|
Ativan 2 mg Charge
|
Facility
|
OP
|
$34.00
|
|
|
Service Code
|
HCPCS J2060
|
| Hospital Charge Code |
2958974
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.32 |
| Max. Negotiated Rate |
$32.53 |
| Rate for Payer: Aetna Commercial |
$31.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$30.41
|
| Rate for Payer: Aetna Managed Medicare |
$9.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.74
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cash Price |
$10.20
|
| Rate for Payer: Cigna Commercial |
$32.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.32
|
| Rate for Payer: Health EOS Commercial |
$31.47
|
| Rate for Payer: HFN Commercial |
$32.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26.52
|
| Rate for Payer: Multiplan Commercial |
$28.29
|
| Rate for Payer: NAPHCARE Commercial |
$21.22
|
| Rate for Payer: Preferred Network Access Commercial |
$32.53
|
| Rate for Payer: Quartz Beloit One Network |
$17.33
|
| Rate for Payer: Quartz Commercial |
$22.98
|
| Rate for Payer: Quartz Medicare Advantage |
$21.22
|
| Rate for Payer: The Alliance Commercial |
$5.87
|
| Rate for Payer: WEA Trust Commercial |
$19.45
|
| Rate for Payer: WPS Commercial |
$2.50
|
|
|
ATOMIC EDGE KNIFE 600 MICRON 370260
|
Facility
|
IP
|
$701.00
|
|
| Hospital Charge Code |
5415298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$357.23 |
| Max. Negotiated Rate |
$670.72 |
| Rate for Payer: Aetna Commercial |
$656.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.39
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$670.72
|
| Rate for Payer: Health EOS Commercial |
$648.85
|
| Rate for Payer: HFN Commercial |
$670.72
|
| Rate for Payer: Multiplan Commercial |
$583.23
|
| Rate for Payer: Preferred Network Access Commercial |
$670.72
|
| Rate for Payer: Quartz Beloit One Network |
$357.23
|
| Rate for Payer: Quartz Commercial |
$437.42
|
| Rate for Payer: WEA Trust Commercial |
$400.97
|
| Rate for Payer: WPS Commercial |
$539.98
|
|
|
ATOMIC EDGE KNIFE 600 MICRON 370260
|
Facility
|
OP
|
$701.00
|
|
| Hospital Charge Code |
5415298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$204.13 |
| Max. Negotiated Rate |
$670.72 |
| Rate for Payer: Aetna Commercial |
$656.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.97
|
| Rate for Payer: Aetna Managed Medicare |
$204.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$473.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$364.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$349.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$386.39
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$670.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$407.98
|
| Rate for Payer: Health EOS Commercial |
$648.85
|
| Rate for Payer: HFN Commercial |
$670.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.78
|
| Rate for Payer: Multiplan Commercial |
$583.23
|
| Rate for Payer: NAPHCARE Commercial |
$437.42
|
| Rate for Payer: Preferred Network Access Commercial |
$670.72
|
| Rate for Payer: Quartz Beloit One Network |
$357.23
|
| Rate for Payer: Quartz Commercial |
$473.88
|
| Rate for Payer: Quartz Medicare Advantage |
$437.42
|
| Rate for Payer: The Alliance Commercial |
$364.52
|
| Rate for Payer: WEA Trust Commercial |
$400.97
|
| Rate for Payer: WPS Commercial |
$539.98
|
|
|
Atomoxetine, Serum
|
Facility
|
OP
|
$417.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3674168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$121.43 |
| Max. Negotiated Rate |
$398.99 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Aetna Managed Medicare |
$121.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$281.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$216.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.85
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$398.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.69
|
| Rate for Payer: Health EOS Commercial |
$385.98
|
| Rate for Payer: HFN Commercial |
$398.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$325.26
|
| Rate for Payer: Multiplan Commercial |
$346.94
|
| Rate for Payer: NAPHCARE Commercial |
$260.21
|
| Rate for Payer: Preferred Network Access Commercial |
$398.99
|
| Rate for Payer: Quartz Beloit One Network |
$212.50
|
| Rate for Payer: Quartz Commercial |
$281.89
|
| Rate for Payer: Quartz Medicare Advantage |
$260.21
|
| Rate for Payer: The Alliance Commercial |
$216.84
|
