|
CATH CHEST THOR 32F 8888570556
|
Facility
IP
|
$151.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
CATH CHEST THOR 32F 8888570556
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963437
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
CATH CHEST THOR 36F 8888570564
|
Facility
IP
|
$151.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
CATH CHEST THOR 36F 8888570564
|
Facility
OP
|
$151.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963436
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| Rate for Payer: Aetna Managed Medicare |
$42.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.03
|
| Rate for Payer: Cash Price |
$45.30
|
| Rate for Payer: Cigna Commercial |
$138.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.50
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$138.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.25
|
| Rate for Payer: Multiplan Commercial |
$120.80
|
| Rate for Payer: NAPHCARE Commercial |
$90.60
|
| Rate for Payer: Preferred Network Access Commercial |
$138.92
|
| Rate for Payer: Quartz Beloit One Network |
$73.99
|
| Rate for Payer: Quartz Commercial |
$98.15
|
| Rate for Payer: Quartz Medicare Advantage |
$90.60
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
CATH CHEST TROCAR 12F
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHEST TROCAR 12F
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963114
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$90.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$209.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$161.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHEST TROCAR 16F
|
Facility
IP
|
$335.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.15 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.00
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
CATH CHEST TROCAR 16F
|
Facility
OP
|
$335.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963070
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.47
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.25
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.00
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$217.75
|
| Rate for Payer: Quartz Medicare Advantage |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
CATH CHEST TROCAR 20F
|
Facility
OP
|
$335.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.47
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.25
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.00
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$217.75
|
| Rate for Payer: Quartz Medicare Advantage |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
CATH CHEST TROCAR 20F
|
Facility
IP
|
$335.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963072
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$164.15 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.00
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
CATH CHEST TROCAR 24F
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHEST TROCAR 24F
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963095
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$90.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$209.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$161.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHEST TROCAR 28F
|
Facility
IP
|
$322.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHEST TROCAR 28F
|
Facility
OP
|
$322.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963818
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$90.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$209.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$161.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHEST TROCAR 32F
|
Facility
IP
|
$322.00
|
|
| Hospital Charge Code |
2963071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.78 |
| Max. Negotiated Rate |
$296.24 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$193.20
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHEST TROCAR 32F
|
Facility
OP
|
$322.00
|
|
| Hospital Charge Code |
2963071
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$90.16 |
| Max. Negotiated Rate |
$1,288.00 |
| Rate for Payer: Aetna Commercial |
$289.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| Rate for Payer: Aetna Managed Medicare |
$90.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$209.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$161.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$154.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.66
|
| Rate for Payer: Cash Price |
$96.60
|
| Rate for Payer: Cigna Commercial |
$296.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$180.19
|
| Rate for Payer: Health EOS Commercial |
$286.58
|
| Rate for Payer: HFN Commercial |
$296.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$241.50
|
| Rate for Payer: Multiplan Commercial |
$257.60
|
| Rate for Payer: NAPHCARE Commercial |
$193.20
|
| Rate for Payer: Preferred Network Access Commercial |
$296.24
|
| Rate for Payer: Quartz Beloit One Network |
$157.78
|
| Rate for Payer: Quartz Commercial |
$209.30
|
| Rate for Payer: Quartz Medicare Advantage |
