|
Eosinophil Urine
|
Facility
|
IP
|
$103.00
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
633722
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.47 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$61.80
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$61.80
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
Eosinophil Urine
|
Facility
|
OP
|
$103.00
|
|
|
Service Code
|
CPT 81015
|
| Hospital Charge Code |
633722
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.05 |
| Max. Negotiated Rate |
$94.76 |
| Rate for Payer: Aetna Commercial |
$92.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$88.58
|
| Rate for Payer: Aetna Managed Medicare |
$3.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.06
|
| Rate for Payer: Anthem Medicaid |
$3.15
|
| Rate for Payer: Anthem Medicare Advantage |
$3.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$54.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.05
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cash Price |
$30.90
|
| Rate for Payer: Cigna Commercial |
$94.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.64
|
| Rate for Payer: Dean Health Medicaid |
$3.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3.05
|
| Rate for Payer: Health EOS Commercial |
$91.67
|
| Rate for Payer: HFN Commercial |
$94.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.05
|
| Rate for Payer: Managed Health Services Medicaid |
$3.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3.05
|
| Rate for Payer: Multiplan Commercial |
$82.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.58
|
| Rate for Payer: Preferred Network Access Commercial |
$94.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3.15
|
| Rate for Payer: Quartz Beloit One Network |
$50.47
|
| Rate for Payer: Quartz Commercial |
$66.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3.05
|
| Rate for Payer: The Alliance Commercial |
$12.20
|
| Rate for Payer: United Healthcare Medicaid |
$3.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.05
|
| Rate for Payer: United Healthcare PPO |
$77.25
|
| Rate for Payer: WEA Trust Commercial |
$56.65
|
| Rate for Payer: Wellcare Medicare |
$3.05
|
| Rate for Payer: WMAP Medicaid |
$3.15
|
| Rate for Payer: WPS Commercial |
$76.29
|
|
|
EO with joint, Prefabricated L3760
|
Facility
|
OP
|
$251.00
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
3713509
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$70.28 |
| Max. Negotiated Rate |
$1,004.00 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Aetna Managed Medicare |
$70.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$353.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$353.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$353.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$140.46
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.25
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$163.15
|
| Rate for Payer: Quartz Medicare Advantage |
$150.60
|
| Rate for Payer: The Alliance Commercial |
$1,004.00
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
EO with joint, Prefabricated L3760
|
Professional
|
Both
|
$251.00
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
3713509
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$110.44 |
| Max. Negotiated Rate |
$1,612.82 |
| Rate for Payer: Aetna Commercial |
$238.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$238.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$150.60
|
| Rate for Payer: Health EOS Commercial |
$228.41
|
| Rate for Payer: HFN Commercial |
$238.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,612.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,612.82
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: Preferred Network Access Commercial |
$238.45
|
| Rate for Payer: Quartz Beloit One Network |
$110.44
|
| Rate for Payer: Quartz Commercial |
$143.07
|
| Rate for Payer: The Alliance Commercial |
$125.50
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
EO with joint, Prefabricated L3760
|
Facility
|
IP
|
$251.00
|
|
|
Service Code
|
HCPCS L3760
|
| Hospital Charge Code |
3713509
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$122.99 |
| Max. Negotiated Rate |
$230.92 |
| Rate for Payer: Aetna Commercial |
$225.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$215.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.03
|
| Rate for Payer: Cash Price |
$75.30
|
| Rate for Payer: Cigna Commercial |
$230.92
|
| Rate for Payer: Health EOS Commercial |
$223.39
|
| Rate for Payer: HFN Commercial |
$230.92
|
| Rate for Payer: Multiplan Commercial |
$200.80
|
| Rate for Payer: NAPHCARE Commercial |
$150.60
|
| Rate for Payer: Preferred Network Access Commercial |
