|
ICD Gen INS/REP + Multi Lead
|
Facility
|
OP
|
$6,867.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
4318574
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,499.42 |
| Max. Negotiated Rate |
$132,133.21 |
| Rate for Payer: Aetna Commercial |
$6,427.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,141.84
|
| Rate for Payer: Aetna Managed Medicare |
$33,033.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$33,033.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,785.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33,033.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33,033.30
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cigna Commercial |
$6,570.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33,033.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33,033.30
|
| Rate for Payer: Health EOS Commercial |
$6,356.10
|
| Rate for Payer: HFN Commercial |
$6,570.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122,883.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33,033.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33,033.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33,033.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33,033.30
|
| Rate for Payer: Multiplan Commercial |
$5,713.34
|
| Rate for Payer: NAPHCARE Commercial |
$49,549.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,570.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,499.42
|
| Rate for Payer: Quartz Commercial |
$4,642.09
|
| Rate for Payer: Quartz Medicare Advantage |
$33,033.30
|
| Rate for Payer: The Alliance Commercial |
$132,133.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33,033.30
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$3,927.92
|
| Rate for Payer: Wellcare Medicare |
$33,033.30
|
| Rate for Payer: WPS Commercial |
$5,289.65
|
|
|
ICD Gen INS/REP + Multi Lead
|
Facility
|
IP
|
$6,867.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
4318574
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,499.42 |
| Max. Negotiated Rate |
$6,570.35 |
| Rate for Payer: Aetna Commercial |
$6,427.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,141.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,785.09
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cigna Commercial |
$6,570.35
|
| Rate for Payer: Health EOS Commercial |
$6,356.10
|
| Rate for Payer: HFN Commercial |
$6,570.35
|
| Rate for Payer: Multiplan Commercial |
$5,713.34
|
| Rate for Payer: Preferred Network Access Commercial |
$6,570.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,499.42
|
| Rate for Payer: Quartz Commercial |
$4,285.01
|
| Rate for Payer: WEA Trust Commercial |
$3,927.92
|
| Rate for Payer: WPS Commercial |
$5,289.65
|
|
|
ICD Gen Ins/Rep + Single or Dual Leads
|
Facility
|
OP
|
$8,583.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
4017928
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,373.90 |
| Max. Negotiated Rate |
$132,133.21 |
| Rate for Payer: Aetna Commercial |
$8,033.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,676.64
|
| Rate for Payer: Aetna Managed Medicare |
$33,033.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$33,033.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,730.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33,033.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33,033.30
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna Commercial |
$8,212.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33,033.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33,033.30
|
| Rate for Payer: Health EOS Commercial |
$7,944.42
|
| Rate for Payer: HFN Commercial |
$8,212.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122,883.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33,033.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33,033.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33,033.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33,033.30
|
| Rate for Payer: Multiplan Commercial |
$7,141.06
|
| Rate for Payer: NAPHCARE Commercial |
$49,549.95
|
| Rate for Payer: Preferred Network Access Commercial |
$8,212.21
|
| Rate for Payer: Quartz Beloit One Network |
$4,373.90
|
| Rate for Payer: Quartz Commercial |
$5,802.11
|
| Rate for Payer: Quartz Medicare Advantage |
$33,033.30
|
| Rate for Payer: The Alliance Commercial |
$132,133.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33,033.30
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$4,909.48
|
| Rate for Payer: Wellcare Medicare |
$33,033.30
|
| Rate for Payer: WPS Commercial |
$6,611.48
|
|
|
ICD Gen Ins/Rep + Single or Dual Leads
|
Facility
|
IP
|
$8,583.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
4017928
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,373.90 |
| Max. Negotiated Rate |
$8,212.21 |
| Rate for Payer: Aetna Commercial |
$8,033.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,676.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,730.95
