|
CATHETER 7FR XB3.5 GUIDE 778-054-00
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972656
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| 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: 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: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
CATHETER 7FR XB3.5 GUIDE 778-054-00
|
Facility
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972656
|
|
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: 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
|
|
|
CATHETER 7FR x XB3 SH 778-053-00
|
Facility
OP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972658
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$478.24 |
| 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: 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: WEA Trust Commercial |
$939.40
|
| Rate for Payer: WPS Commercial |
$1,265.12
|
|
|
CATHETER 7FR x XB3 SH 778-053-00
|
Facility
IP
|
$1,708.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972658
|
|
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: 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
|
|
|
CATHETER 8FR EMBOLECTOMY AP4518
|
Facility
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.45 |
| Max. Negotiated Rate |
$1,108.60 |
| Rate for Payer: Aetna Commercial |
$1,084.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.65
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$1,108.60
|
| Rate for Payer: Health EOS Commercial |
$1,072.45
|
| Rate for Payer: HFN Commercial |
$1,108.60
|
| Rate for Payer: Multiplan Commercial |
$964.00
|
| Rate for Payer: NAPHCARE Commercial |
$723.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.60
|
| Rate for Payer: Quartz Beloit One Network |
$590.45
|
| Rate for Payer: Quartz Commercial |
$723.00
|
| Rate for Payer: WEA Trust Commercial |
$662.75
|
| Rate for Payer: WPS Commercial |
$892.54
|
|
|
CATHETER 8FR EMBOLECTOMY AP4518
|
Facility
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.40 |
| Max. Negotiated Rate |
$1,108.60 |
| Rate for Payer: Aetna Commercial |
$1,084.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,036.30
|
| Rate for Payer: Aetna Managed Medicare |
$337.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$783.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$602.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$578.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.65
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$1,108.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$674.32
|
| Rate for Payer: Health EOS Commercial |
$1,072.45
|
| Rate for Payer: HFN Commercial |
$1,108.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$903.75
|
| Rate for Payer: Multiplan Commercial |
$964.00
|
| Rate for Payer: NAPHCARE Commercial |
$723.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.60
|
| Rate for Payer: Quartz Beloit One Network |
$590.45
|
| Rate for Payer: Quartz Commercial |
$783.25
|
| Rate for Payer: Quartz Medicare Advantage |
$723.00
|
| Rate for Payer: WEA Trust Commercial |
$662.75
|
| Rate for Payer: WPS Commercial |
$892.54
|
|
|
CATHETER 8FR JL4-SH GUIDE 588834
|
Facility
OP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972612
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$469.84 |
| 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: 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: WEA Trust Commercial |
$922.90
|
| Rate for Payer: WPS Commercial |
$1,242.89
|
|
|
CATHETER 8FR JL4-SH GUIDE 588834
|
Facility
IP
|
$1,678.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2972612
|
|
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: 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
|
|
|
CATHETER 8FR RCB-SH GUIDE 588-819
|
Facility
IP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3107475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.49 |
| Max. Negotiated Rate |
$460.92 |
| Rate for Payer: Aetna Commercial |
$450.90
|
| 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
|
|
|
CATHETER 8FR RCB-SH GUIDE 588-819
|
Facility
OP
|
$501.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
3107475
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.28 |
| Max. Negotiated Rate |
$460.92 |
| 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: WEA Trust Commercial |
$275.55
|
| Rate for Payer: WPS Commercial |
$371.09
|
|
|
CATHETER 8FR X 25CM NEPHRO REPLCMNT M001271790
|
Facility
OP
|
$1,734.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2972394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$485.52 |
| Max. Negotiated Rate |
$1,595.28 |
| Rate for Payer: Aetna Commercial |
$1,560.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,491.24
|
| Rate for Payer: Aetna Managed Medicare |
$485.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,127.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$867.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$832.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$919.02
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$1,595.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$970.35