$193.20
|
| Rate for Payer: The Alliance Commercial |
$1,288.00
|
| Rate for Payer: WEA Trust Commercial |
$177.10
|
| Rate for Payer: WPS Commercial |
$238.51
|
|
|
CATH CHOLANGIOGRAM REDDICK SCOOP TIP e24051-50
|
Facility
IP
|
$1,907.00
|
|
| Hospital Charge Code |
3969315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$934.43 |
| Max. Negotiated Rate |
$1,754.44 |
| Rate for Payer: Aetna Commercial |
$1,716.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.71
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,754.44
|
| Rate for Payer: Health EOS Commercial |
$1,697.23
|
| Rate for Payer: HFN Commercial |
$1,754.44
|
| Rate for Payer: Multiplan Commercial |
$1,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.44
|
| Rate for Payer: Quartz Beloit One Network |
$934.43
|
| Rate for Payer: Quartz Commercial |
$1,144.20
|
| Rate for Payer: WEA Trust Commercial |
$1,048.85
|
| Rate for Payer: WPS Commercial |
$1,412.51
|
|
|
CATH CHOLANGIOGRAM REDDICK SCOOP TIP e24051-50
|
Facility
OP
|
$1,907.00
|
|
| Hospital Charge Code |
3969315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$533.96 |
| Max. Negotiated Rate |
$7,628.00 |
| Rate for Payer: Aetna Commercial |
$1,716.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.02
|
| Rate for Payer: Aetna Managed Medicare |
$533.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,239.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$953.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$915.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,010.71
|
| Rate for Payer: Cash Price |
$572.10
|
| Rate for Payer: Cigna Commercial |
$1,754.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,067.16
|
| Rate for Payer: Health EOS Commercial |
$1,697.23
|
| Rate for Payer: HFN Commercial |
$1,754.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,430.25
|
| Rate for Payer: Multiplan Commercial |
$1,525.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,754.44
|
| Rate for Payer: Quartz Beloit One Network |
$934.43
|
| Rate for Payer: Quartz Commercial |
$1,239.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,144.20
|
| Rate for Payer: The Alliance Commercial |
$7,628.00
|
| Rate for Payer: WEA Trust Commercial |
$1,048.85
|
| Rate for Payer: WPS Commercial |
$1,412.51
|
|
|
CATH DIAL PERMHEMO FLOW STEP ANTEGRADE STRAIGHT 14.5F X 36CM DHFS 36
|
Facility
IP
|
$1,302.00
|
|
| Hospital Charge Code |
6207069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$637.98 |
| Max. Negotiated Rate |
$1,197.84 |
| Rate for Payer: Aetna Commercial |
$1,171.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.06
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna Commercial |
$1,197.84
|
| Rate for Payer: Health EOS Commercial |
$1,158.78
|
| Rate for Payer: HFN Commercial |
$1,197.84
|
| Rate for Payer: Multiplan Commercial |
$1,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$781.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,197.84
|
| Rate for Payer: Quartz Beloit One Network |
$637.98
|
| Rate for Payer: Quartz Commercial |
$781.20
|
| Rate for Payer: WEA Trust Commercial |
$716.10
|
| Rate for Payer: WPS Commercial |
$964.39
|
|
|
CATH DIAL PERMHEMO FLOW STEP ANTEGRADE STRAIGHT 14.5F X 36CM DHFS 36
|
Facility
OP
|
$1,302.00
|
|
| Hospital Charge Code |
6207069
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$364.56 |
| Max. Negotiated Rate |
$5,208.00 |
| Rate for Payer: Aetna Commercial |
$1,171.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,119.72
|
| Rate for Payer: Aetna Managed Medicare |
$364.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$846.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$651.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$624.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$690.06
|
| Rate for Payer: Cash Price |
$390.60
|
| Rate for Payer: Cigna Commercial |
$1,197.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$728.60
|
| Rate for Payer: Health EOS Commercial |
$1,158.78
|
| Rate for Payer: HFN Commercial |
$1,197.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$976.50
|
| Rate for Payer: Multiplan Commercial |
$1,041.60
|
| Rate for Payer: NAPHCARE Commercial |
$781.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,197.84
|
| Rate for Payer: Quartz Beloit One Network |
$637.98
|
| Rate for Payer: Quartz Commercial |
$846.30
|
| Rate for Payer: Quartz Medicare Advantage |
$781.20
|
| Rate for Payer: The Alliance Commercial |
$5,208.00
|
| Rate for Payer: WEA Trust Commercial |
$716.10
|
| Rate for Payer: WPS Commercial |
$964.39
|
|
|
CATH DIAL PERM HEMOSTAR LT STEP STRAIGHT 14.5F X 24CM 5833690
|
Facility
IP
|
$6,845.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
6207013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,354.05 |
| Max. Negotiated Rate |
$6,297.40 |
| Rate for Payer: Aetna Commercial |
$6,160.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,627.85
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,297.40
|
| Rate for Payer: Health EOS Commercial |
$6,092.05
|
| Rate for Payer: HFN Commercial |
$6,297.40
|
| Rate for Payer: Multiplan Commercial |