|
| Rate for Payer: Cash Price |
$2,574.90
|
| Rate for Payer: Cigna Commercial |
$8,212.21
|
| Rate for Payer: Health EOS Commercial |
$7,944.42
|
| Rate for Payer: HFN Commercial |
$8,212.21
|
| Rate for Payer: Multiplan Commercial |
$7,141.06
|
| Rate for Payer: Preferred Network Access Commercial |
$8,212.21
|
| Rate for Payer: Quartz Beloit One Network |
$4,373.90
|
| Rate for Payer: Quartz Commercial |
$5,355.79
|
| Rate for Payer: WEA Trust Commercial |
$4,909.48
|
| Rate for Payer: WPS Commercial |
$6,611.48
|
|
|
ICD Gen INS/REP + Single or Dual Leads
|
Facility
|
OP
|
$6,867.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
4318586
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,499.42 |
| Max. Negotiated Rate |
$132,133.21 |
| Rate for Payer: Aetna Commercial |
$6,427.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,141.84
|
| Rate for Payer: Aetna Managed Medicare |
$33,033.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$33,033.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,785.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33,033.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33,033.30
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cigna Commercial |
$6,570.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33,033.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33,033.30
|
| Rate for Payer: Health EOS Commercial |
$6,356.10
|
| Rate for Payer: HFN Commercial |
$6,570.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122,883.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33,033.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33,033.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33,033.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33,033.30
|
| Rate for Payer: Multiplan Commercial |
$5,713.34
|
| Rate for Payer: NAPHCARE Commercial |
$49,549.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,570.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,499.42
|
| Rate for Payer: Quartz Commercial |
$4,642.09
|
| Rate for Payer: Quartz Medicare Advantage |
$33,033.30
|
| Rate for Payer: The Alliance Commercial |
$132,133.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33,033.30
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$3,927.92
|
| Rate for Payer: Wellcare Medicare |
$33,033.30
|
| Rate for Payer: WPS Commercial |
$5,289.65
|
|
|
ICD Gen INS/REP + Single or Dual Leads
|
Facility
|
IP
|
$6,867.00
|
|
|
Service Code
|
CPT 33249
|
| Hospital Charge Code |
4318586
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,499.42 |
| Max. Negotiated Rate |
$6,570.35 |
| Rate for Payer: Aetna Commercial |
$6,427.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,141.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,785.09
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cigna Commercial |
$6,570.35
|
| Rate for Payer: Health EOS Commercial |
$6,356.10
|
| Rate for Payer: HFN Commercial |
$6,570.35
|
| Rate for Payer: Multiplan Commercial |
$5,713.34
|
| Rate for Payer: Preferred Network Access Commercial |
$6,570.35
|
| Rate for Payer: Quartz Beloit One Network |
$3,499.42
|
| Rate for Payer: Quartz Commercial |
$4,285.01
|
| Rate for Payer: WEA Trust Commercial |
$3,927.92
|
| Rate for Payer: WPS Commercial |
$5,289.65
|
|
|
ICD Gen Removal W/O Replacement
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
3052397
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$611.01 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$748.18
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
ICD Gen Removal W/O Replacement
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 33241
|
| Hospital Charge Code |
3052397
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$611.01 |
| Max. Negotiated Rate |
$15,730.96 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Aetna Managed Medicare |
$3,932.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,932.74
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,932.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,932.74
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,629.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,932.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,932.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,932.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,932.74
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: NAPHCARE Commercial |
$5,899.11
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$810.52
|
| Rate for Payer: Quartz Medicare Advantage |
$3,932.74
|
| Rate for Payer: The Alliance Commercial |
$15,730.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,932.74
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: Wellcare Medicare |
$3,932.74
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
ICD Ins/Rep Subq w/Lead
|
Facility
|
OP
|
$6,681.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
4584634
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,404.64 |