| Rate for Payer: United Healthcare PPO |
$325.26
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: WPS Commercial |
$321.22
|
|
|
Atomoxetine, Serum
|
Facility
|
IP
|
$417.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3674168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$212.50 |
| Max. Negotiated Rate |
$398.99 |
| Rate for Payer: Aetna Commercial |
$390.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$229.85
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$398.99
|
| Rate for Payer: Health EOS Commercial |
$385.98
|
| Rate for Payer: HFN Commercial |
$398.99
|
| Rate for Payer: Multiplan Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$398.99
|
| Rate for Payer: Quartz Beloit One Network |
$212.50
|
| Rate for Payer: Quartz Commercial |
$260.21
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: WPS Commercial |
$321.22
|
|
|
Atomoxetine, Serum
|
Professional
|
Both
|
$417.00
|
|
|
Service Code
|
CPT 80338
|
| Hospital Charge Code |
3674168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.81 |
| Max. Negotiated Rate |
$412.00 |
| Rate for Payer: Aetna Commercial |
$412.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$372.96
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cash Price |
$125.10
|
| Rate for Payer: Cigna Commercial |
$412.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$216.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.21
|
| Rate for Payer: Health EOS Commercial |
$394.65
|
| Rate for Payer: HFN Commercial |
$412.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.81
|
| Rate for Payer: Multiplan Commercial |
$346.94
|
| Rate for Payer: Preferred Network Access Commercial |
$412.00
|
| Rate for Payer: Quartz Beloit One Network |
$190.82
|
| Rate for Payer: Quartz Commercial |
$247.20
|
| Rate for Payer: The Alliance Commercial |
$216.84
|
| Rate for Payer: WEA Trust Commercial |
$238.52
|
| Rate for Payer: WPS Commercial |
$321.22
|
|
|
ATRIAL AND VENTRICULAR RECORDING AND PACING
|
Facility
|
OP
|
$383.92
|
|
|
Service Code
|
EAPG 00096
|
| Min. Negotiated Rate |
$369.15 |
| Max. Negotiated Rate |
$383.92 |
| Rate for Payer: Anthem Medicaid |
$369.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$369.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$369.15
|
| Rate for Payer: Dean Health Medicaid |
$369.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$369.15
|
| Rate for Payer: Managed Health Services Medicaid |
$383.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$369.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$369.15
|
| Rate for Payer: United Healthcare Medicaid |
$369.15
|
|
|
ATRIAL FIBRILLATION
|
Facility
|
OP
|
$91.72
|
|
|
Service Code
|
EAPG 00602
|
| Min. Negotiated Rate |
$88.19 |
| Max. Negotiated Rate |
$91.72 |
| Rate for Payer: Anthem Medicaid |
$88.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$88.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$88.19
|
| Rate for Payer: Dean Health Medicaid |
$88.19
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$88.19
|
| Rate for Payer: Managed Health Services Medicaid |
$91.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$88.19
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$88.19
|
| Rate for Payer: United Healthcare Medicaid |
$88.19
|
|
|
ATRIAL SEPTAL DEFECT
|
Facility
|
OP
|
$15,894.00
|
|
| Hospital Charge Code |
4494606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,628.33 |
| Max. Negotiated Rate |
$15,207.38 |
| Rate for Payer: Aetna Commercial |
$14,876.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,215.59
|
| Rate for Payer: Aetna Managed Medicare |
$4,628.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,744.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,264.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,934.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,760.77
|
| Rate for Payer: Cash Price |
$4,768.20
|
| Rate for Payer: Cigna Commercial |
$15,207.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,250.31
|
| Rate for Payer: Health EOS Commercial |
$14,711.49
|
| Rate for Payer: HFN Commercial |
$15,207.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,397.32
|
| Rate for Payer: Multiplan Commercial |
$13,223.81
|
| Rate for Payer: NAPHCARE Commercial |
$9,917.86
|
| Rate for Payer: Preferred Network Access Commercial |
$15,207.38
|
| Rate for Payer: Quartz Beloit One Network |
$8,099.58
|
| Rate for Payer: Quartz Commercial |
