|
SHEATH 7FR ANSEL G29985
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972191
|
|
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 7FR HLS-1007
|
Facility
|
IP
|
$1,399.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2973529
|
|
Hospital Revenue Code
|
272
|
| 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 7FR HLS-1007
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2973529
|
|
Hospital Revenue Code
|
272
|
| 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
|
|
|
Sheath 8Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550840
|
|
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 8Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550840
|
|
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 8Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550840
|
|
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 8FR 45CM BRITE TIP 401845M
|
Facility
|
OP
|
$781.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.43 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Aetna Managed Medicare |
$227.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$527.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$406.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$389.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$454.54
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$609.18
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: NAPHCARE Commercial |
$487.34
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$527.96
|
| Rate for Payer: Quartz Medicare Advantage |
$487.34
|
| Rate for Payer: The Alliance Commercial |
$406.12
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
|
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 |
$398.00 |
| Max. Negotiated Rate |
$747.26 |
| Rate for Payer: Aetna Commercial |
$731.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$698.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$430.49
|
| Rate for Payer: Cash Price |
$234.30
|
| Rate for Payer: Cigna Commercial |
$747.26
|
| Rate for Payer: Health EOS Commercial |
$722.89
|
| Rate for Payer: HFN Commercial |
$747.26
|
| Rate for Payer: Multiplan Commercial |
$649.79
|
| Rate for Payer: Preferred Network Access Commercial |
$747.26
|
| Rate for Payer: Quartz Beloit One Network |
$398.00
|
| Rate for Payer: Quartz Commercial |
$487.34
|
| Rate for Payer: WEA Trust Commercial |
$446.73
|
| Rate for Payer: WPS Commercial |
$601.60
|
|
|
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 |
$755.74 |
| Max. Negotiated Rate |
$1,418.93 |
| Rate for Payer: Aetna Commercial |
$1,388.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.43
|
| Rate for Payer: Cash Price |
$444.90
|
| Rate for Payer: Cigna Commercial |
$1,418.93
|
| Rate for Payer: Health EOS Commercial |
$1,372.66
|
| Rate for Payer: HFN Commercial |
$1,418.93
|
| Rate for Payer: Multiplan Commercial |
$1,233.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.93
|
| Rate for Payer: Quartz Beloit One Network |
$755.74
|
| Rate for Payer: Quartz Commercial |
$925.39
|
| Rate for Payer: WEA Trust Commercial |
$848.28
|
| Rate for Payer: WPS Commercial |
$1,142.35
|
|
|
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 |
$431.85 |
| Max. Negotiated Rate |
$1,418.93 |
| Rate for Payer: Aetna Commercial |
$1,388.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.40
|
| Rate for Payer: Aetna Managed Medicare |
$431.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,002.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$771.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$740.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.43
|
| Rate for Payer: Cash Price |
$444.90
|
| Rate for Payer: Cigna Commercial |
$1,418.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$863.11
|
| Rate for Payer: Health EOS Commercial |
$1,372.66
|
| Rate for Payer: HFN Commercial |
$1,418.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,156.74
|
| Rate for Payer: Multiplan Commercial |
$1,233.86
|
| Rate for Payer: NAPHCARE Commercial |
$925.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.93
|
| Rate for Payer: Quartz Beloit One Network |
$755.74
|
| Rate for Payer: Quartz Commercial |
$1,002.51
|
| Rate for Payer: Quartz Medicare Advantage |
$925.39
|
| Rate for Payer: The Alliance Commercial |
$771.16
|
| Rate for Payer: WEA Trust Commercial |
$848.28
|
| Rate for Payer: WPS Commercial |
$1,142.35
|
|
|
SHEATH 8FR ANLO FLEXOR
|
Facility
|
IP
|
$1,483.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$755.74 |
| Max. Negotiated Rate |
$1,418.93 |
| Rate for Payer: Aetna Commercial |
$1,388.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.43
|
| Rate for Payer: Cash Price |
$444.90
|
| Rate for Payer: Cigna Commercial |
$1,418.93
|
| Rate for Payer: Health EOS Commercial |
$1,372.66
|
| Rate for Payer: HFN Commercial |
$1,418.93
|
| Rate for Payer: Multiplan Commercial |
$1,233.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.93
|
| Rate for Payer: Quartz Beloit One Network |
$755.74
|
| Rate for Payer: Quartz Commercial |
$925.39
|
| Rate for Payer: WEA Trust Commercial |
$848.28
|
| Rate for Payer: WPS Commercial |
$1,142.35
|
|
|
SHEATH 8FR ANLO FLEXOR
|
Facility
|
OP
|
$1,483.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972308
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$431.85 |
