|
SHEATH 6.0fr ANL0 FLEXOR ANSEL
|
Facility
|
OP
|
$1,369.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$398.65 |
| Max. Negotiated Rate |
$1,309.86 |
| Rate for Payer: Aetna Commercial |
$1,281.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,224.43
|
| Rate for Payer: Aetna Managed Medicare |
$398.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$925.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$711.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$683.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$754.59
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cigna Commercial |
$1,309.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$796.76
|
| Rate for Payer: Health EOS Commercial |
$1,267.15
|
| Rate for Payer: HFN Commercial |
$1,309.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,067.82
|
| Rate for Payer: Multiplan Commercial |
$1,139.01
|
| Rate for Payer: NAPHCARE Commercial |
$854.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,309.86
|
| Rate for Payer: Quartz Beloit One Network |
$697.64
|
| Rate for Payer: Quartz Commercial |
$925.44
|
| Rate for Payer: Quartz Medicare Advantage |
$854.26
|
| Rate for Payer: The Alliance Commercial |
$711.88
|
| Rate for Payer: WEA Trust Commercial |
$783.07
|
| Rate for Payer: WPS Commercial |
$1,054.54
|
|
|
SHEATH 6.0fr ANL1 90CM FLEXOR ANSEL
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
3107498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$97.26 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Aetna Managed Medicare |
$97.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.39
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$260.52
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: NAPHCARE Commercial |
$208.42
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$225.78
|
| Rate for Payer: Quartz Medicare Advantage |
$208.42
|
| Rate for Payer: The Alliance Commercial |
$173.68
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
SHEATH 6.0fr ANL1 90CM FLEXOR ANSEL
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
3107498
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$170.21 |
| Max. Negotiated Rate |
$319.57 |
| Rate for Payer: Aetna Commercial |
$312.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$298.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.10
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$319.57
|
| Rate for Payer: Health EOS Commercial |
$309.15
|
| Rate for Payer: HFN Commercial |
$319.57
|
| Rate for Payer: Multiplan Commercial |
$277.89
|
| Rate for Payer: Preferred Network Access Commercial |
$319.57
|
| Rate for Payer: Quartz Beloit One Network |
$170.21
|
| Rate for Payer: Quartz Commercial |
$208.42
|
| Rate for Payer: WEA Trust Commercial |
$191.05
|
| Rate for Payer: WPS Commercial |
$257.28
|
|
|
SHEATH 6.0fr ANL1 FLEXOR ANSEL
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2971885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$713.95 |
| Max. Negotiated Rate |
$1,340.48 |
| Rate for Payer: Aetna Commercial |
$1,311.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$772.23
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,340.48
|
| Rate for Payer: Health EOS Commercial |
$1,296.77
|
| Rate for Payer: HFN Commercial |
$1,340.48
|
| Rate for Payer: Multiplan Commercial |
$1,165.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$713.95
|
| Rate for Payer: Quartz Commercial |
$874.22
|
| Rate for Payer: WEA Trust Commercial |
$801.37
|
| Rate for Payer: WPS Commercial |
$1,079.19
|
|
|
SHEATH 6.0fr ANL1 FLEXOR ANSEL
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2971885
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.97 |
| Max. Negotiated Rate |
$1,340.48 |
| Rate for Payer: Aetna Commercial |
$1,311.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,253.05
|
| Rate for Payer: Aetna Managed Medicare |
$407.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$947.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$728.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$699.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$772.23
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,340.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$815.38
|
| Rate for Payer: Health EOS Commercial |
$1,296.77
|
| Rate for Payer: HFN Commercial |
$1,340.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,092.78
|
| Rate for Payer: Multiplan Commercial |
$1,165.63
|
| Rate for Payer: NAPHCARE Commercial |
$874.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,340.48
|
| Rate for Payer: Quartz Beloit One Network |
$713.95
|
| Rate for Payer: Quartz Commercial |
$947.08
|
| Rate for Payer: Quartz Medicare Advantage |
$874.22
|
| Rate for Payer: The Alliance Commercial |
$728.52
|
| Rate for Payer: WEA Trust Commercial |
$801.37
|
| Rate for Payer: WPS Commercial |
$1,079.19
|
|
|
SHEATH 6.0fr ANL2 FLEXOR ANSEL
|
Facility
|
OP
|
$1,349.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.83 |
| Max. Negotiated Rate |
$1,290.72 |
| Rate for Payer: Aetna Commercial |
$1,262.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,206.55