| Max. Negotiated Rate |
$132,133.21 |
| Rate for Payer: Aetna Commercial |
$6,253.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,975.49
|
| Rate for Payer: Aetna Managed Medicare |
$33,033.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$33,033.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,682.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33,033.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33,033.30
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cigna Commercial |
$6,392.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$33,033.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$33,033.30
|
| Rate for Payer: Health EOS Commercial |
$6,183.93
|
| Rate for Payer: HFN Commercial |
$6,392.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122,883.88
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$33,033.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33,033.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$33,033.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$33,033.30
|
| Rate for Payer: Multiplan Commercial |
$5,558.59
|
| Rate for Payer: NAPHCARE Commercial |
$49,549.95
|
| Rate for Payer: Preferred Network Access Commercial |
$6,392.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,404.64
|
| Rate for Payer: Quartz Commercial |
$4,516.36
|
| Rate for Payer: Quartz Medicare Advantage |
$33,033.30
|
| Rate for Payer: The Alliance Commercial |
$132,133.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33,033.30
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$3,821.53
|
| Rate for Payer: Wellcare Medicare |
$33,033.30
|
| Rate for Payer: WPS Commercial |
$5,146.37
|
|
|
ICD Ins/Rep Subq w/Lead
|
Facility
|
IP
|
$6,681.00
|
|
|
Service Code
|
CPT 33270
|
| Hospital Charge Code |
4584634
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,404.64 |
| Max. Negotiated Rate |
$6,392.38 |
| Rate for Payer: Aetna Commercial |
$6,253.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,975.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,682.57
|
| Rate for Payer: Cash Price |
$2,004.30
|
| Rate for Payer: Cigna Commercial |
$6,392.38
|
| Rate for Payer: Health EOS Commercial |
$6,183.93
|
| Rate for Payer: HFN Commercial |
$6,392.38
|
| Rate for Payer: Multiplan Commercial |
$5,558.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,392.38
|
| Rate for Payer: Quartz Beloit One Network |
$3,404.64
|
| Rate for Payer: Quartz Commercial |
$4,168.94
|
| Rate for Payer: WEA Trust Commercial |
$3,821.53
|
| Rate for Payer: WPS Commercial |
$5,146.37
|
|
|
ICD Ins Subq Lead Only
|
Facility
|
IP
|
$4,945.00
|
|
|
Service Code
|
CPT 33271
|
| Hospital Charge Code |
4584633
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,519.97 |
| Max. Negotiated Rate |
$4,731.38 |
| Rate for Payer: Aetna Commercial |
$4,628.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,422.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,725.68
|
| Rate for Payer: Cash Price |
$1,483.50
|
| Rate for Payer: Cigna Commercial |
$4,731.38
|
| Rate for Payer: Health EOS Commercial |
$4,577.09
|
| Rate for Payer: HFN Commercial |
$4,731.38
|
| Rate for Payer: Multiplan Commercial |
$4,114.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,731.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,519.97
|
| Rate for Payer: Quartz Commercial |
$3,085.68
|
| Rate for Payer: WEA Trust Commercial |
$2,828.54
|
| Rate for Payer: WPS Commercial |
$3,809.13
|
|
|
ICD Ins Subq Lead Only
|
Facility
|
OP
|
$4,945.00
|
|
|
Service Code
|
CPT 33271
|
| Hospital Charge Code |
4584633
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,519.97 |
| Max. Negotiated Rate |
$34,835.72 |
| Rate for Payer: Aetna Commercial |
$4,628.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,422.81
|
| Rate for Payer: Aetna Managed Medicare |
$8,708.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,725.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,708.93
|
| Rate for Payer: Cash Price |
$1,483.50
|
| Rate for Payer: Cash Price |
$1,483.50
|
| Rate for Payer: Cash Price |
$1,483.50
|
| Rate for Payer: Cigna Commercial |
$4,731.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,708.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,708.93
|
| Rate for Payer: Health EOS Commercial |
$4,577.09
|
| Rate for Payer: HFN Commercial |
$4,731.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,397.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,708.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,708.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,708.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,708.93
|
| Rate for Payer: Multiplan Commercial |
$4,114.24
|
| Rate for Payer: NAPHCARE Commercial |
$13,063.39
|
| Rate for Payer: Preferred Network Access Commercial |
$4,731.38
|
| Rate for Payer: Quartz Beloit One Network |
$2,519.97
|
| Rate for Payer: Quartz Commercial |
$3,342.82
|
