|
Guide 8Fr JL4
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr JL4 SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr JL4 SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr JL4 SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546946
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr JR4
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr JR4
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr JR4
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546936
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr JR4 SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr JR4 SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr JR4 SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546938
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr MPA1 SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr MPA1 SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr MPA1 SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr RCB
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr RCB
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr RCB
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546940
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr RCB SH
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr RCB SH
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr RCB SH
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546942
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
GUIDE 8FR. RDC INTRODUCER 403-8553A
|
Facility
|
OP
|
$1,188.00
|
|
| Hospital Charge Code |
2972094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$345.95 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Aetna Managed Medicare |
$345.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$803.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$617.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$593.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.42
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$926.64
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: NAPHCARE Commercial |
$741.31
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$803.09
|
| Rate for Payer: Quartz Medicare Advantage |
$741.31
|
| Rate for Payer: The Alliance Commercial |
$617.76
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
GUIDE 8FR. RDC INTRODUCER 403-8553A
|
Facility
|
IP
|
$1,188.00
|
|
| Hospital Charge Code |
2972094
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$605.40 |
| Max. Negotiated Rate |
$1,136.68 |
| Rate for Payer: Aetna Commercial |
$1,111.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,062.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$654.83
|
| Rate for Payer: Cash Price |
$356.40
|
| Rate for Payer: Cigna Commercial |
$1,136.68
|
| Rate for Payer: Health EOS Commercial |
$1,099.61
|
| Rate for Payer: HFN Commercial |
$1,136.68
|
| Rate for Payer: Multiplan Commercial |
$988.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,136.68
|
| Rate for Payer: Quartz Beloit One Network |
$605.40
|
| Rate for Payer: Quartz Commercial |
$741.31
|
| Rate for Payer: WEA Trust Commercial |
$679.54
|
| Rate for Payer: WPS Commercial |
$915.12
|
|
|
Guide 8Fr XB3
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB3
|
Professional
|
Both
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$229.26 |
| Max. Negotiated Rate |
$494.99 |
| Rate for Payer: Aetna Commercial |
$494.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$494.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$260.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.62
|
| Rate for Payer: Health EOS Commercial |
$474.15
|
| Rate for Payer: HFN Commercial |
$494.99
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$494.99
|
| Rate for Payer: Quartz Beloit One Network |
$229.26
|
| Rate for Payer: Quartz Commercial |
$296.99
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB3
|
Facility
|
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546924
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$145.89 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Aetna Managed Medicare |
$145.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.58
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.78
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: NAPHCARE Commercial |
$312.62
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$338.68
|
| Rate for Payer: Quartz Medicare Advantage |
$312.62
|
| Rate for Payer: The Alliance Commercial |
$260.52
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
|
Guide 8Fr XB3.5
|
Facility
|
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2546928
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$255.31 |
| Max. Negotiated Rate |
$479.36 |
| Rate for Payer: Aetna Commercial |
$468.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.15
|
| Rate for Payer: Cash Price |
$150.30
|
| Rate for Payer: Cigna Commercial |
$479.36
|
| Rate for Payer: Health EOS Commercial |
$463.73
|
| Rate for Payer: HFN Commercial |
$479.36
|
| Rate for Payer: Multiplan Commercial |
$416.83
|
| Rate for Payer: Preferred Network Access Commercial |
$479.36
|
| Rate for Payer: Quartz Beloit One Network |
$255.31
|
| Rate for Payer: Quartz Commercial |
$312.62
|
| Rate for Payer: WEA Trust Commercial |
$286.57
|
| Rate for Payer: WPS Commercial |
$385.92
|
|