$10,744.34
|
| Rate for Payer: Quartz Medicare Advantage |
$9,917.86
|
| Rate for Payer: The Alliance Commercial |
$8,264.88
|
| Rate for Payer: WEA Trust Commercial |
$9,091.37
|
| Rate for Payer: WPS Commercial |
$12,243.15
|
|
|
ATRIAL SEPTAL DEFECT
|
Facility
|
IP
|
$15,894.00
|
|
| Hospital Charge Code |
4494606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,099.58 |
| Max. Negotiated Rate |
$15,207.38 |
| Rate for Payer: Aetna Commercial |
$14,876.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,215.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,760.77
|
| Rate for Payer: Cash Price |
$4,768.20
|
| Rate for Payer: Cigna Commercial |
$15,207.38
|
| Rate for Payer: Health EOS Commercial |
$14,711.49
|
| Rate for Payer: HFN Commercial |
$15,207.38
|
| Rate for Payer: Multiplan Commercial |
$13,223.81
|
| Rate for Payer: Preferred Network Access Commercial |
$15,207.38
|
| Rate for Payer: Quartz Beloit One Network |
$8,099.58
|
| Rate for Payer: Quartz Commercial |
$9,917.86
|
| Rate for Payer: WEA Trust Commercial |
$9,091.37
|
| Rate for Payer: WPS Commercial |
$12,243.15
|
|
|
ATRICLIP 35MM LAA EXCLUSION FLEX HANDLE ACH235
|
Facility
|
IP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,851.23 |
| Max. Negotiated Rate |
$10,985.98 |
| Rate for Payer: Aetna Commercial |
$10,747.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,269.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,328.88
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,985.98
|
| Rate for Payer: Health EOS Commercial |
$10,627.74
|
| Rate for Payer: HFN Commercial |
$10,985.98
|
| Rate for Payer: Multiplan Commercial |
$9,553.02
|
| Rate for Payer: Preferred Network Access Commercial |
$10,985.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,851.23
|
| Rate for Payer: Quartz Commercial |
$7,164.77
|
| Rate for Payer: WEA Trust Commercial |
$6,567.70
|
| Rate for Payer: WPS Commercial |
$8,844.58
|
|
|
ATRICLIP 35MM LAA EXCLUSION FLEX HANDLE ACH235
|
Facility
|
OP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964748
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,343.56 |
| Max. Negotiated Rate |
$10,985.98 |
| Rate for Payer: Aetna Commercial |
$10,747.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,269.50
|
| Rate for Payer: Aetna Managed Medicare |
$3,343.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,761.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,970.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,731.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,328.88
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,985.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,682.52
|
| Rate for Payer: Health EOS Commercial |
$10,627.74
|
| Rate for Payer: HFN Commercial |
$10,985.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,955.96
|
| Rate for Payer: Multiplan Commercial |
$9,553.02
|
| Rate for Payer: NAPHCARE Commercial |
$7,164.77
|
| Rate for Payer: Preferred Network Access Commercial |
$10,985.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,851.23
|
| Rate for Payer: Quartz Commercial |
$7,761.83
|
| Rate for Payer: Quartz Medicare Advantage |
$7,164.77
|
| Rate for Payer: The Alliance Commercial |
$5,970.64
|
| Rate for Payer: WEA Trust Commercial |
$6,567.70
|
| Rate for Payer: WPS Commercial |
$8,844.58
|
|
|
ATRICLIP 40MM LAA EXCLUSION FLEX HANDLE ACH240
|
Facility
|
IP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,851.23 |
| Max. Negotiated Rate |
$10,985.98 |
| Rate for Payer: Aetna Commercial |
$10,747.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,269.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,328.88
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,985.98
|
| Rate for Payer: Health EOS Commercial |
$10,627.74
|
| Rate for Payer: HFN Commercial |
$10,985.98
|
| Rate for Payer: Multiplan Commercial |
$9,553.02
|
| Rate for Payer: Preferred Network Access Commercial |
$10,985.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,851.23
|
| Rate for Payer: Quartz Commercial |
$7,164.77
|
| Rate for Payer: WEA Trust Commercial |
$6,567.70
|
| Rate for Payer: WPS Commercial |
$8,844.58
|
|
|
ATRICLIP 40MM LAA EXCLUSION FLEX HANDLE ACH240
|
Facility
|
OP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,343.56 |
| Max. Negotiated Rate |
$10,985.98 |
| Rate for Payer: Aetna Commercial |
$10,747.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,269.50
