|
Sheath 5Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2549138
|
|
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 5Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2549138
|
|
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 5Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2549138
|
|
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 5FR PRO-5F-11-038
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.66 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$200.40
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
SHEATH 5FR PRO-5F-11-038
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970222
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.52 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Aetna Managed Medicare |
$93.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.91
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$217.10
|
| Rate for Payer: Quartz Medicare Advantage |
$200.40
|
| Rate for Payer: The Alliance Commercial |
$1,336.00
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
SHEATH 5fr SHUTTLE 110cm
|
Facility
|
IP
|
$2,059.00
|
|
| Hospital Charge Code |
2972832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,008.91 |
| Max. Negotiated Rate |
$1,894.28 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,235.40
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
SHEATH 5fr SHUTTLE 110cm
|
Facility
|
OP
|
$2,059.00
|
|
| Hospital Charge Code |
2972832
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$576.52 |
| Max. Negotiated Rate |
$8,236.00 |
| Rate for Payer: Aetna Commercial |
$1,853.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,770.74
|
| Rate for Payer: Aetna Managed Medicare |
$576.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,338.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,029.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$988.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,091.27
|
| Rate for Payer: Cash Price |
$617.70
|
| Rate for Payer: Cigna Commercial |
$1,894.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,152.22
|
| Rate for Payer: Health EOS Commercial |
$1,832.51
|
| Rate for Payer: HFN Commercial |
$1,894.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,544.25
|
| Rate for Payer: Multiplan Commercial |
$1,647.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,235.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,894.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,008.91
|
| Rate for Payer: Quartz Commercial |
$1,338.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,235.40
|
| Rate for Payer: The Alliance Commercial |
$8,236.00
|
| Rate for Payer: WEA Trust Commercial |
$1,132.45
|
| Rate for Payer: WPS Commercial |
$1,525.10
|
|
|
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 |
$383.32 |
| Max. Negotiated Rate |
$5,476.00 |
| Rate for Payer: Aetna Commercial |
$1,232.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,177.34
|
| Rate for Payer: Aetna Managed Medicare |
$383.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$889.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$684.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$657.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$725.57
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cigna Commercial |
$1,259.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$766.09
|
| Rate for Payer: Health EOS Commercial |
$1,218.41
|
| Rate for Payer: HFN Commercial |
$1,259.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,026.75
|
| Rate for Payer: Multiplan Commercial |
$1,095.20
|
| Rate for Payer: NAPHCARE Commercial |
$821.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,259.48
|
| Rate for Payer: Quartz Beloit One Network |
$670.81
|
| Rate for Payer: Quartz Commercial |
$889.85
|
| Rate for Payer: Quartz Medicare Advantage |
$821.40
|
| Rate for Payer: The Alliance Commercial |
$5,476.00
|
| Rate for Payer: WEA Trust Commercial |
$752.95
|
| Rate for Payer: WPS Commercial |
$1,014.02
|
|
|
SHEATH 6.0fr ANL0 FLEXOR ANSEL
|
Facility
|
IP
|
$1,369.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972173
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$670.81 |
| Max. Negotiated Rate |
$1,259.48 |
| Rate for Payer: Aetna Commercial |
$1,232.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,177.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$725.57
|
| Rate for Payer: Cash Price |
$410.70
|
| Rate for Payer: Cigna Commercial |
$1,259.48
|
| Rate for Payer: Health EOS Commercial |
$1,218.41
|
| Rate for Payer: HFN Commercial |
$1,259.48
|
| Rate for Payer: Multiplan Commercial |
$1,095.20
|
| Rate for Payer: NAPHCARE Commercial |
$821.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,259.48
|
| Rate for Payer: Quartz Beloit One Network |
$670.81
|
| Rate for Payer: Quartz Commercial |
$821.40
|
| Rate for Payer: WEA Trust Commercial |
$752.95
|
| Rate for Payer: WPS Commercial |
$1,014.02
|
|
|
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 |
$93.52 |
| Max. Negotiated Rate |
$1,336.00 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Aetna Managed Medicare |
$93.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.91
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.50
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$217.10
|
| Rate for Payer: Quartz Medicare Advantage |
$200.40
|
| Rate for Payer: The Alliance Commercial |
$1,336.00