$230.92
|
| Rate for Payer: Quartz Beloit One Network |
$122.99
|
| Rate for Payer: Quartz Commercial |
$150.60
|
| Rate for Payer: WEA Trust Commercial |
$138.05
|
| Rate for Payer: WPS Commercial |
$185.92
|
|
|
EO w/o joints CF L3702
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
3375561
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$5.04 |
| Max. Negotiated Rate |
$129.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Aetna Managed Medicare |
$5.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$129.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$129.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.07
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.50
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$11.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10.80
|
| Rate for Payer: The Alliance Commercial |
$72.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
EO w/o joints CF L3702
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
3375561
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$7.92 |
| Max. Negotiated Rate |
$931.25 |
| Rate for Payer: Aetna Commercial |
$17.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.80
|
| Rate for Payer: Health EOS Commercial |
$16.38
|
| Rate for Payer: HFN Commercial |
$17.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$931.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$931.25
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17.10
|
| Rate for Payer: Quartz Beloit One Network |
$7.92
|
| Rate for Payer: Quartz Commercial |
$10.26
|
| Rate for Payer: The Alliance Commercial |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
EO w/o joints CF L3702
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
HCPCS L3702
|
| Hospital Charge Code |
3375561
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$8.82 |
| Max. Negotiated Rate |
$16.56 |
| Rate for Payer: Aetna Commercial |
$16.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.54
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$16.56
|
| Rate for Payer: Health EOS Commercial |
$16.02
|
| Rate for Payer: HFN Commercial |
$16.56
|
| Rate for Payer: Multiplan Commercial |
$14.40
|
| Rate for Payer: NAPHCARE Commercial |
$10.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16.56
|
| Rate for Payer: Quartz Beloit One Network |
$8.82
|
| Rate for Payer: Quartz Commercial |
$10.80
|
| Rate for Payer: WEA Trust Commercial |
$9.90
|
| Rate for Payer: WPS Commercial |
$13.33
|
|
|
EP 3-D Mapping +
|
Facility
|
OP
|
$3,021.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
4125525
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$845.88 |
| Max. Negotiated Rate |
$29,139.00 |
| Rate for Payer: Aetna Commercial |
$2,718.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.06
|
| Rate for Payer: Aetna Managed Medicare |
$845.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,139.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,420.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,100.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.13
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cigna Commercial |
$2,779.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,690.55
|
| Rate for Payer: Health EOS Commercial |
$2,688.69
|
| Rate for Payer: HFN Commercial |
$2,779.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,265.75
|
| Rate for Payer: Multiplan Commercial |
$2,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,812.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,779.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.29
|
| Rate for Payer: Quartz Commercial |
$1,963.65
|
| Rate for Payer: Quartz Medicare Advantage |
$1,812.60
|
| Rate for Payer: The Alliance Commercial |
$12,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,661.55
|
| Rate for Payer: WPS Commercial |
$2,237.65
|
|
|
EP 3-D Mapping +
|
Facility
|
IP
|
$3,021.00
|
|
|
Service Code
|
CPT 93613
|
| Hospital Charge Code |
4125525
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,480.29 |
| Max. Negotiated Rate |
$2,779.32 |
| Rate for Payer: Aetna Commercial |
$2,718.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,598.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,601.13
|
| Rate for Payer: Cash Price |
$906.30
|
| Rate for Payer: Cigna Commercial |
$2,779.32
|
| Rate for Payer: Health EOS Commercial |
$2,688.69
|
| Rate for Payer: HFN Commercial |
$2,779.32
|
| Rate for Payer: Multiplan Commercial |
$2,416.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,812.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,779.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,480.29
|
| Rate for Payer: Quartz Commercial |
$1,812.60
|