| Max. Negotiated Rate |
$1,418.93 |
| Rate for Payer: Aetna Commercial |
$1,388.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,326.40
|
| Rate for Payer: Aetna Managed Medicare |
$431.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,002.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$771.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$740.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$817.43
|
| Rate for Payer: Cash Price |
$444.90
|
| Rate for Payer: Cigna Commercial |
$1,418.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$863.11
|
| Rate for Payer: Health EOS Commercial |
$1,372.66
|
| Rate for Payer: HFN Commercial |
$1,418.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,156.74
|
| Rate for Payer: Multiplan Commercial |
$1,233.86
|
| Rate for Payer: NAPHCARE Commercial |
$925.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,418.93
|
| Rate for Payer: Quartz Beloit One Network |
$755.74
|
| Rate for Payer: Quartz Commercial |
$1,002.51
|
| Rate for Payer: Quartz Medicare Advantage |
$925.39
|
| Rate for Payer: The Alliance Commercial |
$771.16
|
| Rate for Payer: WEA Trust Commercial |
$848.28
|
| Rate for Payer: WPS Commercial |
$1,142.35
|
|
|
SHEATH 8FR HLS-1008
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
3107492
|
|
Hospital Revenue Code
|
278
|
| 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 8FR HLS-1008
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
3107492
|
|
Hospital Revenue Code
|
278
|
| 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 9Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550842
|
|
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 9Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550842
|
|
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 9Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550842
|
|
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 9FR 11CM 402-609X
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Aetna Managed Medicare |
$55.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.58
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.20
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$118.56
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$128.44
|
| Rate for Payer: Quartz Medicare Advantage |
$118.56
|
| Rate for Payer: The Alliance Commercial |
$98.80
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
SHEATH 9FR 11CM 402-609X
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.82 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
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 |
$55.33 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Aetna Managed Medicare |
$55.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.58
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.20
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$118.56
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$128.44
|
| Rate for Payer: Quartz Medicare Advantage |
$118.56
|
| Rate for Payer: The Alliance Commercial |
$98.80
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
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 |
$96.82 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
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 |
$96.82 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
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 |
$55.33 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Aetna Managed Medicare |
$55.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.58
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.20
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$118.56
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$128.44
|
| Rate for Payer: Quartz Medicare Advantage |
$118.56
|
| Rate for Payer: The Alliance Commercial |
$98.80
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
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 |
$96.82 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$118.56
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
|
SHEATH AVANTI 6F 5.5CM WITH .035 GW 402-606P
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201012
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$55.33 |
| Max. Negotiated Rate |
$181.79 |
| Rate for Payer: Aetna Commercial |
$177.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$169.94
|
| Rate for Payer: Aetna Managed Medicare |
$55.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$128.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$98.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$104.73
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$181.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.58
|
| Rate for Payer: Health EOS Commercial |
$175.86
|
| Rate for Payer: HFN Commercial |
$181.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$148.20
|
| Rate for Payer: Multiplan Commercial |
$158.08
|
| Rate for Payer: NAPHCARE Commercial |
$118.56
|
| Rate for Payer: Preferred Network Access Commercial |
$181.79
|
| Rate for Payer: Quartz Beloit One Network |
$96.82
|
| Rate for Payer: Quartz Commercial |
$128.44
|
| Rate for Payer: Quartz Medicare Advantage |
$118.56
|
| Rate for Payer: The Alliance Commercial |
$98.80
|
| Rate for Payer: WEA Trust Commercial |
$108.68
|
| Rate for Payer: WPS Commercial |
$146.36
|
|
