|
CATHETER 8FR EMBOLECTOMY AP4518
|
Facility
|
IP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$614.07 |
| Max. Negotiated Rate |
$1,152.94 |
| Rate for Payer: Aetna Commercial |
$1,127.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,077.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$664.20
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$1,152.94
|
| Rate for Payer: Health EOS Commercial |
$1,115.35
|
| Rate for Payer: HFN Commercial |
$1,152.94
|
| Rate for Payer: Multiplan Commercial |
$1,002.56
|
| Rate for Payer: Preferred Network Access Commercial |
$1,152.94
|
| Rate for Payer: Quartz Beloit One Network |
$614.07
|
| Rate for Payer: Quartz Commercial |
$751.92
|
| Rate for Payer: WEA Trust Commercial |
$689.26
|
| Rate for Payer: WPS Commercial |
$928.21
|
|
|
CATHETER 8FR EMBOLECTOMY AP4518
|
Facility
|
OP
|
$1,205.00
|
|
|
Service Code
|
HCPCS C1757
|
| Hospital Charge Code |
2964648
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$350.90 |
| Max. Negotiated Rate |
$1,152.94 |
| Rate for Payer: Aetna Commercial |
$1,127.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,077.75
|
| Rate for Payer: Aetna Managed Medicare |
$350.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$814.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$626.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$601.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$664.20
|
| Rate for Payer: Cash Price |
$361.50
|
| Rate for Payer: Cigna Commercial |
$1,152.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$701.31
|
| Rate for Payer: Health EOS Commercial |
$1,115.35
|
| Rate for Payer: HFN Commercial |
$1,152.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$939.90
|
| Rate for Payer: Multiplan Commercial |
$1,002.56
|
| Rate for Payer: NAPHCARE Commercial |
$751.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,152.94
|
| Rate for Payer: Quartz Beloit One Network |
$614.07
|
| Rate for Payer: Quartz Commercial |
$814.58
|
| Rate for Payer: Quartz Medicare Advantage |
$751.92
|
| Rate for Payer: The Alliance Commercial |
$626.60
|
| Rate for Payer: WEA Trust Commercial |
$689.26
|
| Rate for Payer: WPS Commercial |
$928.21
|
|
|
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 |
$488.63 |
| Max. Negotiated Rate |
$1,605.51 |
| Rate for Payer: Aetna Commercial |
$1,570.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,500.80
|
| Rate for Payer: Aetna Managed Medicare |
$488.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,134.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$872.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$837.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$924.91
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,605.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$976.60
|
| Rate for Payer: Health EOS Commercial |
$1,553.16
|
| Rate for Payer: HFN Commercial |
$1,605.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,308.84
|
| Rate for Payer: Multiplan Commercial |
$1,396.10
|
| Rate for Payer: NAPHCARE Commercial |
$1,047.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,605.51
|
| Rate for Payer: Quartz Beloit One Network |
$855.11
|
| Rate for Payer: Quartz Commercial |
$1,134.33
|
| Rate for Payer: Quartz Medicare Advantage |
$1,047.07
|
| Rate for Payer: The Alliance Commercial |
$872.56
|
| Rate for Payer: WEA Trust Commercial |
$959.82
|
| Rate for Payer: WPS Commercial |
$1,292.56
|
|
|
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 |
$855.11 |
| Max. Negotiated Rate |
$1,605.51 |
| Rate for Payer: Aetna Commercial |
$1,570.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,500.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$924.91
|
| Rate for Payer: Cash Price |
$503.40
|
| Rate for Payer: Cigna Commercial |
$1,605.51
|
| Rate for Payer: Health EOS Commercial |
$1,553.16
|
| Rate for Payer: HFN Commercial |
$1,605.51
|
| Rate for Payer: Multiplan Commercial |
$1,396.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,605.51
|
| Rate for Payer: Quartz Beloit One Network |
$855.11
|
| Rate for Payer: Quartz Commercial |
$1,047.07
|
| Rate for Payer: WEA Trust Commercial |
$959.82
|
| Rate for Payer: WPS Commercial |
$1,292.56
|
|
|
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 |
$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
|
|
|
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 |
$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
|
|
|
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 |
$504.94 |
| Max. Negotiated Rate |
$1,659.09 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,550.89
|
| Rate for Payer: Aetna Managed Medicare |
$504.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,172.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$901.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$865.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$955.78