| Rate for Payer: WEA Trust Commercial |
$1,661.55
|
| Rate for Payer: WPS Commercial |
$2,237.65
|
|
|
EP Ablation Addl Site +
|
Facility
|
OP
|
$3,982.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
3052518
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,114.96 |
| Max. Negotiated Rate |
$29,139.00 |
| Rate for Payer: Aetna Commercial |
$3,583.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,424.52
|
| Rate for Payer: Aetna Managed Medicare |
$1,114.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,139.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,420.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,100.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,110.46
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Cigna Commercial |
$3,663.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,228.33
|
| Rate for Payer: Health EOS Commercial |
$3,543.98
|
| Rate for Payer: HFN Commercial |
$3,663.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,986.50
|
| Rate for Payer: Multiplan Commercial |
$3,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,389.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,663.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,951.18
|
| Rate for Payer: Quartz Commercial |
$2,588.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,389.20
|
| Rate for Payer: The Alliance Commercial |
$15,928.00
|
| Rate for Payer: WEA Trust Commercial |
$2,190.10
|
| Rate for Payer: WPS Commercial |
$2,949.47
|
|
|
EP Ablation Addl Site +
|
Facility
|
IP
|
$3,982.00
|
|
|
Service Code
|
CPT 93655
|
| Hospital Charge Code |
3052518
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,951.18 |
| Max. Negotiated Rate |
$3,663.44 |
| Rate for Payer: Aetna Commercial |
$3,583.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,424.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,110.46
|
| Rate for Payer: Cash Price |
$1,194.60
|
| Rate for Payer: Cigna Commercial |
$3,663.44
|
| Rate for Payer: Health EOS Commercial |
$3,543.98
|
| Rate for Payer: HFN Commercial |
$3,663.44
|
| Rate for Payer: Multiplan Commercial |
$3,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,389.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,663.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,951.18
|
| Rate for Payer: Quartz Commercial |
$2,389.20
|
| Rate for Payer: WEA Trust Commercial |
$2,190.10
|
| Rate for Payer: WPS Commercial |
$2,949.47
|
|
|
EP AV Node Ablation W/WO Pacing
|
Facility
|
OP
|
$12,080.00
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
3052515
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,919.20 |
| Max. Negotiated Rate |
$29,526.40 |
| Rate for Payer: Aetna Commercial |
$10,872.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,388.80
|
| Rate for Payer: Aetna Managed Medicare |
$7,381.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,139.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,420.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,100.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,381.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,402.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,381.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,381.60
|
| Rate for Payer: Cash Price |
$3,624.00
|
| Rate for Payer: Cash Price |
$3,624.00
|
| Rate for Payer: Cash Price |
$3,624.00
|
| Rate for Payer: Cigna Commercial |
$11,113.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,381.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,759.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,381.60
|
| Rate for Payer: Health EOS Commercial |
$10,751.20
|
| Rate for Payer: HFN Commercial |
$11,113.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,459.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,381.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,381.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,381.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,381.60
|
| Rate for Payer: Multiplan Commercial |
$9,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$11,072.40
|
| Rate for Payer: Preferred Network Access Commercial |
$11,113.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,919.20
|
| Rate for Payer: Quartz Commercial |
$7,852.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,381.60
|
| Rate for Payer: The Alliance Commercial |
$29,526.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,381.60
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: WEA Trust Commercial |
$6,644.00
|
| Rate for Payer: Wellcare Medicare |
$7,381.60
|
| Rate for Payer: WPS Commercial |
$8,947.66
|
|
|
EP AV Node Ablation W/WO Pacing
|
Facility
|
IP
|
$12,080.00
|
|
|
Service Code
|
CPT 93650
|
| Hospital Charge Code |