| Rate for Payer: Quartz Medicare Advantage |
$8,708.93
|
| Rate for Payer: The Alliance Commercial |
$34,835.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,708.93
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$2,828.54
|
| Rate for Payer: Wellcare Medicare |
$8,708.93
|
| Rate for Payer: WPS Commercial |
$3,809.13
|
|
|
ICD Lead Removal Single or Dual Leads
|
Facility
|
IP
|
$5,485.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
4125703
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,795.16 |
| Max. Negotiated Rate |
$5,248.05 |
| Rate for Payer: Aetna Commercial |
$5,133.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,905.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,023.33
|
| Rate for Payer: Cash Price |
$1,645.50
|
| Rate for Payer: Cigna Commercial |
$5,248.05
|
| Rate for Payer: Health EOS Commercial |
$5,076.92
|
| Rate for Payer: HFN Commercial |
$5,248.05
|
| Rate for Payer: Multiplan Commercial |
$4,563.52
|
| Rate for Payer: Preferred Network Access Commercial |
$5,248.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,795.16
|
| Rate for Payer: Quartz Commercial |
$3,422.64
|
| Rate for Payer: WEA Trust Commercial |
$3,137.42
|
| Rate for Payer: WPS Commercial |
$4,225.10
|
|
|
ICD Lead Removal Single or Dual Leads
|
Facility
|
IP
|
$5,485.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
4318602
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,795.16 |
| Max. Negotiated Rate |
$5,248.05 |
| Rate for Payer: Aetna Commercial |
$5,133.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,905.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,023.33
|
| Rate for Payer: Cash Price |
$1,645.50
|
| Rate for Payer: Cigna Commercial |
$5,248.05
|
| Rate for Payer: Health EOS Commercial |
$5,076.92
|
| Rate for Payer: HFN Commercial |
$5,248.05
|
| Rate for Payer: Multiplan Commercial |
$4,563.52
|
| Rate for Payer: Preferred Network Access Commercial |
$5,248.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,795.16
|
| Rate for Payer: Quartz Commercial |
$3,422.64
|
| Rate for Payer: WEA Trust Commercial |
$3,137.42
|
| Rate for Payer: WPS Commercial |
$4,225.10
|
|
|
ICD Lead Removal Single or Dual Leads
|
Facility
|
OP
|
$5,485.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
4125703
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,795.16 |
| Max. Negotiated Rate |
$15,730.96 |
| Rate for Payer: Aetna Commercial |
$5,133.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,905.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,932.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,023.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,932.74
|
| Rate for Payer: Cash Price |
$1,645.50
|
| Rate for Payer: Cash Price |
$1,645.50
|
| Rate for Payer: Cash Price |
$1,645.50
|
| Rate for Payer: Cigna Commercial |
$5,248.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,932.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,932.74
|
| Rate for Payer: Health EOS Commercial |
$5,076.92
|
| Rate for Payer: HFN Commercial |
$5,248.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,629.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,932.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,932.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,932.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,932.74
|
| Rate for Payer: Multiplan Commercial |
$4,563.52
|
| Rate for Payer: NAPHCARE Commercial |
$5,899.11
|
| Rate for Payer: Preferred Network Access Commercial |
$5,248.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,795.16
|
| Rate for Payer: Quartz Commercial |
$3,707.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,932.74
|
| Rate for Payer: The Alliance Commercial |
$15,730.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,932.74
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$3,137.42
|
| Rate for Payer: Wellcare Medicare |
$3,932.74
|
| Rate for Payer: WPS Commercial |
$4,225.10
|
|
|
ICD Lead Removal Single or Dual Leads
|
Facility
|
OP
|
$5,485.00
|
|
|
Service Code
|
CPT 33244
|
| Hospital Charge Code |
4318602
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,795.16 |
| Max. Negotiated Rate |
$15,730.96 |
| Rate for Payer: Aetna Commercial |
$5,133.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,905.78
|
| Rate for Payer: Aetna Managed Medicare |
$3,932.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,023.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,932.74
|
| Rate for Payer: Cash Price |
$1,645.50
|
| Rate for Payer: Cash Price |
$1,645.50
|
| Rate for Payer: Cash Price |
$1,645.50
|
| Rate for Payer: Cigna Commercial |
$5,248.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,932.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,932.74
|
| Rate for Payer: Health EOS Commercial |
$5,076.92
|
| Rate for Payer: HFN Commercial |
