|
SHEATH 6FR HLS-1006
|
Facility
|
IP
|
$1,399.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
2973528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$712.93 |
| 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: 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: Health EOS Commercial |
$1,294.91
|
| Rate for Payer: HFN Commercial |
$1,338.56
|
| Rate for Payer: Multiplan Commercial |
$1,163.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,338.56
|
| Rate for Payer: Quartz Beloit One Network |
$712.93
|
| Rate for Payer: Quartz Commercial |
$872.98
|
| Rate for Payer: WEA Trust Commercial |
$800.23
|
| Rate for Payer: WPS Commercial |
$1,077.65
|
|
|
SHEATH 6FR PRO-6F-11-038
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970221
|
|
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 6FR PRO-6F-11-038
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970221
|
|
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 FR. SUPER FLEX #CP-07611
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2973306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.45 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Aetna Managed Medicare |
$160.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$372.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$286.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$275.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$320.68
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$429.78
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: NAPHCARE Commercial |
$343.82
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$372.48
|
| Rate for Payer: Quartz Medicare Advantage |
$343.82
|
| Rate for Payer: The Alliance Commercial |
$286.52
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
SHEATH 6 FR. SUPER FLEX #CP-07611
|
Facility
|
IP
|
$551.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2973306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$280.79 |
| Max. Negotiated Rate |
$527.20 |
| Rate for Payer: Aetna Commercial |
$515.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$492.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$303.71
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$527.20
|
| Rate for Payer: Health EOS Commercial |
$510.01
|
| Rate for Payer: HFN Commercial |
$527.20
|
| Rate for Payer: Multiplan Commercial |
$458.43
|
| Rate for Payer: Preferred Network Access Commercial |
$527.20
|
| Rate for Payer: Quartz Beloit One Network |
$280.79
|
| Rate for Payer: Quartz Commercial |
$343.82
|
| Rate for Payer: WEA Trust Commercial |
$315.17
|
| Rate for Payer: WPS Commercial |
$424.44
|
|
|
SHEATH 7.0fr ANL0 FLEXOR ANSEL
|
Facility
|
IP
|
$1,401.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972178
|
|
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 7.0fr ANL0 FLEXOR ANSEL
|
Facility
|
OP
|
$1,401.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972178
|
|
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 7FR
|
Facility
|
OP
|
$470.00
|
|
| Hospital Charge Code |
2971274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.86 |
| Max. Negotiated Rate |
$449.70 |
| Rate for Payer: Aetna Commercial |
$439.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Aetna Managed Medicare |
$136.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.06
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$449.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.54
|
| Rate for Payer: Health EOS Commercial |
$435.03
|
| Rate for Payer: HFN Commercial |
$449.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$366.60
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: NAPHCARE Commercial |
$293.28
|
| Rate for Payer: Preferred Network Access Commercial |
$449.70
|
| Rate for Payer: Quartz Beloit One Network |
$239.51
|
| Rate for Payer: Quartz Commercial |
$317.72
|
| Rate for Payer: Quartz Medicare Advantage |
$293.28
|
| Rate for Payer: The Alliance Commercial |
$244.40
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$362.04
|
|
|
SHEATH 7FR
|
Facility
|
IP
|
$470.00
|
|
| Hospital Charge Code |
2971274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$239.51 |
| Max. Negotiated Rate |
$449.70 |
| Rate for Payer: Aetna Commercial |
$439.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.06
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$449.70
|
| Rate for Payer: Health EOS Commercial |
$435.03
|
| Rate for Payer: HFN Commercial |
$449.70
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: Preferred Network Access Commercial |
$449.70
|
| Rate for Payer: Quartz Beloit One Network |
$239.51
|
| Rate for Payer: Quartz Commercial |
$293.28
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$362.04
|
|
|
Sheath 7Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550838
|
|
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 7Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550838
|
|
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 7Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550838
|
|
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 7FR. 45CM BRITE TIP 401745M
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972184
|
|
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 7FR. 45CM BRITE TIP 401745M
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972184
|
|
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 7FR. 55CM BRITE TIP 401755M
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971630
|
|
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 7FR. 55CM BRITE TIP 401755M
|
Facility
|
IP
|
$620.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971630
|
|
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 7FR 55CM MIN ORDER 5 EA
|
Facility
|
IP
|
$1,524.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$776.63 |
| Max. Negotiated Rate |
$1,458.16 |
| Rate for Payer: Aetna Commercial |
$1,426.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.03
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,458.16
|
| Rate for Payer: Health EOS Commercial |