3052515
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,919.20 |
| Max. Negotiated Rate |
$11,113.60 |
| Rate for Payer: Aetna Commercial |
$10,872.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,388.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,402.40
|
| Rate for Payer: Cash Price |
$3,624.00
|
| Rate for Payer: Cigna Commercial |
$11,113.60
|
| Rate for Payer: Health EOS Commercial |
$10,751.20
|
| Rate for Payer: HFN Commercial |
$11,113.60
|
| Rate for Payer: Multiplan Commercial |
$9,664.00
|
| Rate for Payer: NAPHCARE Commercial |
$7,248.00
|
| Rate for Payer: Preferred Network Access Commercial |
$11,113.60
|
| Rate for Payer: Quartz Beloit One Network |
$5,919.20
|
| Rate for Payer: Quartz Commercial |
$7,248.00
|
| Rate for Payer: WEA Trust Commercial |
$6,644.00
|
| Rate for Payer: WPS Commercial |
$8,947.66
|
|
|
EP Blazer II Small Curve 4mm
|
Facility
|
IP
|
$6,303.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
4534616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,088.47 |
| Max. Negotiated Rate |
$5,798.76 |
| Rate for Payer: Aetna Commercial |
$5,672.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,420.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,340.59
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cigna Commercial |
$5,798.76
|
| Rate for Payer: Health EOS Commercial |
$5,609.67
|
| Rate for Payer: HFN Commercial |
$5,798.76
|
| Rate for Payer: Multiplan Commercial |
$5,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,798.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,088.47
|
| Rate for Payer: Quartz Commercial |
$3,781.80
|
| Rate for Payer: WEA Trust Commercial |
$3,466.65
|
| Rate for Payer: WPS Commercial |
$4,668.63
|
|
|
EP Blazer II Small Curve 4mm
|
Facility
|
OP
|
$6,303.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
4534616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,764.84 |
| Max. Negotiated Rate |
$25,212.00 |
| Rate for Payer: Aetna Commercial |
$5,672.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,420.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,764.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,096.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,151.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,025.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,340.59
|
| Rate for Payer: Cash Price |
$1,890.90
|
| Rate for Payer: Cigna Commercial |
$5,798.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,527.16
|
| Rate for Payer: Health EOS Commercial |
$5,609.67
|
| Rate for Payer: HFN Commercial |
$5,798.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,727.25
|
| Rate for Payer: Multiplan Commercial |
$5,042.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,781.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,798.76
|
| Rate for Payer: Quartz Beloit One Network |
$3,088.47
|
| Rate for Payer: Quartz Commercial |
$4,096.95
|
| Rate for Payer: Quartz Medicare Advantage |
$3,781.80
|
| Rate for Payer: The Alliance Commercial |
$25,212.00
|
| Rate for Payer: WEA Trust Commercial |
$3,466.65
|
| Rate for Payer: WPS Commercial |
$4,668.63
|
|
|
EP Blazer Prime STD Curve 4mm
|
Facility
|
OP
|
$6,598.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
4534615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,847.44 |
| Max. Negotiated Rate |
$26,392.00 |
| Rate for Payer: Aetna Commercial |
$5,938.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,847.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,288.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,299.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,167.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.94
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$6,070.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,692.24
|
| Rate for Payer: Health EOS Commercial |
$5,872.22
|
| Rate for Payer: HFN Commercial |
$6,070.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,948.50
|
| Rate for Payer: Multiplan Commercial |
$5,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,070.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,233.02
|
| Rate for Payer: Quartz Commercial |
$4,288.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,958.80
|
| Rate for Payer: The Alliance Commercial |
$26,392.00
|
| Rate for Payer: WEA Trust Commercial |
$3,628.90
|
| Rate for Payer: WPS Commercial |
$4,887.14
|
|
|
EP Blazer Prime STD Curve 4mm
|
Facility
|
IP
|
$6,598.00
|
|
|
Service Code
|
HCPCS C1733
|
| Hospital Charge Code |
4534615
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,233.02 |
| Max. Negotiated Rate |
$6,070.16 |
| Rate for Payer: Aetna Commercial |