$5,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,297.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,354.05
|
| Rate for Payer: Quartz Commercial |
$4,107.00
|
| Rate for Payer: WEA Trust Commercial |
$3,764.75
|
| Rate for Payer: WPS Commercial |
$5,070.09
|
|
|
CATH DIAL PERM HEMOSTAR LT STEP STRAIGHT 14.5F X 24CM 5833690
|
Facility
OP
|
$6,845.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
6207013
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,916.60 |
| Max. Negotiated Rate |
$6,297.40 |
| Rate for Payer: Aetna Commercial |
$6,160.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,886.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,916.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,449.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,422.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,285.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,627.85
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,297.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,830.46
|
| Rate for Payer: Health EOS Commercial |
$6,092.05
|
| Rate for Payer: HFN Commercial |
$6,297.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,133.75
|
| Rate for Payer: Multiplan Commercial |
$5,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,297.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,354.05
|
| Rate for Payer: Quartz Commercial |
$4,449.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,107.00
|
| Rate for Payer: WEA Trust Commercial |
$3,764.75
|
| Rate for Payer: WPS Commercial |
$5,070.09
|
|
|
CATH DIAL PERM HEMOSTAR STEP STRAIGHT 14.5F X 28CM 5833730
|
Facility
OP
|
$6,845.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
6207011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,916.60 |
| Max. Negotiated Rate |
$6,297.40 |
| Rate for Payer: Aetna Commercial |
$6,160.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,886.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,916.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,449.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,422.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,285.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,627.85
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,297.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,830.46
|
| Rate for Payer: Health EOS Commercial |
$6,092.05
|
| Rate for Payer: HFN Commercial |
$6,297.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,133.75
|
| Rate for Payer: Multiplan Commercial |
$5,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,297.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,354.05
|
| Rate for Payer: Quartz Commercial |
$4,449.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,107.00
|
| Rate for Payer: WEA Trust Commercial |
$3,764.75
|
| Rate for Payer: WPS Commercial |
$5,070.09
|
|
|
CATH DIAL PERM HEMOSTAR STEP STRAIGHT 14.5F X 28CM 5833730
|
Facility
IP
|
$6,845.00
|
|
|
Service Code
|
HCPCS C1750
|
| Hospital Charge Code |
6207011
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,354.05 |
| Max. Negotiated Rate |
$6,297.40 |
| Rate for Payer: Aetna Commercial |
$6,160.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,627.85
|
| Rate for Payer: Cash Price |
$2,053.50
|
| Rate for Payer: Cigna Commercial |
$6,297.40
|
| Rate for Payer: Health EOS Commercial |
$6,092.05
|
| Rate for Payer: HFN Commercial |
$6,297.40
|
| Rate for Payer: Multiplan Commercial |
$5,476.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,107.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,297.40
|
| Rate for Payer: Quartz Beloit One Network |
$3,354.05
|
| Rate for Payer: Quartz Commercial |
$4,107.00
|
| Rate for Payer: WEA Trust Commercial |
$3,764.75
|
| Rate for Payer: WPS Commercial |
$5,070.09
|
|
|
CATHETER 100 LGTH ROYAL FLUSH QTY of 5
|
Facility
OP
|
$2,033.00
|
|
| Hospital Charge Code |
2972814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.24 |
| Max. Negotiated Rate |
$8,132.00 |
| Rate for Payer: Aetna Commercial |
$1,829.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,748.38
|
| Rate for Payer: Aetna Managed Medicare |
$569.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,321.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,016.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$975.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,077.49
|
| Rate for Payer: Cash Price |
$609.90
|
| Rate for Payer: Cigna Commercial |
$1,870.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,137.67
|
| Rate for Payer: Health EOS Commercial |
$1,809.37
|
| Rate for Payer: HFN Commercial |
$1,870.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,524.75
|
| Rate for Payer: Multiplan Commercial |
$1,626.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,219.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,870.36
|
| Rate for Payer: Quartz Beloit One Network |
$996.17
|
| Rate for Payer: Quartz Commercial |
$1,321.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,219.80
|
| Rate for Payer: The Alliance Commercial |
$8,132.00
|
| Rate for Payer: WEA Trust Commercial |
$1,118.15
|
| Rate for Payer: WPS Commercial |
$1,505.84
|
|