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$1,659.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,009.19
|
| Rate for Payer: Health EOS Commercial |
$1,604.99
|
| Rate for Payer: HFN Commercial |
$1,659.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,352.52
|
| Rate for Payer: Multiplan Commercial |
$1,442.69
|
| Rate for Payer: NAPHCARE Commercial |
$1,082.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,659.09
|
| Rate for Payer: Quartz Beloit One Network |
$883.65
|
| Rate for Payer: Quartz Commercial |
$1,172.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,082.02
|
| Rate for Payer: The Alliance Commercial |
$901.68
|
| Rate for Payer: WEA Trust Commercial |
$991.85
|
| Rate for Payer: WPS Commercial |
$1,335.70
|
|
|
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 |
$883.65 |
| Max. Negotiated Rate |
$1,659.09 |
| Rate for Payer: Aetna Commercial |
$1,623.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,550.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$955.78
|
| Rate for Payer: Cash Price |
$520.20
|
| Rate for Payer: Cigna Commercial |
$1,659.09
|
| Rate for Payer: Health EOS Commercial |
$1,604.99
|
| Rate for Payer: HFN Commercial |
$1,659.09
|
| Rate for Payer: Multiplan Commercial |
$1,442.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,659.09
|
| Rate for Payer: Quartz Beloit One Network |
$883.65
|
| Rate for Payer: Quartz Commercial |
$1,082.02
|
| Rate for Payer: WEA Trust Commercial |
$991.85
|
| Rate for Payer: WPS Commercial |
$1,335.70
|
|
|
CATHETER ABDOMINAL T-DOC #T-DOC-7FA
|
Facility
|
IP
|
$517.00
|
|
| Hospital Charge Code |
2973289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$263.46 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$322.61
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
|
CATHETER ABDOMINAL T-DOC #T-DOC-7FA
|
Facility
|
OP
|
$517.00
|
|
| Hospital Charge Code |
2973289
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$150.55 |
| Max. Negotiated Rate |
$494.67 |
| Rate for Payer: Aetna Commercial |
$483.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$462.40
|
| Rate for Payer: Aetna Managed Medicare |
$150.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$258.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.97
|
| Rate for Payer: Cash Price |
$155.10
|
| Rate for Payer: Cigna Commercial |
$494.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$300.89
|
| Rate for Payer: Health EOS Commercial |
$478.54
|
| Rate for Payer: HFN Commercial |
$494.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$403.26
|
| Rate for Payer: Multiplan Commercial |
$430.14
|
| Rate for Payer: NAPHCARE Commercial |
$322.61
|
| Rate for Payer: Preferred Network Access Commercial |
$494.67
|
| Rate for Payer: Quartz Beloit One Network |
$263.46
|
| Rate for Payer: Quartz Commercial |
$349.49
|
| Rate for Payer: Quartz Medicare Advantage |
$322.61
|
| Rate for Payer: The Alliance Commercial |
$268.84
|
| Rate for Payer: WEA Trust Commercial |
$295.72
|
| Rate for Payer: WPS Commercial |
$398.25
|
|
|
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 |
$5,130.14 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,281.81
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
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 |
$2,931.51 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,931.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,805.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,234.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,025.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,858.99
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,852.26
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,281.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,805.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6,281.81
|
| Rate for Payer: The Alliance Commercial |
$5,234.84
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
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 |
$2,576.54 |
| Max. Negotiated Rate |
$8,465.77 |
| Rate for Payer: Aetna Commercial |
$8,281.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,913.65
|
| Rate for Payer: Aetna Managed Medicare |
$2,576.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,981.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,600.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,416.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,877.02
|
| Rate for Payer: Cash Price |
$2,654.40
|
| Rate for Payer: Cigna Commercial |
$8,465.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,149.54
|
| Rate for Payer: Health EOS Commercial |
$8,189.71
|
| Rate for Payer: HFN Commercial |
$8,465.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,901.44
|
| Rate for Payer: Multiplan Commercial |
$7,361.54
|