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
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 |
$163.66 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$200.40
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
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 |
$392.28 |
| Max. Negotiated Rate |
$5,604.00 |
| Rate for Payer: Aetna Commercial |
$1,260.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.86
|
| Rate for Payer: Aetna Managed Medicare |
$392.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$910.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$700.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$672.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.53
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,288.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$784.00
|
| Rate for Payer: Health EOS Commercial |
$1,246.89
|
| Rate for Payer: HFN Commercial |
$1,288.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,050.75
|
| Rate for Payer: Multiplan Commercial |
$1,120.80
|
| Rate for Payer: NAPHCARE Commercial |
$840.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.92
|
| Rate for Payer: Quartz Beloit One Network |
$686.49
|
| Rate for Payer: Quartz Commercial |
$910.65
|
| Rate for Payer: Quartz Medicare Advantage |
$840.60
|
| Rate for Payer: The Alliance Commercial |
$5,604.00
|
| Rate for Payer: WEA Trust Commercial |
$770.55
|
| Rate for Payer: WPS Commercial |
$1,037.72
|
|
|
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 |
$686.49 |
| Max. Negotiated Rate |
$1,288.92 |
| Rate for Payer: Aetna Commercial |
$1,260.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,204.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$742.53
|
| Rate for Payer: Cash Price |
$420.30
|
| Rate for Payer: Cigna Commercial |
$1,288.92
|
| Rate for Payer: Health EOS Commercial |
$1,246.89
|
| Rate for Payer: HFN Commercial |
$1,288.92
|
| Rate for Payer: Multiplan Commercial |
$1,120.80
|
| Rate for Payer: NAPHCARE Commercial |
$840.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,288.92
|
| Rate for Payer: Quartz Beloit One Network |
$686.49
|
| Rate for Payer: Quartz Commercial |
$840.60
|
| Rate for Payer: WEA Trust Commercial |
$770.55
|
| Rate for Payer: WPS Commercial |
$1,037.72
|
|
|
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 |
$661.01 |
| Max. Negotiated Rate |
$1,241.08 |
| Rate for Payer: Aetna Commercial |
$1,214.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,160.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.97
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cigna Commercial |
$1,241.08
|
| Rate for Payer: Health EOS Commercial |
$1,200.61
|
| Rate for Payer: HFN Commercial |
$1,241.08
|
| Rate for Payer: Multiplan Commercial |
$1,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$809.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,241.08
|
| Rate for Payer: Quartz Beloit One Network |
$661.01
|
| Rate for Payer: Quartz Commercial |
$809.40
|
| Rate for Payer: WEA Trust Commercial |
$741.95
|
| Rate for Payer: WPS Commercial |
$999.20
|
|
|
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 |
$377.72 |
| Max. Negotiated Rate |
$5,396.00 |
| Rate for Payer: Aetna Commercial |
$1,214.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,160.14
|
| Rate for Payer: Aetna Managed Medicare |
$377.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$876.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$674.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$647.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$714.97
|
| Rate for Payer: Cash Price |
$404.70
|
| Rate for Payer: Cigna Commercial |
$1,241.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$754.90
|
| Rate for Payer: Health EOS Commercial |
$1,200.61
|
| Rate for Payer: HFN Commercial |
$1,241.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,011.75
|
| Rate for Payer: Multiplan Commercial |
$1,079.20
|
| Rate for Payer: NAPHCARE Commercial |
$809.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,241.08
|
| Rate for Payer: Quartz Beloit One Network |
$661.01
|
| Rate for Payer: Quartz Commercial |
$876.85
|
| Rate for Payer: Quartz Medicare Advantage |
$809.40
|
| Rate for Payer: The Alliance Commercial |
$5,396.00
|
| Rate for Payer: WEA Trust Commercial |
$741.95
|
| Rate for Payer: WPS Commercial |
$999.20
|
|
|
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 |
$161.56 |
| Max. Negotiated Rate |
$2,308.00 |
| Rate for Payer: Aetna Commercial |
$519.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.22
|
| Rate for Payer: Aetna Managed Medicare |
$161.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$375.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$288.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.81
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$530.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$322.89
|
| Rate for Payer: Health EOS Commercial |
$513.53
|
| Rate for Payer: HFN Commercial |
$530.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$432.75
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: NAPHCARE Commercial |
$346.20
|
| Rate for Payer: Preferred Network Access Commercial |
$530.84
|
| Rate for Payer: Quartz Beloit One Network |
$282.73
|
| Rate for Payer: Quartz Commercial |
$375.05
|
| Rate for Payer: Quartz Medicare Advantage |
$346.20
|
| Rate for Payer: The Alliance Commercial |
