|
Guide 8Fr XB3.5
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB3.5
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB3.5 SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB3.5 SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB3.5 SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546930
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB3 SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB3 SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB3 SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546926
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB4.5 SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB4.5 SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB4.5 SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546934
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB4 SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB4 SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB4 SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546932
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
GUIDE CATHETER 5FR JL3.5 556-002-00
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3553543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.66 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Aetna Managed Medicare |
$497.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$853.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.64
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,333.02
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,155.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,066.42
|
| Rate for Payer: The Alliance Commercial |
$888.68
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
GUIDE CATHETER 5FR JL3.5 556-002-00
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3553543
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.91 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,066.42
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
GUIDE CATHETER 5FR JL4 556-004-00
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3553544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.66 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Aetna Managed Medicare |
$497.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$853.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.64
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,333.02
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,155.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,066.42
|
| Rate for Payer: The Alliance Commercial |
$888.68
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
GUIDE CATHETER 5FR JL4 556-004-00
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3553544
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.91 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,066.42
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
GUIDE CATHETER 5FR JR4 556-082-00
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3553546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.91 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,066.42
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
GUIDE CATHETER 5FR JR4 556-082-00
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3553546
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.66 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Aetna Managed Medicare |
$497.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$853.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.64
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,333.02
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,155.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,066.42
|
| Rate for Payer: The Alliance Commercial |
$888.68
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
GUIDE CATHETER 6FR AR2-SH 67011300
|
Facility
|
IP
|
$1,709.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971933
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.91 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,066.42
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
GUIDE CATHETER 6FR AR2-SH 67011300
|
Facility
|
OP
|
$1,709.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2971933
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.66 |
| Max. Negotiated Rate |
$1,635.17 |
| Rate for Payer: Aetna Commercial |
$1,599.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,528.53
|
| Rate for Payer: Aetna Managed Medicare |
$497.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,155.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$853.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$942.00
|
| Rate for Payer: Cash Price |
$512.70
|
| Rate for Payer: Cigna Commercial |
$1,635.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.64
|
| Rate for Payer: Health EOS Commercial |
$1,581.85
|
| Rate for Payer: HFN Commercial |
$1,635.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,333.02
|
| Rate for Payer: Multiplan Commercial |
$1,421.89
|
| Rate for Payer: NAPHCARE Commercial |
$1,066.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,635.17
|
| Rate for Payer: Quartz Beloit One Network |
$870.91
|
| Rate for Payer: Quartz Commercial |
$1,155.28
|
| Rate for Payer: Quartz Medicare Advantage |
$1,066.42
|
| Rate for Payer: The Alliance Commercial |
$888.68
|
| Rate for Payer: WEA Trust Commercial |
$977.55
|
| Rate for Payer: WPS Commercial |
$1,316.44
|
|
|
GUIDE CATHETER 6FR MP2-55CM
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3549511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$923.90 |
| Max. Negotiated Rate |
$1,734.68 |
| Rate for Payer: Aetna Commercial |
$1,696.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,621.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$999.33
|
| Rate for Payer: Cash Price |
$543.90
|
| Rate for Payer: Cigna Commercial |
$1,734.68
|
| Rate for Payer: Health EOS Commercial |
$1,678.11
|
| Rate for Payer: HFN Commercial |
$1,734.68
|
| Rate for Payer: Multiplan Commercial |
$1,508.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,734.68
|
| Rate for Payer: Quartz Beloit One Network |
$923.90
|
| Rate for Payer: Quartz Commercial |
$1,131.31
|
| Rate for Payer: WEA Trust Commercial |
$1,037.04
|
| Rate for Payer: WPS Commercial |
$1,396.55
|
|
|
GUIDE CATHETER 6FR MP2-55CM
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3549511
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$527.95 |
| Max. Negotiated Rate |
$1,734.68 |
| Rate for Payer: Aetna Commercial |
$1,696.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,621.55
|
| Rate for Payer: Aetna Managed Medicare |
$527.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,225.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$942.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$905.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$999.33
|
| Rate for Payer: Cash Price |
$543.90
|
| Rate for Payer: Cigna Commercial |
$1,734.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,055.17
|
| Rate for Payer: Health EOS Commercial |
$1,678.11
|
| Rate for Payer: HFN Commercial |
$1,734.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,414.14
|
| Rate for Payer: Multiplan Commercial |
$1,508.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,131.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,734.68
|
| Rate for Payer: Quartz Beloit One Network |
$923.90
|
| Rate for Payer: Quartz Commercial |
$1,225.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,131.31
|
| Rate for Payer: The Alliance Commercial |
$942.76
|
| Rate for Payer: WEA Trust Commercial |
$1,037.04
|
| Rate for Payer: WPS Commercial |
$1,396.55
|
|
|
GUIDE CATHETER 6FR. XB 3.0 67005200
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$497.37 |
| Max. Negotiated Rate |
$1,634.21 |
| Rate for Payer: Aetna Commercial |
$1,598.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,527.64
|
| Rate for Payer: Aetna Managed Medicare |
$497.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,154.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$888.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$852.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$941.45
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,634.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$994.06
|
| Rate for Payer: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,332.24
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: NAPHCARE Commercial |
$1,065.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,154.61
|
| Rate for Payer: Quartz Medicare Advantage |
$1,065.79
|
| Rate for Payer: The Alliance Commercial |
$888.16
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
