|
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 |
$565.60 |
| Max. Negotiated Rate |
$8,080.00 |
| Rate for Payer: Aetna Commercial |
$1,818.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,737.20
|
| Rate for Payer: Aetna Managed Medicare |
$565.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,313.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,010.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$969.60
|
| 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: Dean Health DHI/DHP/ASO |
$1,130.39
|
| Rate for Payer: Health EOS Commercial |
$1,797.80
|
| Rate for Payer: HFN Commercial |
$1,858.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,515.00
|
| 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 |
$1,313.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,212.00
|
| Rate for Payer: The Alliance Commercial |
$8,080.00
|
| Rate for Payer: WEA Trust Commercial |
$1,111.00
|
| Rate for Payer: WPS Commercial |
$1,496.21
|
|
|
SHEATH 6FR ANSEL 3 INTRODUCER
|
Facility
|
IP
|
$952.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$466.48 |
| Max. Negotiated Rate |
$875.84 |
| Rate for Payer: Aetna Commercial |
$856.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.56
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$875.84
|
| Rate for Payer: Health EOS Commercial |
$847.28
|
| Rate for Payer: HFN Commercial |
$875.84
|
| Rate for Payer: Multiplan Commercial |
$761.60
|
| Rate for Payer: NAPHCARE Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$875.84
|
| Rate for Payer: Quartz Beloit One Network |
$466.48
|
| Rate for Payer: Quartz Commercial |
$571.20
|
| Rate for Payer: WEA Trust Commercial |
$523.60
|
| Rate for Payer: WPS Commercial |
$705.15
|
|
|
SHEATH 6FR ANSEL 3 INTRODUCER
|
Facility
|
OP
|
$952.00
|
|
|
Service Code
|
HCPCS C1766
|
| Hospital Charge Code |
2972193
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$266.56 |
| Max. Negotiated Rate |
$3,808.00 |
| Rate for Payer: Aetna Commercial |
$856.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.72
|
| Rate for Payer: Aetna Managed Medicare |
$266.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$476.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.56
|
| Rate for Payer: Cash Price |
$285.60
|
| Rate for Payer: Cigna Commercial |
$875.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.74
|
| Rate for Payer: Health EOS Commercial |
$847.28
|
| Rate for Payer: HFN Commercial |
$875.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.00
|
| Rate for Payer: Multiplan Commercial |
$761.60
|
| Rate for Payer: NAPHCARE Commercial |
$571.20
|
| Rate for Payer: Preferred Network Access Commercial |
$875.84
|
| Rate for Payer: Quartz Beloit One Network |
$466.48
|
| Rate for Payer: Quartz Commercial |
$618.80
|
| Rate for Payer: Quartz Medicare Advantage |
$571.20
|
| Rate for Payer: The Alliance Commercial |
$3,808.00
|
| Rate for Payer: WEA Trust Commercial |
$523.60
|
| Rate for Payer: WPS Commercial |
$705.15
|
|
|
SHEATH 6FR. BRITE TIP 45CM 401645M
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2971629
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$2,480.00 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$173.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| Rate for Payer: Quartz Medicare Advantage |
$372.00
|
| Rate for Payer: The Alliance Commercial |
$2,480.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
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 |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
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 |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
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 |
$173.60 |
| Max. Negotiated Rate |
$2,480.00 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$173.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| Rate for Payer: Quartz Medicare Advantage |
$372.00
|
| Rate for Payer: The Alliance Commercial |
$2,480.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
SHEATH 6FR HLS-1006
|
Facility
|
IP
|
$1,399.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
2973528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$685.51 |
| Max. Negotiated Rate |
$1,287.08 |
| Rate for Payer: Aetna Commercial |
$1,259.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.47
|
| Rate for Payer: Cash Price |
$419.70
|
| Rate for Payer: Cigna Commercial |
$1,287.08
|
| Rate for Payer: Health EOS Commercial |
$1,245.11
|
| Rate for Payer: HFN Commercial |
$1,287.08
|
| Rate for Payer: Multiplan Commercial |