|
| Rate for Payer: Aetna Managed Medicare |
$392.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$911.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$701.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$673.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$743.57
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cigna Commercial |
$1,290.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$785.12
|
| Rate for Payer: Health EOS Commercial |
$1,248.63
|
| Rate for Payer: HFN Commercial |
$1,290.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,052.22
|
| Rate for Payer: Multiplan Commercial |
$1,122.37
|
| Rate for Payer: NAPHCARE Commercial |
$841.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,290.72
|
| Rate for Payer: Quartz Beloit One Network |
$687.45
|
| Rate for Payer: Quartz Commercial |
$911.92
|
| Rate for Payer: Quartz Medicare Advantage |
$841.78
|
| Rate for Payer: The Alliance Commercial |
$701.48
|
| Rate for Payer: WEA Trust Commercial |
$771.63
|
| Rate for Payer: WPS Commercial |
$1,039.13
|
|
|
SHEATH 6.0fr ANL2 FLEXOR ANSEL
|
Facility
|
IP
|
$1,349.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972189
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$687.45 |
| Max. Negotiated Rate |
$1,290.72 |
| Rate for Payer: Aetna Commercial |
$1,262.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,206.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$743.57
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cigna Commercial |
$1,290.72
|
| Rate for Payer: Health EOS Commercial |
$1,248.63
|
| Rate for Payer: HFN Commercial |
$1,290.72
|
| Rate for Payer: Multiplan Commercial |
$1,122.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,290.72
|
| Rate for Payer: Quartz Beloit One Network |
$687.45
|
| Rate for Payer: Quartz Commercial |
$841.78
|
| Rate for Payer: WEA Trust Commercial |
$771.63
|
| Rate for Payer: WPS Commercial |
$1,039.13
|
|
|
SHEATH 6F 23CM BRITE TIP PSI-6F-23-038MT
|
Facility
|
IP
|
$577.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$294.04 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$360.05
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
SHEATH 6F 23CM BRITE TIP PSI-6F-23-038MT
|
Facility
|
OP
|
$577.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$168.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$390.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$300.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.81
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.06
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$360.05
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$390.05
|
| Rate for Payer: Quartz Medicare Advantage |
$360.05
|
| Rate for Payer: The Alliance Commercial |
$300.04
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
|
SHEATH 6F PRELUDE SHORT PSS-6F-4-038MT
|
Facility
|
IP
|
$328.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3417501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.15 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$204.67
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
SHEATH 6F PRELUDE SHORT PSS-6F-4-038MT
|
Facility
|
OP
|
$328.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3417501
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.51 |
| Max. Negotiated Rate |
$313.83 |
| Rate for Payer: Aetna Commercial |
$307.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$95.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$221.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$170.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$163.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$180.79
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$313.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$190.90
|
| Rate for Payer: Health EOS Commercial |
$303.60
|
| Rate for Payer: HFN Commercial |
$313.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$255.84
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$313.83
|
| Rate for Payer: Quartz Beloit One Network |
$167.15
|
| Rate for Payer: Quartz Commercial |
$221.73
|
| Rate for Payer: Quartz Medicare Advantage |
$204.67
|
| Rate for Payer: The Alliance Commercial |
$170.56
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$252.66
|
|
|
Sheath 6Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.58 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$200.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Sheath 6Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.48 |
| Max. Negotiated Rate |
$307.13 |
| Rate for Payer: Aetna Commercial |
$300.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.94
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$307.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.82
|
| Rate for Payer: Health EOS Commercial |
$297.12
|
| Rate for Payer: HFN Commercial |
$307.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.38
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$200.30
|
| Rate for Payer: Preferred Network Access Commercial |
$307.13
|
| Rate for Payer: Quartz Beloit One Network |
$163.58
|
| Rate for Payer: Quartz Commercial |
