|
Guide 6Fr XB4 SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: The Alliance Commercial |
$2,004.00
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 6Fr XB4 SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 6Fr XB4 SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546830
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$475.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.60
|
| Rate for Payer: Health EOS Commercial |
$455.91
|
| Rate for Payer: HFN Commercial |
$475.95
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$475.95
|
| Rate for Payer: Quartz Beloit One Network |
$220.44
|
| Rate for Payer: Quartz Commercial |
$285.57
|
| Rate for Payer: The Alliance Commercial |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 6Fr XBR1
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$475.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.60
|
| Rate for Payer: Health EOS Commercial |
$455.91
|
| Rate for Payer: HFN Commercial |
$475.95
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$475.95
|
| Rate for Payer: Quartz Beloit One Network |
$220.44
|
| Rate for Payer: Quartz Commercial |
$285.57
|
| Rate for Payer: The Alliance Commercial |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 6Fr XBR1
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 6Fr XBR1
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: The Alliance Commercial |
$2,004.00
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 6Fr XBRCA
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 6Fr XBRCA
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$475.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.60
|
| Rate for Payer: Health EOS Commercial |
$455.91
|
| Rate for Payer: HFN Commercial |
$475.95
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$475.95
|
| Rate for Payer: Quartz Beloit One Network |
$220.44
|
| Rate for Payer: Quartz Commercial |
$285.57
|
| Rate for Payer: The Alliance Commercial |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 6Fr XBRCA
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: The Alliance Commercial |
$2,004.00
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
GUIDE 6FR. XB RCA 67012600
|
Facility
|
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| Max. Negotiated Rate |
$6,832.00 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Aetna Managed Medicare |
$478.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,110.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$854.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.80
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,281.00
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,110.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.80
|
| Rate for Payer: The Alliance Commercial |
$6,832.00
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
GUIDE 6FR. XB RCA 67012600
|
Facility
|
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972649
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$836.92 |
| Max. Negotiated Rate |
$1,571.36 |
| Rate for Payer: Aetna Commercial |
$1,537.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.24
|
| Rate for Payer: Cash Price |
$512.40
|
| Rate for Payer: Cigna Commercial |
$1,571.36
|
| Rate for Payer: Health EOS Commercial |
$1,520.12
|
| Rate for Payer: HFN Commercial |
$1,571.36
|
| Rate for Payer: Multiplan Commercial |
$1,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.36
|
| Rate for Payer: Quartz Beloit One Network |
$836.92
|
| Rate for Payer: Quartz Commercial |
$1,024.80
|
| Rate for Payer: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
Guide 6Fr XBRCA SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$475.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.60
|
| Rate for Payer: Health EOS Commercial |
$455.91
|
| Rate for Payer: HFN Commercial |
$475.95
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$475.95
|
| Rate for Payer: Quartz Beloit One Network |
$220.44
|
| Rate for Payer: Quartz Commercial |
$285.57
|
| Rate for Payer: The Alliance Commercial |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 6Fr XBRCA SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 6Fr XBRCA SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: The Alliance Commercial |
$2,004.00
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 7Fr AL1
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: The Alliance Commercial |
$2,004.00
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 7Fr AL1
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 7Fr AL1
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$475.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.60
|
| Rate for Payer: Health EOS Commercial |
$455.91
|
| Rate for Payer: HFN Commercial |
$475.95
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$475.95
|
| Rate for Payer: Quartz Beloit One Network |
$220.44
|
| Rate for Payer: Quartz Commercial |
$285.57
|
| Rate for Payer: The Alliance Commercial |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
GUIDE 7 FR. AL 1 #778-036-00
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$822.22 |
| Max. Negotiated Rate |
$1,543.76 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,006.80
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
GUIDE 7 FR. AL 1 #778-036-00
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.84 |
| Max. Negotiated Rate |
$6,712.00 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Aetna Managed Medicare |
$469.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,090.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$839.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$805.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$939.01
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.50
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,090.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,006.80
|
| Rate for Payer: The Alliance Commercial |
$6,712.00
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
Guide 7Fr AL1 SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: The Alliance Commercial |
$2,004.00
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 7Fr AL1 SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$300.60
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
Guide 7Fr AL1 SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$220.44 |
| Max. Negotiated Rate |
$475.95 |
| Rate for Payer: Aetna Commercial |
$475.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$475.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$250.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.60
|
| Rate for Payer: Health EOS Commercial |
$455.91
|
| Rate for Payer: HFN Commercial |
$475.95
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: Preferred Network Access Commercial |
$475.95
|
| Rate for Payer: Quartz Beloit One Network |
$220.44
|
| Rate for Payer: Quartz Commercial |
$285.57
|
| Rate for Payer: The Alliance Commercial |
$250.50
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
GUIDE 7FR. AL 1 SH 778-037-00
|
Facility
|
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$822.22 |
| Max. Negotiated Rate |
$1,543.76 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,006.80
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
GUIDE 7FR. AL 1 SH 778-037-00
|
Facility
|
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972640
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.84 |
| Max. Negotiated Rate |
$6,712.00 |
| Rate for Payer: Aetna Commercial |
$1,510.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,443.08
|
| Rate for Payer: Aetna Managed Medicare |
$469.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,090.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$839.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$805.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$889.34
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,543.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$939.01
|
| Rate for Payer: Health EOS Commercial |
$1,493.42
|
| Rate for Payer: HFN Commercial |
$1,543.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,258.50
|
| Rate for Payer: Multiplan Commercial |
$1,342.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,006.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,543.76
|
| Rate for Payer: Quartz Beloit One Network |
$822.22
|
| Rate for Payer: Quartz Commercial |
$1,090.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,006.80
|
| Rate for Payer: The Alliance Commercial |
$6,712.00
|
| Rate for Payer: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
Guide 7Fr AL2
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546910
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$2,004.00 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$430.86
|
| Rate for Payer: Aetna Managed Medicare |
$140.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$325.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$250.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$265.53
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$460.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.36
|
| Rate for Payer: Health EOS Commercial |
$445.89
|
| Rate for Payer: HFN Commercial |
$460.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.75
|
| Rate for Payer: Multiplan Commercial |
$400.80
|
| Rate for Payer: NAPHCARE Commercial |
$300.60
|
| Rate for Payer: Preferred Network Access Commercial |
$460.92
|
| Rate for Payer: Quartz Beloit One Network |
$245.49
|
| Rate for Payer: Quartz Commercial |
$325.65
|
| Rate for Payer: Quartz Medicare Advantage |
$300.60
|
| Rate for Payer: The Alliance Commercial |
$2,004.00
|
| Rate for Payer: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