|
| Rate for Payer: Health EOS Commercial |
$1,543.26
|
| Rate for Payer: HFN Commercial |
$1,595.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,300.50
|
| Rate for Payer: Multiplan Commercial |
$1,387.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,040.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,595.28
|
| Rate for Payer: Quartz Beloit One Network |
$849.66
|
| Rate for Payer: Quartz Commercial |
$1,127.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,040.40
|
| Rate for Payer: WEA Trust Commercial |
$953.70
|
| Rate for Payer: WPS Commercial |
$1,284.37
|
|
|
CATHETER 8FR X 25CM NEPHRO REPLCMNT M001271790
|
Facility
IP
|
$1,734.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
2972394
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$849.66 |
| Max. Negotiated Rate |
$1,595.28 |
| Rate for Payer: Aetna Commercial |
$1,560.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$919.02
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$1,595.28
|
| Rate for Payer: Health EOS Commercial |
$1,543.26
|
| Rate for Payer: HFN Commercial |
$1,595.28
|
| Rate for Payer: Multiplan Commercial |
$1,387.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,040.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,595.28
|
| Rate for Payer: Quartz Beloit One Network |
$849.66
|
| Rate for Payer: Quartz Commercial |
$1,040.40
|
| Rate for Payer: WEA Trust Commercial |
$953.70
|
| Rate for Payer: WPS Commercial |
$1,284.37
|
|
|
CATHETER ABDOMINAL T-DOC #T-DOC-7FA
|
Facility
OP
|
$517.00
|
|
| Hospital Charge Code |
2973289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$144.76 |
| Max. Negotiated Rate |
$2,068.00 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.62
|
| Rate for Payer: Aetna Managed Medicare |
$144.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$336.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.31
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$387.75
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$310.20
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$336.05
|
| Rate for Payer: Quartz Medicare Advantage |
$310.20
|
| Rate for Payer: The Alliance Commercial |
$2,068.00
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
CATHETER ABDOMINAL T-DOC #T-DOC-7FA
|
Facility
IP
|
$517.00
|
|
| Hospital Charge Code |
2973289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$253.33 |
| Max. Negotiated Rate |
$475.64 |
| Rate for Payer: Aetna Commercial |
$465.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$274.01
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$475.64
|
| Rate for Payer: Health EOS Commercial |
$460.13
|
| Rate for Payer: HFN Commercial |
$475.64
|
| Rate for Payer: Multiplan Commercial |
$413.60
|
| Rate for Payer: NAPHCARE Commercial |
$310.20
|
| Rate for Payer: Preferred Network Access Commercial |
$475.64
|
| Rate for Payer: Quartz Beloit One Network |
$253.33
|
| Rate for Payer: Quartz Commercial |
$310.20
|
| Rate for Payer: WEA Trust Commercial |
$284.35
|
| Rate for Payer: WPS Commercial |
$382.94
|
|
|
CATHETER ABLATION 18mm 32041-18
|
Facility
IP
|
$10,067.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,932.83 |
| Max. Negotiated Rate |
$9,261.64 |
| Rate for Payer: Aetna Commercial |
$9,060.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,335.51
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,261.64
|
| Rate for Payer: Health EOS Commercial |
$8,959.63
|
| Rate for Payer: HFN Commercial |
$9,261.64
|
| Rate for Payer: Multiplan Commercial |
$8,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,040.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,261.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,932.83
|
| Rate for Payer: Quartz Commercial |
$6,040.20
|
| Rate for Payer: WEA Trust Commercial |
$5,536.85
|
| Rate for Payer: WPS Commercial |
$7,456.63
|
|
|
CATHETER ABLATION 18mm 32041-18
|
Facility
OP
|
$10,067.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,818.76 |
| Max. Negotiated Rate |
$9,261.64 |
| Rate for Payer: Aetna Commercial |
$9,060.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,657.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,818.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,543.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,033.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,832.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,335.51
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,261.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,633.49
|
| Rate for Payer: Health EOS Commercial |
$8,959.63
|
| Rate for Payer: HFN Commercial |
$9,261.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,550.25
|
| Rate for Payer: Multiplan Commercial |
$8,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,040.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,261.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,932.83
|
| Rate for Payer: Quartz Commercial |
$6,543.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6,040.20
|
| Rate for Payer: WEA Trust Commercial |
