|
CATH ANGIO IMPRESS STRAIGHT 5F X 30CM X .035 53035STR
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
6201025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.56 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Aetna Managed Medicare |
$63.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.03
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| Rate for Payer: Quartz Medicare Advantage |
$136.20
|
| Rate for Payer: The Alliance Commercial |
$908.00
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
CATH ANGIO IMPRESS STRAIGHT 5F X 30CM X .035 53035STR
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
6201025
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$136.20
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
CATH ANGIO IMPRESS STRAIGHT 5F X 40CM X .035 54035STS
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
6201026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$136.20
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
CATH ANGIO IMPRESS STRAIGHT 5F X 40CM X .035 54035STS
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
6201026
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.56 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Aetna Managed Medicare |
$63.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.03
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| Rate for Payer: Quartz Medicare Advantage |
$136.20
|
| Rate for Payer: The Alliance Commercial |
$908.00
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
CATH ANGIO IMPRESS STRAIGHT 5F X 65CM X .038 56538STS
|
Facility
|
OP
|
$227.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
6201027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.56 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Aetna Managed Medicare |
$63.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.03
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| Rate for Payer: Quartz Medicare Advantage |
$136.20
|
| Rate for Payer: The Alliance Commercial |
$908.00
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
CATH ANGIO IMPRESS STRAIGHT 5F X 65CM X .038 56538STS
|
Facility
|
IP
|
$227.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
6201027
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$136.20
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
CATH ANGIO SOFT VU STRAIGHT ART 2CM 5F X 90CM X .038 H787107315010
|
Facility
|
OP
|
$2,260.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
6200980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$632.80 |
| Max. Negotiated Rate |
$9,040.00 |
| Rate for Payer: Aetna Commercial |
$2,034.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,943.60
|
| Rate for Payer: Aetna Managed Medicare |
$632.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,469.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,084.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,197.80
|
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Cigna Commercial |
$2,079.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,264.70
|
| Rate for Payer: Health EOS Commercial |
$2,011.40
|
| Rate for Payer: HFN Commercial |
$2,079.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,695.00
|
| Rate for Payer: Multiplan Commercial |
$1,808.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,079.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.40
|
| Rate for Payer: Quartz Commercial |
$1,469.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,356.00
|
| Rate for Payer: The Alliance Commercial |
$9,040.00
|
| Rate for Payer: WEA Trust Commercial |
$1,243.00
|
| Rate for Payer: WPS Commercial |
$1,673.98
|
|
|
CATH ANGIO SOFT VU STRAIGHT ART 2CM 5F X 90CM X .038 H787107315010
|
Facility
|
IP
|
$2,260.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
6200980
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,107.40 |
| Max. Negotiated Rate |
$2,079.20 |
| Rate for Payer: Aetna Commercial |
$2,034.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,943.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,197.80
|
| Rate for Payer: Cash Price |
$678.00
|
| Rate for Payer: Cigna Commercial |
$2,079.20
|
| Rate for Payer: Health EOS Commercial |
$2,011.40
|
| Rate for Payer: HFN Commercial |
$2,079.20
|
| Rate for Payer: Multiplan Commercial |
$1,808.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,356.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,079.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,107.40
|
| Rate for Payer: Quartz Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$1,243.00
|
| Rate for Payer: WPS Commercial |
$1,673.98
|
|
|
CATH CHEST THOR 24F 8888570531
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| 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: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
CATH CHEST THOR 24F 8888570531
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963441
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| 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 28F 8888570549
|
Facility
|
IP
|
$151.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.99 |
| Max. Negotiated Rate |
$138.92 |
| Rate for Payer: Aetna Commercial |
$135.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| 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 28F 8888570549
|
Facility
|
OP
|
$151.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2963521
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.28 |
| Max. Negotiated Rate |
$604.00 |
| 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: The Alliance Commercial |
$604.00
|
| 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 |
$604.00 |
| 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: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| 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
|
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: Aetna Gatekeeper/Not Gatekeeper |
$129.86
|
| 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 |
$604.00 |
| 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: The Alliance Commercial |
$604.00
|
| Rate for Payer: WEA Trust Commercial |
$83.05
|
| Rate for Payer: WPS Commercial |
$111.85
|
|
|
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 |
$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 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: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| 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 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: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| 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 |
$1,340.00 |
| 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: The Alliance Commercial |
$1,340.00
|
| 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 |
$1,340.00 |
| 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: The Alliance Commercial |
$1,340.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| 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 |
$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 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: Aetna Gatekeeper/Not Gatekeeper |
$276.92
|
| 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
|
|