$217.00
|
| Rate for Payer: Quartz Medicare Advantage |
$200.30
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
Sheath 6Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550836
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.89 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$166.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$200.30
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: The Alliance Commercial |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$247.27
|
|
|
SHEATH 6FR. 90CM BRITE TIP #401690M
|
Facility
|
OP
|
$1,208.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$351.77 |
| Max. Negotiated Rate |
$1,155.81 |
| Rate for Payer: Aetna Commercial |
$1,130.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.44
|
| Rate for Payer: Aetna Managed Medicare |
$351.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$816.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$628.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$603.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.85
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,155.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$703.06
|
| Rate for Payer: Health EOS Commercial |
$1,118.12
|
| Rate for Payer: HFN Commercial |
$1,155.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$942.24
|
| Rate for Payer: Multiplan Commercial |
$1,005.06
|
| Rate for Payer: NAPHCARE Commercial |
$753.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.81
|
| Rate for Payer: Quartz Beloit One Network |
$615.60
|
| Rate for Payer: Quartz Commercial |
$816.61
|
| Rate for Payer: Quartz Medicare Advantage |
$753.79
|
| Rate for Payer: The Alliance Commercial |
$628.16
|
| Rate for Payer: WEA Trust Commercial |
$690.98
|
| Rate for Payer: WPS Commercial |
$930.52
|
|
|
SHEATH 6FR. 90CM BRITE TIP #401690M
|
Facility
|
IP
|
$1,208.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$615.60 |
| Max. Negotiated Rate |
$1,155.81 |
| Rate for Payer: Aetna Commercial |
$1,130.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,080.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$665.85
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,155.81
|
| Rate for Payer: Health EOS Commercial |
$1,118.12
|
| Rate for Payer: HFN Commercial |
$1,155.81
|
| Rate for Payer: Multiplan Commercial |
$1,005.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,155.81
|
| Rate for Payer: Quartz Beloit One Network |
$615.60
|
| Rate for Payer: Quartz Commercial |
$753.79
|
| Rate for Payer: WEA Trust Commercial |
$690.98
|
| Rate for Payer: WPS Commercial |
$930.52
|
|
|
SHEATH 6FR 90CM INTRODUCER MP
|
Facility
|
IP
|
$2,020.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,029.39 |
| Max. Negotiated Rate |
$1,932.74 |
| Rate for Payer: Aetna Commercial |
$1,890.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,806.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,113.42
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$1,932.74
|
| Rate for Payer: Health EOS Commercial |
$1,869.71
|
| Rate for Payer: HFN Commercial |
$1,932.74
|
| Rate for Payer: Multiplan Commercial |
$1,680.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,932.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.39
|
| Rate for Payer: Quartz Commercial |
$1,260.48
|
| Rate for Payer: WEA Trust Commercial |
$1,155.44
|
| Rate for Payer: WPS Commercial |
$1,556.01
|
|
|
SHEATH 6FR 90CM INTRODUCER MP
|
Facility
|
OP
|
$2,020.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$588.22 |
| Max. Negotiated Rate |
$1,932.74 |
| Rate for Payer: Aetna Commercial |
$1,890.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,806.69
|
| Rate for Payer: Aetna Managed Medicare |
$588.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,365.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,050.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,008.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,113.42
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$1,932.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,175.64
|
| Rate for Payer: Health EOS Commercial |
$1,869.71
|
| Rate for Payer: HFN Commercial |
$1,932.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,575.60
|
| Rate for Payer: Multiplan Commercial |
$1,680.64
|
| Rate for Payer: NAPHCARE Commercial |
$1,260.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,932.74
|
| Rate for Payer: Quartz Beloit One Network |
$1,029.39
|
| Rate for Payer: Quartz Commercial |
$1,365.52
|
| Rate for Payer: Quartz Medicare Advantage |
$1,260.48
|
| Rate for Payer: The Alliance Commercial |
$1,050.40
|
| Rate for Payer: WEA Trust Commercial |
$1,155.44
|
| Rate for Payer: WPS Commercial |
$1,556.01
|
|
|
SHEATH 6FR ANSEL 3 INTRODUCER
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.14 |
| Max. Negotiated Rate |
$910.87 |
| Rate for Payer: Aetna Commercial |
$891.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$851.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.74
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$910.87
|
| Rate for Payer: Health EOS Commercial |
$881.17
|