$5,536.85
|
| Rate for Payer: WPS Commercial |
$7,456.63
|
|
|
CATHETER ABLATION 28mm 32041-28
|
Facility
OP
|
$10,067.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,818.76 |
| Max. Negotiated Rate |
$9,261.64 |
| Rate for Payer: Aetna Commercial |
$9,060.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,657.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,818.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,543.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,033.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,832.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,335.51
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,261.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,633.49
|
| Rate for Payer: Health EOS Commercial |
$8,959.63
|
| Rate for Payer: HFN Commercial |
$9,261.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,550.25
|
| Rate for Payer: Multiplan Commercial |
$8,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,040.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,261.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,932.83
|
| Rate for Payer: Quartz Commercial |
$6,543.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6,040.20
|
| Rate for Payer: WEA Trust Commercial |
$5,536.85
|
| Rate for Payer: WPS Commercial |
$7,456.63
|
|
|
CATHETER ABLATION 28mm 32041-28
|
Facility
IP
|
$10,067.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973872
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,932.83 |
| Max. Negotiated Rate |
$9,261.64 |
| Rate for Payer: Aetna Commercial |
$9,060.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,335.51
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,261.64
|
| Rate for Payer: Health EOS Commercial |
$8,959.63
|
| Rate for Payer: HFN Commercial |
$9,261.64
|
| Rate for Payer: Multiplan Commercial |
$8,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,040.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,261.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,932.83
|
| Rate for Payer: Quartz Commercial |
$6,040.20
|
| Rate for Payer: WEA Trust Commercial |
$5,536.85
|
| Rate for Payer: WPS Commercial |
$7,456.63
|
|
|
CATHETER ABLATION 31mm 32041-31
|
Facility
IP
|
$10,067.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,932.83 |
| Max. Negotiated Rate |
$9,261.64 |
| Rate for Payer: Aetna Commercial |
$9,060.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,335.51
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,261.64
|
| Rate for Payer: Health EOS Commercial |
$8,959.63
|
| Rate for Payer: HFN Commercial |
$9,261.64
|
| Rate for Payer: Multiplan Commercial |
$8,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,040.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,261.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,932.83
|
| Rate for Payer: Quartz Commercial |
$6,040.20
|
| Rate for Payer: WEA Trust Commercial |
$5,536.85
|
| Rate for Payer: WPS Commercial |
$7,456.63
|
|
|
CATHETER ABLATION 31mm 32041-31
|
Facility
OP
|
$10,067.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973873
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,818.76 |
| Max. Negotiated Rate |
$9,261.64 |
| Rate for Payer: Aetna Commercial |
$9,060.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,657.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,818.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,543.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,033.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,832.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,335.51
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,261.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,633.49
|
| Rate for Payer: Health EOS Commercial |
$8,959.63
|
| Rate for Payer: HFN Commercial |
$9,261.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,550.25
|
| Rate for Payer: Multiplan Commercial |
$8,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$6,040.20
|
| Rate for Payer: Preferred Network Access Commercial |
$9,261.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,932.83
|
| Rate for Payer: Quartz Commercial |
$6,543.55
|
| Rate for Payer: Quartz Medicare Advantage |
$6,040.20
|
| Rate for Payer: WEA Trust Commercial |
$5,536.85
|
| Rate for Payer: WPS Commercial |
$7,456.63
|
|
|
CATHETER ABLATION BLUE #D7TDL252RT
|
Facility
OP
|
$11,339.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
2973717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,174.92 |
| Max. Negotiated Rate |
$10,431.88 |
| Rate for Payer: Aetna Commercial |
$10,205.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,751.54
|
| Rate for Payer: Aetna Managed Medicare |
$3,174.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,370.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,669.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,442.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,009.67
|
| Rate for Payer: Cash Price |
$3,401.70
|
| Rate for Payer: Cigna Commercial |
$10,431.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,345.30