|
| Rate for Payer: Aetna Managed Medicare |
$3,343.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,761.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,970.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,731.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,328.88
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,985.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,682.52
|
| Rate for Payer: Health EOS Commercial |
$10,627.74
|
| Rate for Payer: HFN Commercial |
$10,985.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,955.96
|
| Rate for Payer: Multiplan Commercial |
$9,553.02
|
| Rate for Payer: NAPHCARE Commercial |
$7,164.77
|
| Rate for Payer: Preferred Network Access Commercial |
$10,985.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,851.23
|
| Rate for Payer: Quartz Commercial |
$7,761.83
|
| Rate for Payer: Quartz Medicare Advantage |
$7,164.77
|
| Rate for Payer: The Alliance Commercial |
$5,970.64
|
| Rate for Payer: WEA Trust Commercial |
$6,567.70
|
| Rate for Payer: WPS Commercial |
$8,844.58
|
|
|
ATRICLIP 40MM LAA FLEX V ACHV40
|
Facility
|
IP
|
$9,717.00
|
|
| Hospital Charge Code |
5685744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,951.78 |
| Max. Negotiated Rate |
$9,297.23 |
| Rate for Payer: Aetna Commercial |
$9,095.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,690.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,356.01
|
| Rate for Payer: Cash Price |
$2,915.10
|
| Rate for Payer: Cigna Commercial |
$9,297.23
|
| Rate for Payer: Health EOS Commercial |
$8,994.06
|
| Rate for Payer: HFN Commercial |
$9,297.23
|
| Rate for Payer: Multiplan Commercial |
$8,084.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,297.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,951.78
|
| Rate for Payer: Quartz Commercial |
$6,063.41
|
| Rate for Payer: WEA Trust Commercial |
$5,558.12
|
| Rate for Payer: WPS Commercial |
$7,485.01
|
|
|
ATRICLIP 40MM LAA FLEX V ACHV40
|
Facility
|
OP
|
$9,717.00
|
|
| Hospital Charge Code |
5685744
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,829.59 |
| Max. Negotiated Rate |
$9,297.23 |
| Rate for Payer: Aetna Commercial |
$9,095.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,690.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,829.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,568.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,052.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,850.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,356.01
|
| Rate for Payer: Cash Price |
$2,915.10
|
| Rate for Payer: Cigna Commercial |
$9,297.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,655.29
|
| Rate for Payer: Health EOS Commercial |
$8,994.06
|
| Rate for Payer: HFN Commercial |
$9,297.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,579.26
|
| Rate for Payer: Multiplan Commercial |
$8,084.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,063.41
|
| Rate for Payer: Preferred Network Access Commercial |
$9,297.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,951.78
|
| Rate for Payer: Quartz Commercial |
$6,568.69
|
| Rate for Payer: Quartz Medicare Advantage |
$6,063.41
|
| Rate for Payer: The Alliance Commercial |
$5,052.84
|
| Rate for Payer: WEA Trust Commercial |
$5,558.12
|
| Rate for Payer: WPS Commercial |
$7,485.01
|
|
|
ATRICLIP 45MM LAA EXCLUSION FLEX HANDLE ACH245
|
Facility
|
IP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,851.23 |
| Max. Negotiated Rate |
$10,985.98 |
| Rate for Payer: Aetna Commercial |
$10,747.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,269.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,328.88
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,985.98
|
| Rate for Payer: Health EOS Commercial |
$10,627.74
|
| Rate for Payer: HFN Commercial |
$10,985.98
|
| Rate for Payer: Multiplan Commercial |
$9,553.02
|
| Rate for Payer: Preferred Network Access Commercial |
$10,985.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,851.23
|
| Rate for Payer: Quartz Commercial |
$7,164.77
|
| Rate for Payer: WEA Trust Commercial |
$6,567.70
|
| Rate for Payer: WPS Commercial |
$8,844.58
|
|
|
ATRICLIP 45MM LAA EXCLUSION FLEX HANDLE ACH245
|
Facility
|
OP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964750
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,343.56 |
| Max. Negotiated Rate |
$10,985.98 |
| Rate for Payer: Aetna Commercial |
