|
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 |
$40,268.00 |
| 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: The Alliance Commercial |
$40,268.00
|
| Rate for Payer: WEA Trust Commercial |
$5,536.85
|
| Rate for Payer: WPS Commercial |
$7,456.63
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$8,657.62
|
| 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 22mm 32041-22
|
Facility
|
IP
|
$8,848.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4,335.52 |
| Max. Negotiated Rate |
$8,140.16 |
| Rate for Payer: Aetna Commercial |
$7,963.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,609.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,689.44
|
| Rate for Payer: Cash Price |
$2,654.40
|
| Rate for Payer: Cigna Commercial |
$8,140.16
|
| Rate for Payer: Health EOS Commercial |
$7,874.72
|
| Rate for Payer: HFN Commercial |
$8,140.16
|
| Rate for Payer: Multiplan Commercial |
$7,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,140.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,335.52
|
| Rate for Payer: Quartz Commercial |
$5,308.80
|
| Rate for Payer: WEA Trust Commercial |
$4,866.40
|
| Rate for Payer: WPS Commercial |
$6,553.71
|
|
|
CATHETER ABLATION 22mm 32041-22
|
Facility
|
OP
|
$8,848.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973783
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,477.44 |
| Max. Negotiated Rate |
$35,392.00 |
| Rate for Payer: Aetna Commercial |
$7,963.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,609.28
|
| Rate for Payer: Aetna Managed Medicare |
$2,477.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,751.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,424.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,247.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,689.44
|
| Rate for Payer: Cash Price |
$2,654.40
|
| Rate for Payer: Cigna Commercial |
$8,140.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,951.34
|
| Rate for Payer: Health EOS Commercial |
$7,874.72
|
| Rate for Payer: HFN Commercial |
$8,140.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,636.00
|
| Rate for Payer: Multiplan Commercial |
$7,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,140.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,335.52
|
| Rate for Payer: Quartz Commercial |
$5,751.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,308.80
|
| Rate for Payer: The Alliance Commercial |
$35,392.00
|
| Rate for Payer: WEA Trust Commercial |
$4,866.40
|
| Rate for Payer: WPS Commercial |
$6,553.71
|
|
|
CATHETER ABLATION 25mm 32041-25
|
Facility
|
OP
|
$10,067.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973871
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,818.76 |
| Max. Negotiated Rate |
$40,268.00 |
| 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: The Alliance Commercial |
$40,268.00
|
| Rate for Payer: WEA Trust Commercial |
$5,536.85
|
| Rate for Payer: WPS Commercial |
$7,456.63
|
|
|
CATHETER ABLATION 25mm 32041-25
|
Facility
|
IP
|
$10,067.00
|
|
|
Service Code
|
HCPCS C1886
|
| Hospital Charge Code |
2973871
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$8,657.62
|
| 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 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 |
$40,268.00 |
| 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: The Alliance Commercial |
$40,268.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$8,657.62
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$8,657.62
|
| 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 |
$40,268.00 |
| 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: The Alliance Commercial |
$40,268.00
|
| 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 |
$45,356.00 |
| 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: The Alliance Commercial |
$45,356.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$9,751.54
|
| 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 |
$32,948.00 |
| 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: The Alliance Commercial |
$32,948.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$7,083.82
|
| 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
|
IP
|
$11,339.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
2973726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,556.11 |
| 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: 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 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 |
$45,356.00 |
| 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: The Alliance Commercial |
$45,356.00
|
| Rate for Payer: WEA Trust Commercial |
$6,236.45
|
| Rate for Payer: WPS Commercial |
$8,398.80
|
|
|
Catheter Angio #14
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
3101772
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Catheter Angio #14
