|
SHEATH 7FR ANSEL G29985
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.56 |
| Max. Negotiated Rate |
$3,808.00 |
| Rate for Payer: Aetna Commercial |
$856.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.72
|
| Rate for Payer: Aetna Managed Medicare |
$266.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$476.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.56
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$875.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.74
|
| Rate for Payer: Health EOS Commercial |
$847.28
|
| Rate for Payer: HFN Commercial |
$875.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.00
|
| Rate for Payer: Multiplan Commercial |
$761.60
|
| Rate for Payer: NAPHCARE Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$875.84
|
| Rate for Payer: Quartz Beloit One Network |
$466.48
|
| Rate for Payer: Quartz Commercial |
$618.80
|
| Rate for Payer: Quartz Medicare Advantage |
$571.20
|
| Rate for Payer: The Alliance Commercial |
$3,808.00
|
| Rate for Payer: WEA Trust Commercial |
$523.60
|
| Rate for Payer: WPS Commercial |
$705.15
|
|
|
SHEATH 7FR ANSEL G29985
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972191
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.48 |
| Max. Negotiated Rate |
$875.84 |
| Rate for Payer: Aetna Commercial |
$856.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.56
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$875.84
|
| Rate for Payer: Health EOS Commercial |
$847.28
|
| Rate for Payer: HFN Commercial |
$875.84
|
| Rate for Payer: Multiplan Commercial |
$761.60
|
| Rate for Payer: NAPHCARE Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$875.84
|
| Rate for Payer: Quartz Beloit One Network |
$466.48
|
| Rate for Payer: Quartz Commercial |
$571.20
|
| Rate for Payer: WEA Trust Commercial |
$523.60
|
| Rate for Payer: WPS Commercial |
$705.15
|
|
|
SHEATH 7FR HLS-1007
|
Facility
|
IP
|
$1,399.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2973529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$685.51 |
| Max. Negotiated Rate |
$1,287.08 |
| Rate for Payer: Aetna Commercial |
$1,259.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.47
|
| Rate for Payer: Cash Price |
$419.70
|
| Rate for Payer: Cigna Commercial |
$1,287.08
|
| Rate for Payer: Health EOS Commercial |
$1,245.11
|
| Rate for Payer: HFN Commercial |
$1,287.08
|
| Rate for Payer: Multiplan Commercial |
$1,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$839.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.08
|
| Rate for Payer: Quartz Beloit One Network |
$685.51
|
| Rate for Payer: Quartz Commercial |
$839.40
|
| Rate for Payer: WEA Trust Commercial |
$769.45
|
| Rate for Payer: WPS Commercial |
$1,036.24
|
|
|
SHEATH 7FR HLS-1007
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2973529
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$391.72 |
| Max. Negotiated Rate |
$5,596.00 |
| Rate for Payer: Aetna Commercial |
$1,259.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.14
|
| Rate for Payer: Aetna Managed Medicare |
$391.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$909.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$671.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.47
|
| Rate for Payer: Cash Price |
$419.70
|
| Rate for Payer: Cigna Commercial |
$1,287.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$782.88
|
| Rate for Payer: Health EOS Commercial |
$1,245.11
|
| Rate for Payer: HFN Commercial |
$1,287.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.25
|
| Rate for Payer: Multiplan Commercial |
$1,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$839.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.08
|
| Rate for Payer: Quartz Beloit One Network |
$685.51
|
| Rate for Payer: Quartz Commercial |
$909.35
|
| Rate for Payer: Quartz Medicare Advantage |
$839.40
|
| Rate for Payer: The Alliance Commercial |
$5,596.00
|
| Rate for Payer: WEA Trust Commercial |
$769.45
|
| Rate for Payer: WPS Commercial |
$1,036.24
|
|
|
Sheath 8Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550840
|
|
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 8Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550840
|
|
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 8Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550840
|
|
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 8FR 45CM BRITE TIP 401845M
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$218.68 |
| Max. Negotiated Rate |
$3,124.00 |
| Rate for Payer: Aetna Commercial |
$702.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.66
|
| Rate for Payer: Aetna Managed Medicare |
$218.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$507.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$390.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$374.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.93
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$718.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$437.05
|
| Rate for Payer: Health EOS Commercial |
$695.09
|
| Rate for Payer: HFN Commercial |
$718.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.75
|
| Rate for Payer: Multiplan Commercial |
$624.80
|
| Rate for Payer: NAPHCARE Commercial |
$468.60
|
| Rate for Payer: Preferred Network Access Commercial |
$718.52
|
| Rate for Payer: Quartz Beloit One Network |
$382.69
|
| Rate for Payer: Quartz Commercial |
$507.65
|
| Rate for Payer: Quartz Medicare Advantage |
$468.60
|
| Rate for Payer: The Alliance Commercial |
$3,124.00
|
| Rate for Payer: WEA Trust Commercial |
$429.55
|
| Rate for Payer: WPS Commercial |
$578.49
|
|
|
SHEATH 8FR 45CM BRITE TIP 401845M
|
Facility
|
IP
|
$781.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$382.69 |
| Max. Negotiated Rate |
$718.52 |
| Rate for Payer: Aetna Commercial |
$702.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$671.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$413.93
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$718.52
|
| Rate for Payer: Health EOS Commercial |
$695.09
|
| Rate for Payer: HFN Commercial |
$718.52
|