$5,248.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,629.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,932.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,932.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,932.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,932.74
|
| Rate for Payer: Multiplan Commercial |
$4,563.52
|
| Rate for Payer: NAPHCARE Commercial |
$5,899.11
|
| Rate for Payer: Preferred Network Access Commercial |
$5,248.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,795.16
|
| Rate for Payer: Quartz Commercial |
$3,707.86
|
| Rate for Payer: Quartz Medicare Advantage |
$3,932.74
|
| Rate for Payer: The Alliance Commercial |
$15,730.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,932.74
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$3,137.42
|
| Rate for Payer: Wellcare Medicare |
$3,932.74
|
| Rate for Payer: WPS Commercial |
$4,225.10
|
|
|
ICD/Pacemaker Check Remote 90 day
|
Facility
|
IP
|
$426.00
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
3052488
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$217.09 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$265.82
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
ICD/Pacemaker Check Remote 90 day
|
Facility
|
OP
|
$426.00
|
|
|
Service Code
|
CPT 93296
|
| Hospital Charge Code |
3052488
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$407.60 |
| Rate for Payer: Aetna Commercial |
$398.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$381.01
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$287.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$221.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$212.66
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$234.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cash Price |
$127.80
|
| Rate for Payer: Cigna Commercial |
$407.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$247.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$394.31
|
| Rate for Payer: HFN Commercial |
$407.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$354.43
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$407.60
|
| Rate for Payer: Quartz Beloit One Network |
$217.09
|
| Rate for Payer: Quartz Commercial |
$287.98
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$332.28
|
| Rate for Payer: WEA Trust Commercial |
$243.67
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$328.15
|
|
|
ICD Pocket Rev/Relocation
|
Facility
|
OP
|
$2,669.00
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
3052385
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,360.12 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Commercial |
$2,498.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,387.15
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| Rate for Payer: Cash Price |
$800.70
|
| Rate for Payer: Cash Price |
$800.70
|
| Rate for Payer: Cash Price |
$800.70
|
| Rate for Payer: Cigna Commercial |
$2,553.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Health EOS Commercial |
$2,470.43
|
| Rate for Payer: HFN Commercial |
$2,553.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: Multiplan Commercial |
$2,220.61
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.12
|
| Rate for Payer: Quartz Commercial |
$1,804.24
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$1,526.67
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
| Rate for Payer: WPS Commercial |
$2,055.93
|
|
|
ICD Pocket Rev/Relocation
|
Facility
|
IP
|
$2,669.00
|
|
|
Service Code
|
CPT 33223
|
| Hospital Charge Code |
3052385
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,360.12 |
| Max. Negotiated Rate |
$2,553.70 |
| Rate for Payer: Aetna Commercial |
$2,498.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,387.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,471.15
|
| Rate for Payer: Cash Price |
$800.70
|
| Rate for Payer: Cigna Commercial |
$2,553.70
|
| Rate for Payer: Health EOS Commercial |
$2,470.43
|
| Rate for Payer: HFN Commercial |
$2,553.70
|
| Rate for Payer: Multiplan Commercial |
$2,220.61
|
| Rate for Payer: Preferred Network Access Commercial |
$2,553.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,360.12
|
| Rate for Payer: Quartz Commercial |
$1,665.46
|
| Rate for Payer: WEA Trust Commercial |
$1,526.67
|
| Rate for Payer: WPS Commercial |
$2,055.93
|
|
|
ICD Pre/Post OP Adjust
|
Facility
|
IP
|
$423.00
|
|
|
Service Code
|
CPT 93287
|
| Hospital Charge Code |
3052480
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$215.56 |
| Max. Negotiated Rate |
$404.73 |
| Rate for Payer: Aetna Commercial |
$395.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.16
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$404.73
|
| Rate for Payer: Health EOS Commercial |
$391.53
|
| Rate for Payer: HFN Commercial |
$404.73
|
| Rate for Payer: Multiplan Commercial |
$351.94
|
| Rate for Payer: Preferred Network Access Commercial |
$404.73
|
| Rate for Payer: Quartz Beloit One Network |
$215.56
|
| Rate for Payer: Quartz Commercial |
$263.95
|