$10,747.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,269.50
|
| Rate for Payer: Aetna Managed Medicare |
$3,343.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,761.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,970.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,731.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,328.88
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,985.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,682.52
|
| Rate for Payer: Health EOS Commercial |
$10,627.74
|
| Rate for Payer: HFN Commercial |
$10,985.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,955.96
|
| Rate for Payer: Multiplan Commercial |
$9,553.02
|
| Rate for Payer: NAPHCARE Commercial |
$7,164.77
|
| Rate for Payer: Preferred Network Access Commercial |
$10,985.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,851.23
|
| Rate for Payer: Quartz Commercial |
$7,761.83
|
| Rate for Payer: Quartz Medicare Advantage |
$7,164.77
|
| Rate for Payer: The Alliance Commercial |
$5,970.64
|
| Rate for Payer: WEA Trust Commercial |
$6,567.70
|
| Rate for Payer: WPS Commercial |
$8,844.58
|
|
|
ATRICLIP 45MM LAA FLEX V ACHV45
|
Facility
|
OP
|
$9,717.00
|
|
| Hospital Charge Code |
5685805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,829.59 |
| Max. Negotiated Rate |
$9,297.23 |
| Rate for Payer: Aetna Commercial |
$9,095.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,690.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,829.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,568.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,052.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,850.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,356.01
|
| Rate for Payer: Cash Price |
$2,915.10
|
| Rate for Payer: Cigna Commercial |
$9,297.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,655.29
|
| Rate for Payer: Health EOS Commercial |
$8,994.06
|
| Rate for Payer: HFN Commercial |
$9,297.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,579.26
|
| Rate for Payer: Multiplan Commercial |
$8,084.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,063.41
|
| Rate for Payer: Preferred Network Access Commercial |
$9,297.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,951.78
|
| Rate for Payer: Quartz Commercial |
$6,568.69
|
| Rate for Payer: Quartz Medicare Advantage |
$6,063.41
|
| Rate for Payer: The Alliance Commercial |
$5,052.84
|
| Rate for Payer: WEA Trust Commercial |
$5,558.12
|
| Rate for Payer: WPS Commercial |
$7,485.01
|
|
|
ATRICLIP 45MM LAA FLEX V ACHV45
|
Facility
|
IP
|
$9,717.00
|
|
| Hospital Charge Code |
5685805
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,951.78 |
| Max. Negotiated Rate |
$9,297.23 |
| Rate for Payer: Aetna Commercial |
$9,095.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,690.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,356.01
|
| Rate for Payer: Cash Price |
$2,915.10
|
| Rate for Payer: Cigna Commercial |
$9,297.23
|
| Rate for Payer: Health EOS Commercial |
$8,994.06
|
| Rate for Payer: HFN Commercial |
$9,297.23
|
| Rate for Payer: Multiplan Commercial |
$8,084.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,297.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,951.78
|
| Rate for Payer: Quartz Commercial |
$6,063.41
|
| Rate for Payer: WEA Trust Commercial |
$5,558.12
|
| Rate for Payer: WPS Commercial |
$7,485.01
|
|
|
ATRICLIP 50MM LAA EXCLUSION FLEX HANDLE ACH250
|
Facility
|
IP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,851.23 |
| Max. Negotiated Rate |
$10,985.98 |
| Rate for Payer: Aetna Commercial |
$10,747.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,269.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,328.88
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,985.98
|
| Rate for Payer: Health EOS Commercial |
$10,627.74
|
| Rate for Payer: HFN Commercial |
$10,985.98
|
| Rate for Payer: Multiplan Commercial |
$9,553.02
|
| Rate for Payer: Preferred Network Access Commercial |
$10,985.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,851.23
|
| Rate for Payer: Quartz Commercial |
$7,164.77
|
| Rate for Payer: WEA Trust Commercial |
$6,567.70
|
| Rate for Payer: WPS Commercial |
$8,844.58
|
|
|
ATRICLIP 50MM LAA EXCLUSION FLEX HANDLE ACH250
|
Facility
|
OP
|
$11,482.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
2964751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,343.56 |