|
| Rate for Payer: Health EOS Commercial |
$10,091.71
|
| Rate for Payer: HFN Commercial |
$10,431.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,504.25
|
| Rate for Payer: Multiplan Commercial |
$9,071.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,803.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,431.88
|
| Rate for Payer: Quartz Beloit One Network |
$5,556.11
|
| Rate for Payer: Quartz Commercial |
$7,370.35
|
| Rate for Payer: Quartz Medicare Advantage |
$6,803.40
|
| Rate for Payer: WEA Trust Commercial |
$6,236.45
|
| Rate for Payer: WPS Commercial |
$8,398.80
|
|
|
CATHETER ABLATION BLUE #D7TDL252RT
|
Facility
IP
|
$11,339.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
2973717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,556.11 |
| Max. Negotiated Rate |
$10,431.88 |
| Rate for Payer: Aetna Commercial |
$10,205.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,009.67
|
| Rate for Payer: Cash Price |
$3,401.70
|
| Rate for Payer: Cigna Commercial |
$10,431.88
|
| Rate for Payer: Health EOS Commercial |
$10,091.71
|
| Rate for Payer: HFN Commercial |
$10,431.88
|
| Rate for Payer: Multiplan Commercial |
$9,071.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,803.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,431.88
|
| Rate for Payer: Quartz Beloit One Network |
$5,556.11
|
| Rate for Payer: Quartz Commercial |
$6,803.40
|
| Rate for Payer: WEA Trust Commercial |
$6,236.45
|
| Rate for Payer: WPS Commercial |
$8,398.80
|
|
|
CATHETER ABLATION HALO 90-9100
|
Facility
OP
|
$8,237.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,306.36 |
| Max. Negotiated Rate |
$7,578.04 |
| Rate for Payer: Aetna Commercial |
$7,413.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,083.82
|
| Rate for Payer: Aetna Managed Medicare |
$2,306.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,354.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,118.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,953.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,365.61
|
| Rate for Payer: Cash Price |
$2,471.10
|
| Rate for Payer: Cigna Commercial |
$7,578.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,609.43
|
| Rate for Payer: Health EOS Commercial |
$7,330.93
|
| Rate for Payer: HFN Commercial |
$7,578.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,177.75
|
| Rate for Payer: Multiplan Commercial |
$6,589.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,942.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,578.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,036.13
|
| Rate for Payer: Quartz Commercial |
$5,354.05
|
| Rate for Payer: Quartz Medicare Advantage |
$4,942.20
|
| Rate for Payer: WEA Trust Commercial |
$4,530.35
|
| Rate for Payer: WPS Commercial |
$6,101.15
|
|
|
CATHETER ABLATION HALO 90-9100
|
Facility
IP
|
$8,237.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973733
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,036.13 |
| Max. Negotiated Rate |
$7,578.04 |
| Rate for Payer: Aetna Commercial |
$7,413.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,365.61
|
| Rate for Payer: Cash Price |
$2,471.10
|
| Rate for Payer: Cigna Commercial |
$7,578.04
|
| Rate for Payer: Health EOS Commercial |
$7,330.93
|
| Rate for Payer: HFN Commercial |
$7,578.04
|
| Rate for Payer: Multiplan Commercial |
$6,589.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,942.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,578.04
|
| Rate for Payer: Quartz Beloit One Network |
$4,036.13
|
| Rate for Payer: Quartz Commercial |
$4,942.20
|
| Rate for Payer: WEA Trust Commercial |
$4,530.35
|
| Rate for Payer: WPS Commercial |
$6,101.15
|
|
|
CATHETER ABLATION ORANGE #D7TFL252RT
|
Facility
OP
|
$11,339.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
2973726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,174.92 |
| Max. Negotiated Rate |
$10,431.88 |
| Rate for Payer: Aetna Commercial |
$10,205.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,751.54
|
| Rate for Payer: Aetna Managed Medicare |
$3,174.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,370.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,669.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,442.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,009.67
|
| Rate for Payer: Cash Price |
$3,401.70
|
| Rate for Payer: Cigna Commercial |
$10,431.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,345.30
|
| Rate for Payer: Health EOS Commercial |
$10,091.71
|
| Rate for Payer: HFN Commercial |
$10,431.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,504.25
|
| Rate for Payer: Multiplan Commercial |
$9,071.20
|
| Rate for Payer: NAPHCARE Commercial |
$6,803.40
|
| Rate for Payer: Preferred Network Access Commercial |
$10,431.88
|
| Rate for Payer: Quartz Beloit One Network |
$5,556.11
|
| Rate for Payer: Quartz Commercial |
$7,370.35
|
| Rate for Payer: Quartz Medicare Advantage |
$6,803.40
|
| Rate for Payer: WEA Trust Commercial |
$6,236.45
|
| Rate for Payer: WPS Commercial |
$8,398.80
|
|