| Rate for Payer: WEA Trust Commercial |
$241.96
|
| Rate for Payer: WPS Commercial |
$325.84
|
|
|
ICD Pre/Post OP Adjust
|
Facility
|
OP
|
$423.00
|
|
|
Service Code
|
CPT 93287
|
| Hospital Charge Code |
3052480
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$123.18 |
| Max. Negotiated Rate |
$404.73 |
| Rate for Payer: Aetna Commercial |
$395.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$378.33
|
| Rate for Payer: Aetna Managed Medicare |
$123.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$285.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$211.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$233.16
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cash Price |
$126.90
|
| Rate for Payer: Cigna Commercial |
$404.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$246.19
|
| Rate for Payer: Health EOS Commercial |
$391.53
|
| Rate for Payer: HFN Commercial |
$404.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.94
|
| Rate for Payer: Multiplan Commercial |
$351.94
|
| Rate for Payer: NAPHCARE Commercial |
$263.95
|
| Rate for Payer: Preferred Network Access Commercial |
$404.73
|
| Rate for Payer: Quartz Beloit One Network |
$215.56
|
| Rate for Payer: Quartz Commercial |
$285.95
|
| Rate for Payer: Quartz Medicare Advantage |
$263.95
|
| Rate for Payer: The Alliance Commercial |
$206.17
|
| Rate for Payer: United Healthcare PPO |
$329.94
|
| Rate for Payer: WEA Trust Commercial |
$241.96
|
| Rate for Payer: WPS Commercial |
$325.84
|
|
|
ICD Remote Eval w/o Program 90 day
|
Facility
|
IP
|
$245.00
|
|
|
Service Code
|
CPT 93295
|
| Hospital Charge Code |
3052487
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$124.85 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$152.88
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
ICD Remote Eval w/o Program 90 day
|
Facility
|
OP
|
$245.00
|
|
|
Service Code
|
CPT 93295
|
| Hospital Charge Code |
3052487
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$71.34 |
| Max. Negotiated Rate |
$234.42 |
| Rate for Payer: Aetna Commercial |
$229.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$219.13
|
| Rate for Payer: Aetna Managed Medicare |
$71.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$165.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.04
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cash Price |
$73.50
|
| Rate for Payer: Cigna Commercial |
$234.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$142.59
|
| Rate for Payer: Health EOS Commercial |
$226.77
|
| Rate for Payer: HFN Commercial |
$234.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.10
|
| Rate for Payer: Multiplan Commercial |
$203.84
|
| Rate for Payer: NAPHCARE Commercial |
$152.88
|
| Rate for Payer: Preferred Network Access Commercial |
$234.42
|
| Rate for Payer: Quartz Beloit One Network |
$124.85
|
| Rate for Payer: Quartz Commercial |
$165.62
|
| Rate for Payer: Quartz Medicare Advantage |
$152.88
|
| Rate for Payer: The Alliance Commercial |
$143.44
|
| Rate for Payer: United Healthcare PPO |
$191.10
|
| Rate for Payer: WEA Trust Commercial |
$140.14
|
| Rate for Payer: WPS Commercial |
$188.72
|
|
|
ICD Removal Subq Lead Only
|
Facility
|
OP
|
$4,584.00
|
|
|
Service Code
|
CPT 33272
|
| Hospital Charge Code |
4584632
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,336.01 |
| Max. Negotiated Rate |
$15,730.96 |
| Rate for Payer: Aetna Commercial |
$4,290.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,099.93
|
| Rate for Payer: Aetna Managed Medicare |
$3,932.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,526.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,932.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,932.74
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cash Price |
$1,375.20
|
| Rate for Payer: Cigna Commercial |
$4,385.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,932.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,932.74
|
| Rate for Payer: Health EOS Commercial |
$4,242.95
|
| Rate for Payer: HFN Commercial |
$4,385.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,629.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,932.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,932.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,932.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,932.74
|
| Rate for Payer: Multiplan Commercial |
$3,813.89
|
| Rate for Payer: NAPHCARE Commercial |
$5,899.11
|
| Rate for Payer: Preferred Network Access Commercial |
$4,385.97
|
| Rate for Payer: Quartz Beloit One Network |
$2,336.01
|
| Rate for Payer: Quartz Commercial |
$3,098.78
|
| Rate for Payer: Quartz Medicare Advantage |
$3,932.74
|
| Rate for Payer: The Alliance Commercial |
$15,730.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,932.74
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$2,622.05
|
| Rate for Payer: Wellcare Medicare |
$3,932.74
|
| Rate for Payer: WPS Commercial |
$3,531.06
|
|