| Rate for Payer: NAPHCARE Commercial |
$5,521.15
|
| Rate for Payer: Preferred Network Access Commercial |
$8,465.77
|
| Rate for Payer: Quartz Beloit One Network |
$4,508.94
|
| Rate for Payer: Quartz Commercial |
$5,981.25
|
| Rate for Payer: Quartz Medicare Advantage |
$5,521.15
|
| Rate for Payer: The Alliance Commercial |
$4,600.96
|
| Rate for Payer: WEA Trust Commercial |
$5,061.06
|
| Rate for Payer: WPS Commercial |
$6,815.61
|
|
|
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 |
$4,508.94 |
| Max. Negotiated Rate |
$8,465.77 |
| Rate for Payer: Aetna Commercial |
$8,281.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,913.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,877.02
|
| Rate for Payer: Cash Price |
$2,654.40
|
| Rate for Payer: Cigna Commercial |
$8,465.77
|
| Rate for Payer: Health EOS Commercial |
$8,189.71
|
| Rate for Payer: HFN Commercial |
$8,465.77
|
| Rate for Payer: Multiplan Commercial |
$7,361.54
|
| Rate for Payer: Preferred Network Access Commercial |
$8,465.77
|
| Rate for Payer: Quartz Beloit One Network |
$4,508.94
|
| Rate for Payer: Quartz Commercial |
$5,521.15
|
| Rate for Payer: WEA Trust Commercial |
$5,061.06
|
| Rate for Payer: WPS Commercial |
$6,815.61
|
|
|
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 |
$2,931.51 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,931.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,805.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,234.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,025.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,858.99
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,852.26
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,281.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,805.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6,281.81
|
| Rate for Payer: The Alliance Commercial |
$5,234.84
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
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 |
$5,130.14 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,281.81
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
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 |
$2,931.51 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,931.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,805.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,234.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,025.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,858.99
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,852.26
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,281.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,805.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6,281.81
|
| Rate for Payer: The Alliance Commercial |
$5,234.84
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
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 |
$5,130.14 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,281.81
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
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 |
$2,931.51 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,931.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,805.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,234.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,025.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,858.99
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,852.26
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,281.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,805.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6,281.81
|
| Rate for Payer: The Alliance Commercial |
$5,234.84
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
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 |
$5,130.14 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,281.81
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
CATHETER ABLATION BLUE #D7TDL252RT
|
Facility
|
IP
|
$11,339.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
2973717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,778.35 |
| Max. Negotiated Rate |
$10,849.16 |
| Rate for Payer: Aetna Commercial |
$10,613.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,141.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,250.06
|
| Rate for Payer: Cash Price |
$3,401.70
|
| Rate for Payer: Cigna Commercial |
$10,849.16
|
| Rate for Payer: Health EOS Commercial |
$10,495.38
|
| Rate for Payer: HFN Commercial |
$10,849.16
|
| Rate for Payer: Multiplan Commercial |
$9,434.05
|
| Rate for Payer: Preferred Network Access Commercial |
$10,849.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,778.35
|
| Rate for Payer: Quartz Commercial |
$7,075.54
|
| Rate for Payer: WEA Trust Commercial |
$6,485.91
|
| Rate for Payer: WPS Commercial |
$8,734.43
|
|
|
CATHETER ABLATION BLUE #D7TDL252RT
|
Facility
|
OP
|