$5,938.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,674.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,496.94
|
| Rate for Payer: Cash Price |
$1,979.40
|
| Rate for Payer: Cigna Commercial |
$6,070.16
|
| Rate for Payer: Health EOS Commercial |
$5,872.22
|
| Rate for Payer: HFN Commercial |
$6,070.16
|
| Rate for Payer: Multiplan Commercial |
$5,278.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,958.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,070.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,233.02
|
| Rate for Payer: Quartz Commercial |
$3,958.80
|
| Rate for Payer: WEA Trust Commercial |
$3,628.90
|
| Rate for Payer: WPS Commercial |
$4,887.14
|
|
|
EP Bundle of HIS Recording
|
Facility
|
IP
|
$1,892.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
4125702
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$927.08 |
| Max. Negotiated Rate |
$1,740.64 |
| Rate for Payer: Aetna Commercial |
$1,702.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,627.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.76
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,740.64
|
| Rate for Payer: Health EOS Commercial |
$1,683.88
|
| Rate for Payer: HFN Commercial |
$1,740.64
|
| Rate for Payer: Multiplan Commercial |
$1,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,135.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,740.64
|
| Rate for Payer: Quartz Beloit One Network |
$927.08
|
| Rate for Payer: Quartz Commercial |
$1,135.20
|
| Rate for Payer: WEA Trust Commercial |
$1,040.60
|
| Rate for Payer: WPS Commercial |
$1,401.40
|
|
|
EP Bundle of HIS Recording
|
Facility
|
OP
|
$1,892.00
|
|
|
Service Code
|
CPT 93600
|
| Hospital Charge Code |
4125702
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$927.08 |
| Max. Negotiated Rate |
$29,526.40 |
| Rate for Payer: Aetna Commercial |
$1,702.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,627.12
|
| Rate for Payer: Aetna Managed Medicare |
$7,381.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,139.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,420.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,100.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,381.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,381.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,381.60
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,740.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,381.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,058.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,381.60
|
| Rate for Payer: Health EOS Commercial |
$1,683.88
|
| Rate for Payer: HFN Commercial |
$1,740.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,459.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,381.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,381.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,381.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,381.60
|
| Rate for Payer: Multiplan Commercial |
$1,513.60
|
| Rate for Payer: NAPHCARE Commercial |
$11,072.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,740.64
|
| Rate for Payer: Quartz Beloit One Network |
$927.08
|
| Rate for Payer: Quartz Commercial |
$1,229.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7,381.60
|
| Rate for Payer: The Alliance Commercial |
$29,526.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,381.60
|
| Rate for Payer: WEA Trust Commercial |
$1,040.60
|
| Rate for Payer: Wellcare Medicare |
$7,381.60
|
| Rate for Payer: WPS Commercial |
$1,401.40
|
|
|
EPC
|
Facility
|
IP
|
$2,034.00
|
|
| Hospital Charge Code |
3075871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$996.66 |
| Max. Negotiated Rate |
$1,871.28 |
| Rate for Payer: Aetna Commercial |
$1,830.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,749.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,078.02
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$1,871.28
|
| Rate for Payer: Health EOS Commercial |
$1,810.26
|
| Rate for Payer: HFN Commercial |
$1,871.28
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,220.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,871.28
|
| Rate for Payer: Quartz Beloit One Network |
$996.66
|
| Rate for Payer: Quartz Commercial |
$1,220.40
|
| Rate for Payer: WEA Trust Commercial |
$1,118.70
|
| Rate for Payer: WPS Commercial |
$1,506.58
|
|
|
EPC
|
Facility
|
OP
|
$2,034.00
|
|
| Hospital Charge Code |
3075871
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$569.52 |
| Max. Negotiated Rate |
$8,136.00 |
| Rate for Payer: Aetna Commercial |
$1,830.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,749.24
|
| Rate for Payer: Aetna Managed Medicare |
