Price |
$62.70
|
| Rate for Payer: Cigna Commercial |
$192.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.96
|
| Rate for Payer: Health EOS Commercial |
$186.01
|
| Rate for Payer: HFN Commercial |
$192.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.75
|
| Rate for Payer: Multiplan Commercial |
$167.20
|
| Rate for Payer: NAPHCARE Commercial |
$125.40
|
| Rate for Payer: Preferred Network Access Commercial |
$192.28
|
| Rate for Payer: Quartz Beloit One Network |
$102.41
|
| Rate for Payer: Quartz Commercial |
$135.85
|
| Rate for Payer: Quartz Medicare Advantage |
$125.40
|
| Rate for Payer: The Alliance Commercial |
$836.00
|
| Rate for Payer: WEA Trust Commercial |
$114.95
|
| Rate for Payer: WPS Commercial |
$154.81
|
|
|
SNARE SYSM MINI 4-8 #EN1003008
|
Facility
|
OP
|
$6,654.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,863.12 |
| Max. Negotiated Rate |
$26,616.00 |
| Rate for Payer: Aetna Commercial |
$5,988.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,722.44
|
| Rate for Payer: Aetna Managed Medicare |
$1,863.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,325.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,327.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,193.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,526.62
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Cigna Commercial |
$6,121.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,723.58
|
| Rate for Payer: Health EOS Commercial |
$5,922.06
|
| Rate for Payer: HFN Commercial |
$6,121.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,990.50
|
| Rate for Payer: Multiplan Commercial |
$5,323.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,992.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,121.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,260.46
|
| Rate for Payer: Quartz Commercial |
$4,325.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,992.40
|
| Rate for Payer: The Alliance Commercial |
$26,616.00
|
| Rate for Payer: WEA Trust Commercial |
$3,659.70
|
| Rate for Payer: WPS Commercial |
$4,928.62
|
|
|
SNARE SYSM MINI 4-8 #EN1003008
|
Facility
|
IP
|
$6,654.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,260.46 |
| Max. Negotiated Rate |
$6,121.68 |
| Rate for Payer: Aetna Commercial |
$5,988.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,722.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,526.62
|
| Rate for Payer: Cash Price |
$1,996.20
|
| Rate for Payer: Cigna Commercial |
$6,121.68
|
| Rate for Payer: Health EOS Commercial |
$5,922.06
|
| Rate for Payer: HFN Commercial |
$6,121.68
|
| Rate for Payer: Multiplan Commercial |
$5,323.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,992.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,121.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,260.46
|
| Rate for Payer: Quartz Commercial |
$3,992.40
|
| Rate for Payer: WEA Trust Commercial |
$3,659.70
|
| Rate for Payer: WPS Commercial |
$4,928.62
|
|
|
SNARE SYSTEM 6-10MM #EN2006010
|
Facility
|
IP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,086.02 |
| Max. Negotiated Rate |
$5,794.16 |
| Rate for Payer: Aetna Commercial |
$5,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,416.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,337.94
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$5,794.16
|
| Rate for Payer: Health EOS Commercial |
$5,605.22
|
| Rate for Payer: HFN Commercial |
$5,794.16
|
| Rate for Payer: Multiplan Commercial |
$5,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,794.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,086.02
|
| Rate for Payer: Quartz Commercial |
$3,778.80
|
| Rate for Payer: WEA Trust Commercial |
$3,463.90
|
| Rate for Payer: WPS Commercial |
$4,664.93
|
|
|
SNARE SYSTEM 6-10MM #EN2006010
|
Facility
|
OP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973522
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,763.44 |
| Max. Negotiated Rate |
$25,192.00 |
| Rate for Payer: Aetna Commercial |
$5,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,416.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,763.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,093.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,023.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,337.94
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$5,794.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,524.36
|
| Rate for Payer: Health EOS Commercial |
$5,605.22
|
| Rate for Payer: HFN Commercial |
$5,794.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,723.50
|
| Rate for Payer: Multiplan Commercial |