| Rate for Payer: Multiplan Commercial |
$624.80
|
| Rate for Payer: NAPHCARE Commercial |
$468.60
|
| Rate for Payer: Preferred Network Access Commercial |
$718.52
|
| Rate for Payer: Quartz Beloit One Network |
$382.69
|
| Rate for Payer: Quartz Commercial |
$468.60
|
| Rate for Payer: WEA Trust Commercial |
$429.55
|
| Rate for Payer: WPS Commercial |
$578.49
|
|
|
SHEATH 8 FR ANL1 FLEXOR
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.24 |
| Max. Negotiated Rate |
$5,932.00 |
| Rate for Payer: Aetna Commercial |
$1,334.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,275.38
|
| Rate for Payer: Aetna Managed Medicare |
$415.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.99
|
| Rate for Payer: Cash Price |
$444.90
|
| Rate for Payer: Cigna Commercial |
$1,364.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.89
|
| Rate for Payer: Health EOS Commercial |
$1,319.87
|
| Rate for Payer: HFN Commercial |
$1,364.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,112.25
|
| Rate for Payer: Multiplan Commercial |
$1,186.40
|
| Rate for Payer: NAPHCARE Commercial |
$889.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,364.36
|
| Rate for Payer: Quartz Beloit One Network |
$726.67
|
| Rate for Payer: Quartz Commercial |
$963.95
|
| Rate for Payer: Quartz Medicare Advantage |
$889.80
|
| Rate for Payer: The Alliance Commercial |
$5,932.00
|
| Rate for Payer: WEA Trust Commercial |
$815.65
|
| Rate for Payer: WPS Commercial |
$1,098.46
|
|
|
SHEATH 8 FR ANL1 FLEXOR
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972309
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$726.67 |
| Max. Negotiated Rate |
$1,364.36 |
| Rate for Payer: Aetna Commercial |
$1,334.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,275.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.99
|
| Rate for Payer: Cash Price |
$444.90
|
| Rate for Payer: Cigna Commercial |
$1,364.36
|
| Rate for Payer: Health EOS Commercial |
$1,319.87
|
| Rate for Payer: HFN Commercial |
$1,364.36
|
| Rate for Payer: Multiplan Commercial |
$1,186.40
|
| Rate for Payer: NAPHCARE Commercial |
$889.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,364.36
|
| Rate for Payer: Quartz Beloit One Network |
$726.67
|
| Rate for Payer: Quartz Commercial |
$889.80
|
| Rate for Payer: WEA Trust Commercial |
$815.65
|
| Rate for Payer: WPS Commercial |
$1,098.46
|
|
|
SHEATH 8FR ANLO FLEXOR
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$415.24 |
| Max. Negotiated Rate |
$5,932.00 |
| Rate for Payer: Aetna Commercial |
$1,334.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,275.38
|
| Rate for Payer: Aetna Managed Medicare |
$415.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.99
|
| Rate for Payer: Cash Price |
$444.90
|
| Rate for Payer: Cigna Commercial |
$1,364.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.89
|
| Rate for Payer: Health EOS Commercial |
$1,319.87
|
| Rate for Payer: HFN Commercial |
$1,364.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,112.25
|
| Rate for Payer: Multiplan Commercial |
$1,186.40
|
| Rate for Payer: NAPHCARE Commercial |
$889.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,364.36
|
| Rate for Payer: Quartz Beloit One Network |
$726.67
|
| Rate for Payer: Quartz Commercial |
$963.95
|
| Rate for Payer: Quartz Medicare Advantage |
$889.80
|
| Rate for Payer: The Alliance Commercial |
$5,932.00
|
| Rate for Payer: WEA Trust Commercial |
$815.65
|
| Rate for Payer: WPS Commercial |
$1,098.46
|
|
|
SHEATH 8FR ANLO FLEXOR
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$726.67 |
| Max. Negotiated Rate |
$1,364.36 |
| Rate for Payer: Aetna Commercial |
$1,334.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,275.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.99
|
| Rate for Payer: Cash Price |
$444.90
|
| Rate for Payer: Cigna Commercial |
$1,364.36
|
| Rate for Payer: Health EOS Commercial |
$1,319.87
|
| Rate for Payer: HFN Commercial |
$1,364.36
|
| Rate for Payer: Multiplan Commercial |
$1,186.40
|
| Rate for Payer: NAPHCARE Commercial |
$889.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,364.36
|
| Rate for Payer: Quartz Beloit One Network |
$726.67
|
| Rate for Payer: Quartz Commercial |
$889.80
|
| Rate for Payer: WEA Trust Commercial |
$815.65
|
| Rate for Payer: WPS Commercial |
$1,098.46
|
|
|
SHEATH 8FR HLS-1008
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
3107492
|
|
Hospital Revenue Code
|
278
|
| 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 8FR HLS-1008
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
3107492
|
|
Hospital Revenue Code
|
278
|
| 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 9Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550842
|
|
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 9Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550842
|
|
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 9Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550842
|
|
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 9FR 11CM 402-609X
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$53.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.32
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
SHEATH 9FR 11CM 402-609X
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
SHEATH AVANTI 5F 11CM WO MINI GUIDEWIRE 402-605A
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
SHEATH AVANTI 5F 11CM WO MINI GUIDEWIRE 402-605A
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201007
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$53.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.32
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
SHEATH AVANTI 5F 5.5CM WITH .035 GW 402-605P
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
SHEATH AVANTI 5F 5.5CM WITH .035 GW 402-605P
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201010
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$53.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.32
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
SHEATH AVANTI 6F 5.5CM WITH .035 GW 402-606P
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