$569.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,322.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,017.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$976.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,078.02
|
| Rate for Payer: Cash Price |
$610.20
|
| Rate for Payer: Cigna Commercial |
$1,871.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,138.23
|
| Rate for Payer: Health EOS Commercial |
$1,810.26
|
| Rate for Payer: HFN Commercial |
$1,871.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,525.50
|
| Rate for Payer: Multiplan Commercial |
$1,627.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,220.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,871.28
|
| Rate for Payer: Quartz Beloit One Network |
$996.66
|
| Rate for Payer: Quartz Commercial |
$1,322.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,220.40
|
| Rate for Payer: The Alliance Commercial |
$8,136.00
|
| Rate for Payer: WEA Trust Commercial |
$1,118.70
|
| Rate for Payer: WPS Commercial |
$1,506.58
|
|
|
EP Catheter-Ablation
|
Facility
|
OP
|
$6,979.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
4139319
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,954.12 |
| Max. Negotiated Rate |
$27,916.00 |
| Rate for Payer: Aetna Commercial |
$6,281.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,001.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,954.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,536.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,489.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,349.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,698.87
|
| Rate for Payer: Cash Price |
$2,093.70
|
| Rate for Payer: Cigna Commercial |
$6,420.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,905.45
|
| Rate for Payer: Health EOS Commercial |
$6,211.31
|
| Rate for Payer: HFN Commercial |
$6,420.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,234.25
|
| Rate for Payer: Multiplan Commercial |
$5,583.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,187.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,420.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,419.71
|
| Rate for Payer: Quartz Commercial |
$4,536.35
|
| Rate for Payer: Quartz Medicare Advantage |
$4,187.40
|
| Rate for Payer: The Alliance Commercial |
$27,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,838.45
|
| Rate for Payer: WPS Commercial |
$5,169.35
|
|
|
EP Catheter-Ablation
|
Facility
|
IP
|
$6,979.00
|
|
|
Service Code
|
HCPCS C1732
|
| Hospital Charge Code |
4139319
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,419.71 |
| Max. Negotiated Rate |
$6,420.68 |
| Rate for Payer: Aetna Commercial |
$6,281.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,001.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,698.87
|
| Rate for Payer: Cash Price |
$2,093.70
|
| Rate for Payer: Cigna Commercial |
$6,420.68
|
| Rate for Payer: Health EOS Commercial |
$6,211.31
|
| Rate for Payer: HFN Commercial |
$6,420.68
|
| Rate for Payer: Multiplan Commercial |
$5,583.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,187.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,420.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,419.71
|
| Rate for Payer: Quartz Commercial |
$4,187.40
|
| Rate for Payer: WEA Trust Commercial |
$3,838.45
|
| Rate for Payer: WPS Commercial |
$5,169.35
|
|
|
EP Catheter-Diagnostic
|
Facility
|
OP
|
$1,525.00
|
|
|
Service Code
|
HCPCS C1730
|
| Hospital Charge Code |
4139317
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$427.00 |
| Max. Negotiated Rate |
$6,100.00 |
| Rate for Payer: Aetna Commercial |
$1,372.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,311.50
|
| Rate for Payer: Aetna Managed Medicare |
$427.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$991.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$762.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$732.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$808.25
|
| Rate for Payer: Cash Price |
$457.50
|
| Rate for Payer: Cigna Commercial |
$1,403.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$853.39
|
| Rate for Payer: Health EOS Commercial |
$1,357.25
|
| Rate for Payer: HFN Commercial |
$1,403.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,143.75
|
| Rate for Payer: Multiplan Commercial |
$1,220.00
|
| Rate for Payer: NAPHCARE Commercial |
$915.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,403.00
|
| Rate for Payer: Quartz Beloit One Network |
$747.25
|
| Rate for Payer: Quartz Commercial |
$991.25
|
| Rate for Payer: Quartz Medicare Advantage |
$915.00
|
| Rate for Payer: The Alliance Commercial |
$6,100.00
|
| Rate for Payer: WEA Trust Commercial |
$838.75
|
| Rate for Payer: WPS Commercial |
$1,129.57
|
|