$1,410.61
|
| Rate for Payer: HFN Commercial |
$1,458.16
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.16
|
| Rate for Payer: Quartz Beloit One Network |
$776.63
|
| Rate for Payer: Quartz Commercial |
$950.98
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$1,173.94
|
|
|
SHEATH 7FR 55CM MIN ORDER 5 EA
|
Facility
|
OP
|
$1,524.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972587
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$443.79 |
| Max. Negotiated Rate |
$1,458.16 |
| Rate for Payer: Aetna Commercial |
$1,426.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,363.07
|
| Rate for Payer: Aetna Managed Medicare |
$443.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,030.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$792.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$760.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$840.03
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,458.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$886.97
|
| Rate for Payer: Health EOS Commercial |
$1,410.61
|
| Rate for Payer: HFN Commercial |
$1,458.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,188.72
|
| Rate for Payer: Multiplan Commercial |
$1,267.97
|
| Rate for Payer: NAPHCARE Commercial |
$950.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,458.16
|
| Rate for Payer: Quartz Beloit One Network |
$776.63
|
| Rate for Payer: Quartz Commercial |
$1,030.22
|
| Rate for Payer: Quartz Medicare Advantage |
$950.98
|
| Rate for Payer: The Alliance Commercial |
$792.48
|
| Rate for Payer: WEA Trust Commercial |
$871.73
|
| Rate for Payer: WPS Commercial |
$1,173.94
|
|
|
SHEATH 7FR 65CM RSP02
|
Facility
|
IP
|
$2,289.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3553539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SHEATH 7FR 65CM RSP02
|
Facility
|
OP
|
$2,289.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3553539
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SHEATH 7FR. 90CM BRITE TIP 401790M
|
Facility
|
IP
|
$1,198.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$610.50 |
| Max. Negotiated Rate |
$1,146.25 |
| Rate for Payer: Aetna Commercial |
$1,121.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,071.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.34
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Cigna Commercial |
$1,146.25
|
| Rate for Payer: Health EOS Commercial |
$1,108.87
|
| Rate for Payer: HFN Commercial |
$1,146.25
|
| Rate for Payer: Multiplan Commercial |
$996.74
|
| Rate for Payer: Preferred Network Access Commercial |
$1,146.25
|
| Rate for Payer: Quartz Beloit One Network |
$610.50
|
| Rate for Payer: Quartz Commercial |
$747.55
|
| Rate for Payer: WEA Trust Commercial |
$685.26
|
| Rate for Payer: WPS Commercial |
$922.82
|
|
|
SHEATH 7FR. 90CM BRITE TIP 401790M
|
Facility
|
OP
|
$1,198.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972105
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$348.86 |
| Max. Negotiated Rate |
$1,146.25 |
| Rate for Payer: Aetna Commercial |
$1,121.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,071.49
|
| Rate for Payer: Aetna Managed Medicare |
$348.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$809.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$622.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$598.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.34
|
| Rate for Payer: Cash Price |
$359.40
|
| Rate for Payer: Cigna Commercial |
$1,146.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$697.24
|
| Rate for Payer: Health EOS Commercial |
$1,108.87
|
| Rate for Payer: HFN Commercial |
$1,146.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$934.44
|
| Rate for Payer: Multiplan Commercial |
$996.74
|
| Rate for Payer: NAPHCARE Commercial |
$747.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,146.25
|
| Rate for Payer: Quartz Beloit One Network |
$610.50
|
| Rate for Payer: Quartz Commercial |
$809.85
|
| Rate for Payer: Quartz Medicare Advantage |
$747.55
|
| Rate for Payer: The Alliance Commercial |
$622.96
|
| Rate for Payer: WEA Trust Commercial |
$685.26
|
| Rate for Payer: WPS Commercial |
$922.82
|
|
|
SHEATH 7FR 90CM RSC06
|
Facility
|
OP
|
$2,289.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3553540
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$666.56 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Aetna Managed Medicare |
$666.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,547.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,190.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,142.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,332.20
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,785.42
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,428.34
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,547.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,428.34
|
| Rate for Payer: The Alliance Commercial |
$1,190.28
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SHEATH 7FR 90CM RSC06
|
Facility
|
IP
|
$2,289.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
3553540
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,166.47 |
| Max. Negotiated Rate |
$2,190.12 |
| Rate for Payer: Aetna Commercial |
$2,142.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,047.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,261.70
|
| Rate for Payer: Cash Price |
$686.70
|
| Rate for Payer: Cigna Commercial |
$2,190.12
|
| Rate for Payer: Health EOS Commercial |
$2,118.70
|
| Rate for Payer: HFN Commercial |
$2,190.12
|
| Rate for Payer: Multiplan Commercial |
$1,904.45
|
| Rate for Payer: Preferred Network Access Commercial |
$2,190.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,166.47
|
| Rate for Payer: Quartz Commercial |
$1,428.34
|
| Rate for Payer: WEA Trust Commercial |
$1,309.31
|
| Rate for Payer: WPS Commercial |
$1,763.22
|
|
|
SHEATH 7FR ANSEL G29985
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972191
|
|
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
|
|
