|
GUIDE CATHETER 6FR. XB 3.0 67005200
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| 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: 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: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
GUIDE CATHETER 6fr XB 3.5-SH 67005500
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972610
|
|
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
|
|
|
GUIDE CATHETER 6fr XB 3.5-SH 67005500
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972610
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| 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: 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: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
GUIDE CATHETER 6fr XB 3-SH 67005300
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972609
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
GUIDE CATHETER 6fr XB 3-SH 67005300
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.40 |
| 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: 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: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
GUIDE CATHETER 6FR. XBR 1 #667-122-00
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.63 |
| Max. Negotiated Rate |
$1,605.51 |
| Rate for Payer: Aetna Commercial |
$1,570.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,500.80
|
| Rate for Payer: Aetna Managed Medicare |
$488.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,134.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$872.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$837.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$924.91
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,605.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$976.60
|
| Rate for Payer: Health EOS Commercial |
$1,553.16
|
| Rate for Payer: HFN Commercial |
$1,605.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,308.84
|
| Rate for Payer: Multiplan Commercial |
$1,396.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,047.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,605.51
|
| Rate for Payer: Quartz Beloit One Network |
$855.11
|
| Rate for Payer: Quartz Commercial |
$1,134.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,047.07
|
| Rate for Payer: The Alliance Commercial |
$872.56
|
| Rate for Payer: WEA Trust Commercial |
$959.82
|
| Rate for Payer: WPS Commercial |
$1,292.56
|
|
|
GUIDE CATHETER 6FR. XBR 1 #667-122-00
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$855.11 |
| Max. Negotiated Rate |
$1,605.51 |
| Rate for Payer: Aetna Commercial |
$1,570.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,500.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$924.91
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,605.51
|
| Rate for Payer: Health EOS Commercial |
$1,553.16
|
| Rate for Payer: HFN Commercial |
$1,605.51
|
| Rate for Payer: Multiplan Commercial |
$1,396.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,605.51
|
| Rate for Payer: Quartz Beloit One Network |
$855.11
|
| Rate for Payer: Quartz Commercial |
$1,047.07
|
| Rate for Payer: WEA Trust Commercial |
$959.82
|
| Rate for Payer: WPS Commercial |
$1,292.56
|
|
|
GUIDE CATHETER 6FR XB RCA SH 67012700
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972613
|
|
Hospital Revenue Code
|
272
|
| 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 6FR XB RCA SH 67012700
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972613
|
|
Hospital Revenue Code
|
272
|
| 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 CATHETER 7FR MP2-55CM
|
Facility
|
OP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3549512
|
|
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 7FR MP2-55CM
|
Facility
|
IP
|
$1,813.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3549512
|
|
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 8 FR. IM #588817
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$870.40 |
| 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: 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: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
GUIDE CATHETER 8 FR. IM #588817
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972654
|
|
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
|
|
|
GUIDE CATHETER 8 FR. IM-SH 588820
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$488.63 |
| Max. Negotiated Rate |
$1,605.51 |
| Rate for Payer: Aetna Commercial |
$1,570.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,500.80
|
| Rate for Payer: Aetna Managed Medicare |
$488.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,134.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$872.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$837.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$924.91
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,605.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$976.60
|
| Rate for Payer: Health EOS Commercial |
$1,553.16
|
| Rate for Payer: HFN Commercial |
$1,605.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,308.84
|
| Rate for Payer: Multiplan Commercial |
$1,396.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,047.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,605.51
|
| Rate for Payer: Quartz Beloit One Network |
$855.11
|
| Rate for Payer: Quartz Commercial |
$1,134.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,047.07
|
| Rate for Payer: The Alliance Commercial |
$872.56
|
| Rate for Payer: WEA Trust Commercial |
$959.82
|
| Rate for Payer: WPS Commercial |
$1,292.56
|
|
|
GUIDE CATHETER 8 FR. IM-SH 588820
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$855.11 |
| Max. Negotiated Rate |
$1,605.51 |
| Rate for Payer: Aetna Commercial |
$1,570.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,500.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$924.91
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,605.51
|
| Rate for Payer: Health EOS Commercial |
$1,553.16
|
| Rate for Payer: HFN Commercial |
$1,605.51
|
| Rate for Payer: Multiplan Commercial |
$1,396.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,605.51
|
| Rate for Payer: Quartz Beloit One Network |
$855.11
|
| Rate for Payer: Quartz Commercial |
$1,047.07
|
| Rate for Payer: WEA Trust Commercial |
$959.82
|
| Rate for Payer: WPS Commercial |
$1,292.56
|
|
|
GUIDE CATHETER 8FR XB 3.5 5H 588885
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972611
|
|
Hospital Revenue Code
|
278
|
| 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
|
|
|
GUIDE CATHETER 8FR XB 3.5 5H 588885
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$870.40 |
