|
SHEATH 9FR 11CM 402-609X
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
SHEATH 9FR 11CM 402-609X
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2970777
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$53.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.32
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
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 |
$53.20 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$53.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.32
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
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 |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
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 |
$53.20 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$53.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.32
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
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 |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
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 |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
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 |
$53.20 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$53.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.32
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
SHEATH AVANTI 7F 5.5CM WITH .035 GW 402-607P
|
Facility
|
OP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$53.20 |
| Max. Negotiated Rate |
$760.00 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Aetna Managed Medicare |
$53.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$91.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$106.32
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.50
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$123.50
|
| Rate for Payer: Quartz Medicare Advantage |
$114.00
|
| Rate for Payer: The Alliance Commercial |
$760.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
SHEATH AVANTI 7F 5.5CM WITH .035 GW 402-607P
|
Facility
|
IP
|
$190.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.10 |
| Max. Negotiated Rate |
$174.80 |
| Rate for Payer: Aetna Commercial |
$171.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$163.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$100.70
|
| Rate for Payer: Cash Price |
$57.00
|
| Rate for Payer: Cigna Commercial |
$174.80
|
| Rate for Payer: Health EOS Commercial |
$169.10
|
| Rate for Payer: HFN Commercial |
$174.80
|
| Rate for Payer: Multiplan Commercial |
$152.00
|
| Rate for Payer: NAPHCARE Commercial |
$114.00
|
| Rate for Payer: Preferred Network Access Commercial |
$174.80
|
| Rate for Payer: Quartz Beloit One Network |
$93.10
|
| Rate for Payer: Quartz Commercial |
$114.00
|
| Rate for Payer: WEA Trust Commercial |
$104.50
|
| Rate for Payer: WPS Commercial |
$140.73
|
|
|
SHEATH BRITE TIP 10F X 11CM WITH 3MM-J .035 GW 401-011M
|
Facility
|
IP
|
$339.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
SHEATH BRITE TIP 10F X 11CM WITH 3MM-J .035 GW 401-011M
|
Facility
|
OP
|
$339.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
6201008
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.92 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$94.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$220.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.25
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$203.40
|
| Rate for Payer: The Alliance Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
Sheath BriteTip 5Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550844
|
|
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 BriteTip 5Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550844
|
|
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 BriteTip 5Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550844
|
|
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 Brite Tip 5Fr 23cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550852
|
|
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 Brite Tip 5Fr 23cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550852
|
|
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 Brite Tip 5Fr 23cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550852
|
|
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 Brite Tip 6Fr 11cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550846
|
|
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 Brite Tip 6Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550846
|
|
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 Brite Tip 6Fr 11cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550846
|
|
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 Brite Tip 6Fr 23cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550854
|
|
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 Brite Tip 6Fr 23cm
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550854
|
|
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 Brite Tip 6Fr 23cm
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550854
|
|
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 Brite Tip 7Fr 11cm
|
Facility
|
OP
|
$321.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
2550848
|
|
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
|
|