$2,308.00
|
| Rate for Payer: WEA Trust Commercial |
$317.35
|
| Rate for Payer: WPS Commercial |
$427.38
|
|
|
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 |
$282.73 |
| Max. Negotiated Rate |
$530.84 |
| Rate for Payer: Aetna Commercial |
$519.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$496.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$305.81
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$530.84
|
| Rate for Payer: Health EOS Commercial |
$513.53
|
| Rate for Payer: HFN Commercial |
$530.84
|
| Rate for Payer: Multiplan Commercial |
$461.60
|
| Rate for Payer: NAPHCARE Commercial |
$346.20
|
| Rate for Payer: Preferred Network Access Commercial |
$530.84
|
| Rate for Payer: Quartz Beloit One Network |
$282.73
|
| Rate for Payer: Quartz Commercial |
$346.20
|
| Rate for Payer: WEA Trust Commercial |
$317.35
|
| Rate for Payer: WPS Commercial |
$427.38
|
|
|
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 |
$160.72 |
| Max. Negotiated Rate |
$301.76 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$196.80
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
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 |
$91.84 |
| Max. Negotiated Rate |
$1,312.00 |
| Rate for Payer: Aetna Commercial |
$295.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Aetna Managed Medicare |
$91.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$213.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$164.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.84
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$301.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.55
|
| Rate for Payer: Health EOS Commercial |
$291.92
|
| Rate for Payer: HFN Commercial |
$301.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$246.00
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: NAPHCARE Commercial |
$196.80
|
| Rate for Payer: Preferred Network Access Commercial |
$301.76
|
| Rate for Payer: Quartz Beloit One Network |
$160.72
|
| Rate for Payer: Quartz Commercial |
$213.20
|
| Rate for Payer: Quartz Medicare Advantage |
$196.80
|
| Rate for Payer: The Alliance Commercial |
$1,312.00
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
Sheath 6Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550836
|
|
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 6Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550836
|
|
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 6Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550836
|
|
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 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 |
$591.92 |
| Max. Negotiated Rate |
$1,111.36 |
| Rate for Payer: Aetna Commercial |
$1,087.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$640.24
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,111.36
|
| Rate for Payer: Health EOS Commercial |
$1,075.12
|
| Rate for Payer: HFN Commercial |
$1,111.36
|
| Rate for Payer: Multiplan Commercial |
$966.40
|
| Rate for Payer: NAPHCARE Commercial |
$724.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,111.36
|
| Rate for Payer: Quartz Beloit One Network |
$591.92
|
| Rate for Payer: Quartz Commercial |
$724.80
|
| Rate for Payer: WEA Trust Commercial |
$664.40
|
| Rate for Payer: WPS Commercial |
$894.77
|
|
|
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 |
$338.24 |
| Max. Negotiated Rate |
$4,832.00 |
| Rate for Payer: Aetna Commercial |
$1,087.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.88
|
| Rate for Payer: Aetna Managed Medicare |
$338.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$785.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$604.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$579.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$640.24
|
| Rate for Payer: Cash Price |
$362.40
|
| Rate for Payer: Cigna Commercial |
$1,111.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$676.00
|
| Rate for Payer: Health EOS Commercial |
$1,075.12
|
| Rate for Payer: HFN Commercial |
$1,111.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$906.00
|
| Rate for Payer: Multiplan Commercial |
$966.40
|
| Rate for Payer: NAPHCARE Commercial |
$724.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,111.36
|
| Rate for Payer: Quartz Beloit One Network |
$591.92
|
| Rate for Payer: Quartz Commercial |
$785.20
|
| Rate for Payer: Quartz Medicare Advantage |
$724.80
|
| Rate for Payer: The Alliance Commercial |
$4,832.00
|
| Rate for Payer: WEA Trust Commercial |
$664.40
|
| Rate for Payer: WPS Commercial |
$894.77
|
|
|
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 |
$989.80 |
| Max. Negotiated Rate |
$1,858.40 |
| Rate for Payer: Aetna Commercial |
$1,818.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,737.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,070.60
|
| Rate for Payer: Cash Price |
$606.00
|
| Rate for Payer: Cigna Commercial |
$1,858.40
|
| Rate for Payer: Health EOS Commercial |
$1,797.80
|
| Rate for Payer: HFN Commercial |
$1,858.40
|
| Rate for Payer: Multiplan Commercial |
$1,616.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,212.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,858.40
|
| Rate for Payer: Quartz Beloit One Network |
$989.80
|
| Rate for Payer: Quartz Commercial |
$1,212.00
|
| Rate for Payer: WEA Trust Commercial |
$1,111.00
|
| Rate for Payer: WPS Commercial |
$1,496.21
|
|