| 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: 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: Health EOS Commercial |
$1,580.92
|
| Rate for Payer: HFN Commercial |
$1,634.21
|
| Rate for Payer: Multiplan Commercial |
$1,421.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,634.21
|
| Rate for Payer: Quartz Beloit One Network |
$870.40
|
| Rate for Payer: Quartz Commercial |
$1,065.79
|
| Rate for Payer: WEA Trust Commercial |
$976.98
|
| Rate for Payer: WPS Commercial |
$1,315.67
|
|
|
Guide-Coronary
|
Facility
|
IP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4001123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$904.54 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,107.60
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
Guide-Coronary
|
Facility
|
OP
|
$1,775.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4001123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$516.88 |
| Max. Negotiated Rate |
$1,698.32 |
| Rate for Payer: Aetna Commercial |
$1,661.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,587.56
|
| Rate for Payer: Aetna Managed Medicare |
$516.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,199.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$923.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$886.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$978.38
|
| Rate for Payer: Cash Price |
$532.50
|
| Rate for Payer: Cigna Commercial |
$1,698.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,033.05
|
| Rate for Payer: Health EOS Commercial |
$1,642.94
|
| Rate for Payer: HFN Commercial |
$1,698.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,384.50
|
| Rate for Payer: Multiplan Commercial |
$1,476.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,107.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,698.32
|
| Rate for Payer: Quartz Beloit One Network |
$904.54
|
| Rate for Payer: Quartz Commercial |
$1,199.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,107.60
|
| Rate for Payer: The Alliance Commercial |
$923.00
|
| Rate for Payer: WEA Trust Commercial |
$1,015.30
|
| Rate for Payer: WPS Commercial |
$1,367.28
|
|
|
GUIDE IKARI 6FR LEFT 3.75 40.6372
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3477502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.19 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,085.14
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
GUIDE IKARI 6FR LEFT 3.75 40.6372
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3477502
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.40 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Aetna Managed Medicare |
$506.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,175.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$904.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$868.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.10
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,356.42
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,175.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.14
|
| Rate for Payer: The Alliance Commercial |
$904.28
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
GUIDE IKARI 6FR RIGHT 1.5 40-6384
|
Facility
|
IP
|
$1,739.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3477503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$886.19 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,085.14
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
GUIDE IKARI 6FR RIGHT 1.5 40-6384
|
Facility
|
OP
|
$1,739.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3477503
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$506.40 |
| Max. Negotiated Rate |
$1,663.88 |
| Rate for Payer: Aetna Commercial |
$1,627.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,555.36
|
| Rate for Payer: Aetna Managed Medicare |
$506.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,175.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$904.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$868.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$958.54
|
| Rate for Payer: Cash Price |
$521.70
|
| Rate for Payer: Cigna Commercial |
$1,663.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.10
|
| Rate for Payer: Health EOS Commercial |
$1,609.62
|
| Rate for Payer: HFN Commercial |
$1,663.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,356.42
|
| Rate for Payer: Multiplan Commercial |
$1,446.85
|
| Rate for Payer: NAPHCARE Commercial |
$1,085.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,663.88
|
| Rate for Payer: Quartz Beloit One Network |
$886.19
|
| Rate for Payer: Quartz Commercial |
$1,175.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,085.14
|
| Rate for Payer: The Alliance Commercial |
$904.28
|
| Rate for Payer: WEA Trust Commercial |
$994.71
|
| Rate for Payer: WPS Commercial |
$1,339.55
|
|
|
GUIDE K-WIRE .054 80-0688
|
Facility
|
OP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5385156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$746.35 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Aetna Managed Medicare |
$746.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,732.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,332.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,279.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,491.67
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,999.14
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: NAPHCARE Commercial |
$1,599.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,732.59
|
| Rate for Payer: Quartz Medicare Advantage |
$1,599.31
|
| Rate for Payer: The Alliance Commercial |
$1,332.76
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
|
GUIDE K-WIRE .054 80-0688
|
Facility
|
IP
|
$2,563.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
5385156
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,306.10 |
| Max. Negotiated Rate |
$2,452.28 |
| Rate for Payer: Aetna Commercial |
$2,398.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,292.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,412.73
|
| Rate for Payer: Cash Price |
$768.90
|
| Rate for Payer: Cigna Commercial |
$2,452.28
|
| Rate for Payer: Health EOS Commercial |
$2,372.31
|
| Rate for Payer: HFN Commercial |
$2,452.28
|
| Rate for Payer: Multiplan Commercial |
$2,132.42
|
| Rate for Payer: Preferred Network Access Commercial |
$2,452.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,306.10
|
| Rate for Payer: Quartz Commercial |
$1,599.31
|
| Rate for Payer: WEA Trust Commercial |
$1,466.04
|
| Rate for Payer: WPS Commercial |
$1,974.28
|
|