$11,339.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
2973717
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,301.92 |
| Max. Negotiated Rate |
$10,849.16 |
| Rate for Payer: Aetna Commercial |
$10,613.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,141.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,301.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,665.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,896.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,660.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,250.06
|
| Rate for Payer: Cash Price |
$3,401.70
|
| Rate for Payer: Cigna Commercial |
$10,849.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,599.30
|
| Rate for Payer: Health EOS Commercial |
$10,495.38
|
| Rate for Payer: HFN Commercial |
$10,849.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,844.42
|
| Rate for Payer: Multiplan Commercial |
$9,434.05
|
| Rate for Payer: NAPHCARE Commercial |
$7,075.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,849.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,778.35
|
| Rate for Payer: Quartz Commercial |
$7,665.16
|
| Rate for Payer: Quartz Medicare Advantage |
$7,075.54
|
| Rate for Payer: The Alliance Commercial |
$5,896.28
|
| Rate for Payer: WEA Trust Commercial |
$6,485.91
|
| Rate for Payer: WPS Commercial |
$8,734.43
|
|
|
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 |
$4,197.58 |
| Max. Negotiated Rate |
$7,881.16 |
| Rate for Payer: Aetna Commercial |
$7,709.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,367.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,540.23
|
| Rate for Payer: Cash Price |
$2,471.10
|
| Rate for Payer: Cigna Commercial |
$7,881.16
|
| Rate for Payer: Health EOS Commercial |
$7,624.17
|
| Rate for Payer: HFN Commercial |
$7,881.16
|
| Rate for Payer: Multiplan Commercial |
$6,853.18
|
| Rate for Payer: Preferred Network Access Commercial |
$7,881.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,197.58
|
| Rate for Payer: Quartz Commercial |
$5,139.89
|
| Rate for Payer: WEA Trust Commercial |
$4,711.56
|
| Rate for Payer: WPS Commercial |
$6,344.96
|
|
|
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 |
$2,398.61 |
| Max. Negotiated Rate |
$7,881.16 |
| Rate for Payer: Aetna Commercial |
$7,709.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,367.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,398.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,568.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,283.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,111.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,540.23
|
| Rate for Payer: Cash Price |
$2,471.10
|
| Rate for Payer: Cigna Commercial |
$7,881.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,793.93
|
| Rate for Payer: Health EOS Commercial |
$7,624.17
|
| Rate for Payer: HFN Commercial |
$7,881.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,424.86
|
| Rate for Payer: Multiplan Commercial |
$6,853.18
|
| Rate for Payer: NAPHCARE Commercial |
$5,139.89
|
| Rate for Payer: Preferred Network Access Commercial |
$7,881.16
|
| Rate for Payer: Quartz Beloit One Network |
$4,197.58
|
| Rate for Payer: Quartz Commercial |
$5,568.21
|
| Rate for Payer: Quartz Medicare Advantage |
$5,139.89
|
| Rate for Payer: The Alliance Commercial |
$4,283.24
|
| Rate for Payer: WEA Trust Commercial |
$4,711.56
|
| Rate for Payer: WPS Commercial |
$6,344.96
|
|
|
CATHETER ABLATION ORANGE #D7TFL252RT
|
Facility
|
OP
|
$11,339.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
2973726
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,301.92 |
| Max. Negotiated Rate |
$10,849.16 |
| Rate for Payer: Aetna Commercial |
$10,613.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,141.60
|
| Rate for Payer: Aetna Managed Medicare |
$3,301.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,665.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,896.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,660.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,250.06
|
| Rate for Payer: Cash Price |
$3,401.70
|
| Rate for Payer: Cigna Commercial |
$10,849.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,599.30
|
| Rate for Payer: Health EOS Commercial |
$10,495.38
|
| Rate for Payer: HFN Commercial |
$10,849.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,844.42
|
| Rate for Payer: Multiplan Commercial |
$9,434.05
|
| Rate for Payer: NAPHCARE Commercial |
$7,075.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,849.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,778.35
|
| Rate for Payer: Quartz Commercial |
$7,665.16
|
| Rate for Payer: Quartz Medicare Advantage |
$7,075.54
|
| Rate for Payer: The Alliance Commercial |
$5,896.28
|
| Rate for Payer: WEA Trust Commercial |
$6,485.91
|
| Rate for Payer: WPS Commercial |
$8,734.43
|
|