| Max. Negotiated Rate |
$10,985.98 |
| Rate for Payer: Aetna Commercial |
$10,747.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,269.50
|
| Rate for Payer: Aetna Managed Medicare |
$3,343.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,761.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,970.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,731.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,328.88
|
| Rate for Payer: Cash Price |
$3,444.60
|
| Rate for Payer: Cigna Commercial |
$10,985.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,682.52
|
| Rate for Payer: Health EOS Commercial |
$10,627.74
|
| Rate for Payer: HFN Commercial |
$10,985.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,955.96
|
| Rate for Payer: Multiplan Commercial |
$9,553.02
|
| Rate for Payer: NAPHCARE Commercial |
$7,164.77
|
| Rate for Payer: Preferred Network Access Commercial |
$10,985.98
|
| Rate for Payer: Quartz Beloit One Network |
$5,851.23
|
| Rate for Payer: Quartz Commercial |
$7,761.83
|
| Rate for Payer: Quartz Medicare Advantage |
$7,164.77
|
| Rate for Payer: The Alliance Commercial |
$5,970.64
|
| Rate for Payer: WEA Trust Commercial |
$6,567.70
|
| Rate for Payer: WPS Commercial |
$8,844.58
|
|
|
ATRICLIP 50MM LAA FLEX V ACHV50
|
Facility
|
IP
|
$9,717.00
|
|
| Hospital Charge Code |
5685806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,951.78 |
| Max. Negotiated Rate |
$9,297.23 |
| Rate for Payer: Aetna Commercial |
$9,095.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,690.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,356.01
|
| Rate for Payer: Cash Price |
$2,915.10
|
| Rate for Payer: Cigna Commercial |
$9,297.23
|
| Rate for Payer: Health EOS Commercial |
$8,994.06
|
| Rate for Payer: HFN Commercial |
$9,297.23
|
| Rate for Payer: Multiplan Commercial |
$8,084.54
|
| Rate for Payer: Preferred Network Access Commercial |
$9,297.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,951.78
|
| Rate for Payer: Quartz Commercial |
$6,063.41
|
| Rate for Payer: WEA Trust Commercial |
$5,558.12
|
| Rate for Payer: WPS Commercial |
$7,485.01
|
|
|
ATRICLIP 50MM LAA FLEX V ACHV50
|
Facility
|
OP
|
$9,717.00
|
|
| Hospital Charge Code |
5685806
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,829.59 |
| Max. Negotiated Rate |
$9,297.23 |
| Rate for Payer: Aetna Commercial |
$9,095.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,690.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,829.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,568.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,052.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,850.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,356.01
|
| Rate for Payer: Cash Price |
$2,915.10
|
| Rate for Payer: Cigna Commercial |
$9,297.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,655.29
|
| Rate for Payer: Health EOS Commercial |
$8,994.06
|
| Rate for Payer: HFN Commercial |
$9,297.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,579.26
|
| Rate for Payer: Multiplan Commercial |
$8,084.54
|
| Rate for Payer: NAPHCARE Commercial |
$6,063.41
|
| Rate for Payer: Preferred Network Access Commercial |
$9,297.23
|
| Rate for Payer: Quartz Beloit One Network |
$4,951.78
|
| Rate for Payer: Quartz Commercial |
$6,568.69
|
| Rate for Payer: Quartz Medicare Advantage |
$6,063.41
|
| Rate for Payer: The Alliance Commercial |
$5,052.84
|
| Rate for Payer: WEA Trust Commercial |
$5,558.12
|
| Rate for Payer: WPS Commercial |
$7,485.01
|
|
|
ATRICLIP SELECTION GUIDE CGG100
|
Facility
|
IP
|
$2,829.00
|
|
| Hospital Charge Code |
2969515
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,441.66 |
| Max. Negotiated Rate |
$2,706.79 |
| Rate for Payer: Aetna Commercial |
$2,647.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,530.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,559.34
|
| Rate for Payer: Cash Price |
$848.70
|
| Rate for Payer: Cigna Commercial |
$2,706.79
|
| Rate for Payer: Health EOS Commercial |
$2,618.52
|
| Rate for Payer: HFN Commercial |
$2,706.79
|
| Rate for Payer: Multiplan Commercial |
$2,353.73
|
| Rate for Payer: Preferred Network Access Commercial |
$2,706.79
|
| Rate for Payer: Quartz Beloit One Network |
$1,441.66
|
| Rate for Payer: Quartz Commercial |
$1,765.30
|
| Rate for Payer: WEA Trust Commercial |
$1,618.19
|
| Rate for Payer: WPS Commercial |
$2,179.18
|
|