| Rate for Payer: HFN Commercial |
$910.87
|
| Rate for Payer: Multiplan Commercial |
$792.06
|
| Rate for Payer: Preferred Network Access Commercial |
$910.87
|
| Rate for Payer: Quartz Beloit One Network |
$485.14
|
| Rate for Payer: Quartz Commercial |
$594.05
|
| Rate for Payer: WEA Trust Commercial |
$544.54
|
| Rate for Payer: WPS Commercial |
$733.33
|
|
|
SHEATH 6FR ANSEL 3 INTRODUCER
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.22 |
| Max. Negotiated Rate |
$910.87 |
| Rate for Payer: Aetna Commercial |
$891.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$851.47
|
| Rate for Payer: Aetna Managed Medicare |
$277.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$643.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$495.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$475.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$524.74
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$910.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$554.06
|
| Rate for Payer: Health EOS Commercial |
$881.17
|
| Rate for Payer: HFN Commercial |
$910.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$742.56
|
| Rate for Payer: Multiplan Commercial |
$792.06
|
| Rate for Payer: NAPHCARE Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$910.87
|
| Rate for Payer: Quartz Beloit One Network |
$485.14
|
| Rate for Payer: Quartz Commercial |
$643.55
|
| Rate for Payer: Quartz Medicare Advantage |
$594.05
|
| Rate for Payer: The Alliance Commercial |
$495.04
|
| Rate for Payer: WEA Trust Commercial |
$544.54
|
| Rate for Payer: WPS Commercial |
$733.33
|
|
|
SHEATH 6FR. BRITE TIP 45CM 401645M
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$386.88
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
SHEATH 6FR. BRITE TIP 45CM 401645M
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.54 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$180.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$322.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.84
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$386.88
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$419.12
|
| Rate for Payer: Quartz Medicare Advantage |
$386.88
|
| Rate for Payer: The Alliance Commercial |
$322.40
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
SHEATH 6FR. BRITE TIP 55CM 401655M
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.54 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Aetna Managed Medicare |
$180.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$322.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.84
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$483.60
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: NAPHCARE Commercial |
$386.88
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$419.12
|
| Rate for Payer: Quartz Medicare Advantage |
$386.88
|
| Rate for Payer: The Alliance Commercial |
$322.40
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
SHEATH 6FR. BRITE TIP 55CM 401655M
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972185
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$315.95 |
| Max. Negotiated Rate |
$593.22 |
| Rate for Payer: Aetna Commercial |
$580.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$554.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.74
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$593.22
|
| Rate for Payer: Health EOS Commercial |
$573.87
|
| Rate for Payer: HFN Commercial |
$593.22
|
| Rate for Payer: Multiplan Commercial |
$515.84
|
| Rate for Payer: Preferred Network Access Commercial |
$593.22
|
| Rate for Payer: Quartz Beloit One Network |
$315.95
|
| Rate for Payer: Quartz Commercial |
$386.88
|
| Rate for Payer: WEA Trust Commercial |
$354.64
|
| Rate for Payer: WPS Commercial |
$477.59
|
|
|
SHEATH 6FR HLS-1006
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
2973528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$407.39 |
| Max. Negotiated Rate |
$1,338.56 |
| Rate for Payer: Aetna Commercial |
$1,309.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,251.27
|
| Rate for Payer: Aetna Managed Medicare |
$407.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$945.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$727.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$698.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$771.13
|
| Rate for Payer: Cash Price |
$419.70
|
| Rate for Payer: Cigna Commercial |
$1,338.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.22
|
| Rate for Payer: Health EOS Commercial |
$1,294.91
|
| Rate for Payer: HFN Commercial |
$1,338.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,091.22
|
| Rate for Payer: Multiplan Commercial |
$1,163.97
|
| Rate for Payer: NAPHCARE Commercial |
$872.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.56
|
| Rate for Payer: Quartz Beloit One Network |
$712.93
|
| Rate for Payer: Quartz Commercial |
$945.72
|
| Rate for Payer: Quartz Medicare Advantage |
$872.98
|
| Rate for Payer: The Alliance Commercial |
$727.48
|
| Rate for Payer: WEA Trust Commercial |
$800.23
|
| Rate for Payer: WPS Commercial |
$1,077.65
|
|