$1,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$839.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.08
|
| Rate for Payer: Quartz Beloit One Network |
$685.51
|
| Rate for Payer: Quartz Commercial |
$839.40
|
| Rate for Payer: WEA Trust Commercial |
$769.45
|
| Rate for Payer: WPS Commercial |
$1,036.24
|
|
|
SHEATH 6FR HLS-1006
|
Facility
|
OP
|
$1,399.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
2973528
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$391.72 |
| Max. Negotiated Rate |
$5,596.00 |
| Rate for Payer: Aetna Commercial |
$1,259.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,203.14
|
| Rate for Payer: Aetna Managed Medicare |
$391.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$909.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$699.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$671.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$741.47
|
| Rate for Payer: Cash Price |
$419.70
|
| Rate for Payer: Cigna Commercial |
$1,287.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$782.88
|
| Rate for Payer: Health EOS Commercial |
$1,245.11
|
| Rate for Payer: HFN Commercial |
$1,287.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,049.25
|
| Rate for Payer: Multiplan Commercial |
$1,119.20
|
| Rate for Payer: NAPHCARE Commercial |
$839.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,287.08
|
| Rate for Payer: Quartz Beloit One Network |
$685.51
|
| Rate for Payer: Quartz Commercial |
$909.35
|
| Rate for Payer: Quartz Medicare Advantage |
$839.40
|
| Rate for Payer: The Alliance Commercial |
$5,596.00
|
| Rate for Payer: WEA Trust Commercial |
$769.45
|
| Rate for Payer: WPS Commercial |
$1,036.24
|
|
|
SHEATH 6FR PRO-6F-11-038
|
Facility
|
OP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970221
|
|
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 6FR PRO-6F-11-038
|
Facility
|
IP
|
$334.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970221
|
|
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 FR. SUPER FLEX #CP-07611
|
Facility
|
OP
|
$551.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2973306
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.28 |
| Max. Negotiated Rate |
$2,204.00 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Aetna Managed Medicare |
$154.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$358.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$275.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$264.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$308.34
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$413.25
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$358.15
|
| Rate for Payer: Quartz Medicare Advantage |
$330.60
|
| Rate for Payer: The Alliance Commercial |
$2,204.00
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
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 |
$269.99 |
| Max. Negotiated Rate |
$506.92 |
| Rate for Payer: Aetna Commercial |
$495.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$473.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$292.03
|
| Rate for Payer: Cash Price |
$165.30
|
| Rate for Payer: Cigna Commercial |
$506.92
|
| Rate for Payer: Health EOS Commercial |
$490.39
|
| Rate for Payer: HFN Commercial |
$506.92
|
| Rate for Payer: Multiplan Commercial |
$440.80
|
| Rate for Payer: NAPHCARE Commercial |
$330.60
|
| Rate for Payer: Preferred Network Access Commercial |
$506.92
|
| Rate for Payer: Quartz Beloit One Network |
$269.99
|
| Rate for Payer: Quartz Commercial |
$330.60
|
| Rate for Payer: WEA Trust Commercial |
$303.05
|
| Rate for Payer: WPS Commercial |
$408.13
|
|
|
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 |
$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 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 |
$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 7FR
|
Facility
|
IP
|
$470.00
|
|
| Hospital Charge Code |
2971274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$230.30 |
| Max. Negotiated Rate |
$432.40 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.10
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$432.40
|
| Rate for Payer: Health EOS Commercial |
$418.30
|
| Rate for Payer: HFN Commercial |
$432.40
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: NAPHCARE Commercial |
$282.00
|
| Rate for Payer: Preferred Network Access Commercial |
$432.40
|
| Rate for Payer: Quartz Beloit One Network |
$230.30
|
| Rate for Payer: Quartz Commercial |
$282.00
|
| Rate for Payer: WEA Trust Commercial |
$258.50
|
| Rate for Payer: WPS Commercial |