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
3101772
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$208.00 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$14.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.20
|
| Rate for Payer: The Alliance Commercial |
$208.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
Catheter,Angio #14
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3040298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Catheter,Angio #14
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3040298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
CATHETER ANGIO 20GX1.75 383538
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
4519146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.48 |
| Max. Negotiated Rate |
$139.84 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$91.20
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
CATHETER ANGIO 20GX1.75 383538
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
4519146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.56 |
| Max. Negotiated Rate |
$608.00 |
| Rate for Payer: Aetna Commercial |
$136.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.72
|
| Rate for Payer: Aetna Managed Medicare |
$42.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$80.56
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$139.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.06
|
| Rate for Payer: Health EOS Commercial |
$135.28
|
| Rate for Payer: HFN Commercial |
$139.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.00
|
| Rate for Payer: Multiplan Commercial |
$121.60
|
| Rate for Payer: NAPHCARE Commercial |
$91.20
|
| Rate for Payer: Preferred Network Access Commercial |
$139.84
|
| Rate for Payer: Quartz Beloit One Network |
$74.48
|
| Rate for Payer: Quartz Commercial |
$98.80
|
| Rate for Payer: Quartz Medicare Advantage |
$91.20
|
| Rate for Payer: The Alliance Commercial |
$608.00
|
| Rate for Payer: WEA Trust Commercial |
$83.60
|
| Rate for Payer: WPS Commercial |
$112.59
|
|
|
CATHETER ANGIOGRAPHIC 4 FR STRAIGHT 526-422
|
Facility
|
OP
|
$449.00
|
|
| Hospital Charge Code |
2973211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.72 |
| Max. Negotiated Rate |
$1,796.00 |
| Rate for Payer: Aetna Commercial |
$404.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.14
|
| Rate for Payer: Aetna Managed Medicare |
$125.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.97
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$413.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$251.26
|
| Rate for Payer: Health EOS Commercial |
$399.61
|
| Rate for Payer: HFN Commercial |
$413.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.75
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: NAPHCARE Commercial |
$269.40
|
| Rate for Payer: Preferred Network Access Commercial |
$413.08
|
| Rate for Payer: Quartz Beloit One Network |
$220.01
|
| Rate for Payer: Quartz Commercial |
$291.85
|
| Rate for Payer: Quartz Medicare Advantage |
$269.40
|
| Rate for Payer: The Alliance Commercial |
$1,796.00
|
| Rate for Payer: WEA Trust Commercial |
$246.95
|
| Rate for Payer: WPS Commercial |
$332.57
|
|
|
CATHETER ANGIOGRAPHIC 4 FR STRAIGHT 526-422
|
Facility
|
IP
|
$449.00
|
|
| Hospital Charge Code |
2973211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.01 |
| Max. Negotiated Rate |
$413.08 |
| Rate for Payer: Aetna Commercial |
$404.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.97
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$413.08
|
| Rate for Payer: Health EOS Commercial |
$399.61
|
| Rate for Payer: HFN Commercial |
$413.08
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: NAPHCARE Commercial |
$269.40
|
| Rate for Payer: Preferred Network Access Commercial |
$413.08
|
| Rate for Payer: Quartz Beloit One Network |
$220.01
|
| Rate for Payer: Quartz Commercial |
$269.40
|
| Rate for Payer: WEA Trust Commercial |
$246.95
|
| Rate for Payer: WPS Commercial |
$332.57
|
|
|
CATHETER ANGIOGRAPHIC 5 FR STRAIGHT 526-522
|
Facility
|
IP
|
$449.00
|
|
| Hospital Charge Code |
2972356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.01 |
| Max. Negotiated Rate |
$413.08 |
| Rate for Payer: Aetna Commercial |
$404.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$386.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.97
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$413.08
|
| Rate for Payer: Health EOS Commercial |
$399.61
|
| Rate for Payer: HFN Commercial |
$413.08
|
| Rate for Payer: Multiplan Commercial |
$359.20
|
| Rate for Payer: NAPHCARE Commercial |
$269.40
|
| Rate for Payer: Preferred Network Access Commercial |
$413.08
|
| Rate for Payer: Quartz Beloit One Network |
$220.01
|
| Rate for Payer: Quartz Commercial |
$269.40
|
| Rate for Payer: WEA Trust Commercial |
$246.95
|
| Rate for Payer: WPS Commercial |
$332.57
|
|