$5,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,794.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,086.02
|
| Rate for Payer: Quartz Commercial |
$4,093.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,778.80
|
| Rate for Payer: The Alliance Commercial |
$25,192.00
|
| Rate for Payer: WEA Trust Commercial |
$3,463.90
|
| Rate for Payer: WPS Commercial |
$4,664.93
|
|
|
SNARE SYSTEM 9-15MM #EN2006015
|
Facility
|
IP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,086.02 |
| Max. Negotiated Rate |
$5,794.16 |
| Rate for Payer: Aetna Commercial |
$5,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,416.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,337.94
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$5,794.16
|
| Rate for Payer: Health EOS Commercial |
$5,605.22
|
| Rate for Payer: HFN Commercial |
$5,794.16
|
| Rate for Payer: Multiplan Commercial |
$5,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,794.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,086.02
|
| Rate for Payer: Quartz Commercial |
$3,778.80
|
| Rate for Payer: WEA Trust Commercial |
$3,463.90
|
| Rate for Payer: WPS Commercial |
$4,664.93
|
|
|
SNARE SYSTEM 9-15MM #EN2006015
|
Facility
|
OP
|
$6,298.00
|
|
|
Service Code
|
HCPCS C1773
|
| Hospital Charge Code |
2973523
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,763.44 |
| Max. Negotiated Rate |
$25,192.00 |
| Rate for Payer: Aetna Commercial |
$5,668.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,416.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,763.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,093.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,149.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,023.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,337.94
|
| Rate for Payer: Cash Price |
$1,889.40
|
| Rate for Payer: Cigna Commercial |
$5,794.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,524.36
|
| Rate for Payer: Health EOS Commercial |
$5,605.22
|
| Rate for Payer: HFN Commercial |
$5,794.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,723.50
|
| Rate for Payer: Multiplan Commercial |
$5,038.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,778.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,794.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,086.02
|
| Rate for Payer: Quartz Commercial |
$4,093.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,778.80
|
| Rate for Payer: The Alliance Commercial |
$25,192.00
|
| Rate for Payer: WEA Trust Commercial |
$3,463.90
|
| Rate for Payer: WPS Commercial |
$4,664.93
|
|
|
Snip incision Of Lacrimal Punctum
|
Professional
|
Both
|
$462.00
|
|
|
Service Code
|
CPT 68440
|
| Hospital Charge Code |
1188913
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$438.90 |
| Rate for Payer: Aetna Commercial |
$438.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$397.32
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cash Price |
$138.60
|
| Rate for Payer: Cigna Commercial |
$438.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$277.20
|
| Rate for Payer: Health EOS Commercial |
$420.42
|
| Rate for Payer: HFN Commercial |
$438.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.08
|
| Rate for Payer: Multiplan Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$438.90
|
| Rate for Payer: Quartz Beloit One Network |
$203.28
|
| Rate for Payer: Quartz Commercial |
$263.34
|
| Rate for Payer: The Alliance Commercial |
$231.00
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: WEA Trust Commercial |
$254.10
|
| Rate for Payer: WPS Commercial |
$342.20
|
|
|
Snip Incision of Lacrimal Punctum 6844050
|
Professional
|
Both
|
$922.00
|
|
|
Service Code
|
CPT 68440 50
|
| Hospital Charge Code |
5206607
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$405.68 |
| Max. Negotiated Rate |
$875.90 |
| Rate for Payer: Aetna Commercial |
$875.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$792.92
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cash Price |
$276.60
|
| Rate for Payer: Cigna Commercial |
$875.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$461.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$553.20
|
| Rate for Payer: Health EOS Commercial |
$839.02
|
| Rate for Payer: HFN Commercial |
$875.90
|
| Rate for Payer: Multiplan Commercial |
$737.60
|
| Rate for Payer: Preferred Network Access Commercial |
$875.90
|
| Rate for Payer: Quartz Beloit One Network |
$405.68
|
| Rate for Payer: Quartz Commercial |
$525.54
|
| Rate for Payer: The Alliance Commercial |
$461.00
|
| Rate for Payer: WEA Trust Commercial |
$507.10
|
| Rate for Payer: WPS Commercial |
$682.93
|
|
