|
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
|
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 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 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
|
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 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 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 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 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 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 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 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 ORANGE #D7TFL252RT
|
Facility
|
IP
|
$11,339.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
2973726
|
|
Hospital Revenue Code
|
278
|
| 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 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
|
|
|
Catheter Angio #14
|
Facility
|
IP
|
$52.00
|
|
| Hospital Charge Code |
3101772
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.50 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Catheter Angio #14
|
Facility
|
OP
|
$52.00
|
|
| Hospital Charge Code |
3101772
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.14 |
| Max. Negotiated Rate |
$49.75 |
| Rate for Payer: Aetna Commercial |
$48.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46.51
|
| Rate for Payer: Aetna Managed Medicare |
$15.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.66
|
| Rate for Payer: Cash Price |
$15.60
|
| Rate for Payer: Cigna Commercial |
$49.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.26
|
| Rate for Payer: Health EOS Commercial |
$48.13
|
| Rate for Payer: HFN Commercial |
$49.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.56
|
| Rate for Payer: Multiplan Commercial |
$43.26
|
| Rate for Payer: NAPHCARE Commercial |
$32.45
|
| Rate for Payer: Preferred Network Access Commercial |
$49.75
|
| Rate for Payer: Quartz Beloit One Network |
$26.50
|
| Rate for Payer: Quartz Commercial |
$35.15
|
| Rate for Payer: Quartz Medicare Advantage |
$32.45
|
| Rate for Payer: The Alliance Commercial |
$27.04
|
| Rate for Payer: WEA Trust Commercial |
$29.74
|
| Rate for Payer: WPS Commercial |
$40.06
|
|
|
Catheter,Angio #14
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3040298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Catheter,Angio #14
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3040298
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
CATHETER ANGIO 20GX1.75 383538
|
Facility
|
IP
|
$152.00
|
|
| Hospital Charge Code |
4519146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.46 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$94.85
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
CATHETER ANGIO 20GX1.75 383538
|
Facility
|
OP
|
$152.00
|
|
| Hospital Charge Code |
4519146
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.26 |
| Max. Negotiated Rate |
$145.43 |
| Rate for Payer: Aetna Commercial |
$142.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.95
|
| Rate for Payer: Aetna Managed Medicare |
$44.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.78
|
| Rate for Payer: Cash Price |
$45.60
|
| Rate for Payer: Cigna Commercial |
$145.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.46
|
| Rate for Payer: Health EOS Commercial |
$140.69
|
| Rate for Payer: HFN Commercial |
$145.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.56
|
| Rate for Payer: Multiplan Commercial |
$126.46
|
| Rate for Payer: NAPHCARE Commercial |
$94.85
|
| Rate for Payer: Preferred Network Access Commercial |
$145.43
|
| Rate for Payer: Quartz Beloit One Network |
$77.46
|
| Rate for Payer: Quartz Commercial |
$102.75
|
| Rate for Payer: Quartz Medicare Advantage |
$94.85
|
| Rate for Payer: The Alliance Commercial |
$79.04
|
| Rate for Payer: WEA Trust Commercial |
$86.94
|
| Rate for Payer: WPS Commercial |
$117.09
|
|
|
CATHETER ANGIOGRAPHIC 4 FR STRAIGHT 526-422
|
Facility
|
OP
|
$449.00
|
|
| Hospital Charge Code |
2973211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.75 |
| Max. Negotiated Rate |
$429.60 |
| Rate for Payer: Aetna Commercial |
$420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Aetna Managed Medicare |
$130.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$303.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.49
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$429.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.32
|
| Rate for Payer: Health EOS Commercial |
$415.59
|
| Rate for Payer: HFN Commercial |
$429.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$350.22
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: NAPHCARE Commercial |
$280.18
|
| Rate for Payer: Preferred Network Access Commercial |
$429.60
|
| Rate for Payer: Quartz Beloit One Network |
$228.81
|
| Rate for Payer: Quartz Commercial |
$303.52
|
| Rate for Payer: Quartz Medicare Advantage |
$280.18
|
| Rate for Payer: The Alliance Commercial |
$233.48
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
|
CATHETER ANGIOGRAPHIC 4 FR STRAIGHT 526-422
|
Facility
|
IP
|
$449.00
|
|
| Hospital Charge Code |
2973211
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.81 |
| Max. Negotiated Rate |
$429.60 |
| Rate for Payer: Aetna Commercial |
$420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.49
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$429.60
|
| Rate for Payer: Health EOS Commercial |
$415.59
|
| Rate for Payer: HFN Commercial |
$429.60
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: Preferred Network Access Commercial |
$429.60
|
| Rate for Payer: Quartz Beloit One Network |
$228.81
|
| Rate for Payer: Quartz Commercial |
$280.18
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
|
CATHETER ANGIOGRAPHIC 5 FR STRAIGHT 526-522
|
Facility
|
OP
|
$449.00
|
|
| Hospital Charge Code |
2972356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.75 |
| Max. Negotiated Rate |
$429.60 |
| Rate for Payer: Aetna Commercial |
$420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Aetna Managed Medicare |
$130.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$303.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$233.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.49
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$429.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.32
|
| Rate for Payer: Health EOS Commercial |
$415.59
|
| Rate for Payer: HFN Commercial |
$429.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$350.22
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: NAPHCARE Commercial |
$280.18
|
| Rate for Payer: Preferred Network Access Commercial |
$429.60
|
| Rate for Payer: Quartz Beloit One Network |
$228.81
|
| Rate for Payer: Quartz Commercial |
$303.52
|
| Rate for Payer: Quartz Medicare Advantage |
$280.18
|
| Rate for Payer: The Alliance Commercial |
$233.48
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
|
CATHETER ANGIOGRAPHIC 5 FR STRAIGHT 526-522
|
Facility
|
IP
|
$449.00
|
|
| Hospital Charge Code |
2972356
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$228.81 |
| Max. Negotiated Rate |
$429.60 |
| Rate for Payer: Aetna Commercial |
$420.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$247.49
|
| Rate for Payer: Cash Price |
$134.70
|
| Rate for Payer: Cigna Commercial |
$429.60
|
| Rate for Payer: Health EOS Commercial |
$415.59
|
| Rate for Payer: HFN Commercial |
$429.60
|
| Rate for Payer: Multiplan Commercial |
$373.57
|
| Rate for Payer: Preferred Network Access Commercial |
$429.60
|
| Rate for Payer: Quartz Beloit One Network |
$228.81
|
| Rate for Payer: Quartz Commercial |
$280.18
|
| Rate for Payer: WEA Trust Commercial |
$256.83
|
| Rate for Payer: WPS Commercial |
$345.86
|
|