$348.13
|
|
|
SHEATH 7FR
|
Facility
|
OP
|
$470.00
|
|
| Hospital Charge Code |
2971274
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$131.60 |
| Max. Negotiated Rate |
$1,880.00 |
| Rate for Payer: Aetna Commercial |
$423.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$404.20
|
| Rate for Payer: Aetna Managed Medicare |
$131.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$305.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$235.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$225.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$249.10
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$432.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$263.01
|
| Rate for Payer: Health EOS Commercial |
$418.30
|
| Rate for Payer: HFN Commercial |
$432.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$352.50
|
| Rate for Payer: Multiplan Commercial |
$376.00
|
| Rate for Payer: NAPHCARE Commercial |
$282.00
|
| Rate for Payer: Preferred Network Access Commercial |
$432.40
|
| Rate for Payer: Quartz Beloit One Network |
$230.30
|
| Rate for Payer: Quartz Commercial |
$305.50
|
| Rate for Payer: Quartz Medicare Advantage |
$282.00
|
| Rate for Payer: The Alliance Commercial |
$1,880.00
|
| Rate for Payer: WEA Trust Commercial |
$258.50
|
| Rate for Payer: WPS Commercial |
$348.13
|
|
|
Sheath 7Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550838
|
|
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 7Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550838
|
|
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 7Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550838
|
|
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 7FR. 45CM BRITE TIP 401745M
|
Facility
|
OP
|
$620.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2972184
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$173.60 |
| Max. Negotiated Rate |
$2,480.00 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$173.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| Rate for Payer: Quartz Medicare Advantage |
$372.00
|
| Rate for Payer: The Alliance Commercial |
$2,480.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
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 |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
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 |
$173.60 |
| Max. Negotiated Rate |
$2,480.00 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Aetna Managed Medicare |
$173.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$403.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$297.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.95
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$465.00
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$403.00
|
| Rate for Payer: Quartz Medicare Advantage |
$372.00
|
| Rate for Payer: The Alliance Commercial |
$2,480.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
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 |
$303.80 |
| Max. Negotiated Rate |
$570.40 |
| Rate for Payer: Aetna Commercial |
$558.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$533.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$328.60
|
| Rate for Payer: Cash Price |
$186.00
|
| Rate for Payer: Cigna Commercial |
$570.40
|
| Rate for Payer: Health EOS Commercial |
$551.80
|
| Rate for Payer: HFN Commercial |
$570.40
|
| Rate for Payer: Multiplan Commercial |
$496.00
|
| Rate for Payer: NAPHCARE Commercial |
$372.00
|
| Rate for Payer: Preferred Network Access Commercial |
$570.40
|
| Rate for Payer: Quartz Beloit One Network |
$303.80
|
| Rate for Payer: Quartz Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$341.00
|
| Rate for Payer: WPS Commercial |
$459.23
|
|
|
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 |
$746.76 |
| Max. Negotiated Rate |
$1,402.08 |
| Rate for Payer: Aetna Commercial |
$1,371.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,310.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$807.72
|
| Rate for Payer: Cash Price |
$457.20
|
| Rate for Payer: Cigna Commercial |
$1,402.08
|
| Rate for Payer: Health EOS Commercial |
$1,356.36
|
| Rate for Payer: HFN Commercial |
$1,402.08
|
| Rate for Payer: Multiplan Commercial |
$1,219.20
|
| Rate for Payer: NAPHCARE Commercial |
$914.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,402.08
|
| Rate for Payer: Quartz Beloit One Network |
$746.76
|
| Rate for Payer: Quartz Commercial |
$914.40
|
| Rate for Payer: WEA Trust Commercial |
$838.20
|
| Rate for Payer: WPS Commercial |
$1,128.83
|
|
