|
ICAST STENT 10MM X 38MM -80CM
|
Facility
|
IP
|
$9,456.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3104712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,633.44 |
| Max. Negotiated Rate |
$8,699.52 |
| Rate for Payer: Aetna Commercial |
$8,510.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,132.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,011.68
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cigna Commercial |
$8,699.52
|
| Rate for Payer: Health EOS Commercial |
$8,415.84
|
| Rate for Payer: HFN Commercial |
$8,699.52
|
| Rate for Payer: Multiplan Commercial |
$7,564.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,673.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,699.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,633.44
|
| Rate for Payer: Quartz Commercial |
$5,673.60
|
| Rate for Payer: WEA Trust Commercial |
$5,200.80
|
| Rate for Payer: WPS Commercial |
$7,004.06
|
|
|
ICAST STENT 10MM X 38MM -80CM
|
Facility
|
OP
|
$9,456.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3104712
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.68 |
| Max. Negotiated Rate |
$37,824.00 |
| Rate for Payer: Aetna Commercial |
$8,510.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,132.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,647.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,146.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,538.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,011.68
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cigna Commercial |
$8,699.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,291.58
|
| Rate for Payer: Health EOS Commercial |
$8,415.84
|
| Rate for Payer: HFN Commercial |
$8,699.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,092.00
|
| Rate for Payer: Multiplan Commercial |
$7,564.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,673.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,699.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,633.44
|
| Rate for Payer: Quartz Commercial |
$6,146.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,673.60
|
| Rate for Payer: The Alliance Commercial |
$37,824.00
|
| Rate for Payer: WEA Trust Commercial |
$5,200.80
|
| Rate for Payer: WPS Commercial |
$7,004.06
|
|
|
ICAST STENT 7MM X 38MM -80CM
|
Facility
|
IP
|
$9,456.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3104710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,633.44 |
| Max. Negotiated Rate |
$8,699.52 |
| Rate for Payer: Aetna Commercial |
$8,510.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,132.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,011.68
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cigna Commercial |
$8,699.52
|
| Rate for Payer: Health EOS Commercial |
$8,415.84
|
| Rate for Payer: HFN Commercial |
$8,699.52
|
| Rate for Payer: Multiplan Commercial |
$7,564.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,673.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,699.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,633.44
|
| Rate for Payer: Quartz Commercial |
$5,673.60
|
| Rate for Payer: WEA Trust Commercial |
$5,200.80
|
| Rate for Payer: WPS Commercial |
$7,004.06
|
|
|
ICAST STENT 7MM X 38MM -80CM
|
Facility
|
OP
|
$9,456.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
3104710
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,647.68 |
| Max. Negotiated Rate |
$37,824.00 |
| Rate for Payer: Aetna Commercial |
$8,510.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,132.16
|
| Rate for Payer: Aetna Managed Medicare |
$2,647.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,146.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,728.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,538.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,011.68
|
| Rate for Payer: Cash Price |
$2,836.80
|
| Rate for Payer: Cigna Commercial |
$8,699.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,291.58
|
| Rate for Payer: Health EOS Commercial |
$8,415.84
|
| Rate for Payer: HFN Commercial |
$8,699.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,092.00
|
| Rate for Payer: Multiplan Commercial |
$7,564.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,673.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,699.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,633.44
|
| Rate for Payer: Quartz Commercial |
$6,146.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,673.60
|
| Rate for Payer: The Alliance Commercial |
$37,824.00
|
| Rate for Payer: WEA Trust Commercial |
$5,200.80
|
| Rate for Payer: WPS Commercial |
$7,004.06
|
|
|
ICD Check in Person
|
Facility
|
OP
|
$235.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
3052483
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$152.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$117.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$112.80
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$152.75
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$176.25
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
ICD Check in Person
|
Facility
|
IP
|
$235.00
|
|
|
Service Code
|
CPT 93289
|
| Hospital Charge Code |
3052483
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$115.15 |
| Max. Negotiated Rate |
$216.20 |
| Rate for Payer: Aetna Commercial |
$211.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$202.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$124.55
|
| Rate for Payer: Cash Price |
$70.50
|
| Rate for Payer: Cigna Commercial |
$216.20
|
| Rate for Payer: Health EOS Commercial |
$209.15
|
| Rate for Payer: HFN Commercial |
$216.20
|
| Rate for Payer: Multiplan Commercial |
$188.00
|
| Rate for Payer: NAPHCARE Commercial |
$141.00
|
| Rate for Payer: Preferred Network Access Commercial |
$216.20
|
| Rate for Payer: Quartz Beloit One Network |
$115.15
|
| Rate for Payer: Quartz Commercial |
$141.00
|
| Rate for Payer: WEA Trust Commercial |
$129.25
|
| Rate for Payer: WPS Commercial |
$174.06
|
|
|
ICD Check Remote 90 Day
|
Facility
|
OP
|
$263.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
5382699
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$126.24 |
| Max. Negotiated Rate |
$968.80 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Aetna Managed Medicare |
$242.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.24
|
| Rate for Payer: Anthem Medicare Advantage |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$242.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$242.20
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$241.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$242.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$242.20
|
| Rate for Payer: Health EOS Commercial |
$234.07
|
| Rate for Payer: HFN Commercial |
$241.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$900.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$242.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$242.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$242.20
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: NAPHCARE Commercial |
$363.30
|
| Rate for Payer: Preferred Network Access Commercial |
$241.96
|
| Rate for Payer: Quartz Beloit One Network |
$128.87
|
| Rate for Payer: Quartz Commercial |
$170.95
|
| Rate for Payer: Quartz Medicare Advantage |
$242.20
|
| Rate for Payer: The Alliance Commercial |
$968.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$242.20
|
| Rate for Payer: United Healthcare PPO |
$197.25
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: Wellcare Medicare |
$242.20
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
ICD Check Remote 90 Day
|
Facility
|
IP
|
$263.00
|
|
|
Service Code
|
CPT 93925
|
| Hospital Charge Code |
5382699
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$128.87 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.39
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$241.96
|
| Rate for Payer: Health EOS Commercial |
$234.07
|
| Rate for Payer: HFN Commercial |
$241.96
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: NAPHCARE Commercial |
$157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$241.96
|
| Rate for Payer: Quartz Beloit One Network |
$128.87
|
| Rate for Payer: Quartz Commercial |
$157.80
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
ICD Check Reprogram Dual
|
Facility
|
IP
|
$435.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
3052476
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$213.15 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$261.00
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$261.00
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
ICD Check Reprogram Dual
|
Facility
|
OP
|
$435.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
3052476
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$400.20 |
| Rate for Payer: Aetna Commercial |
$391.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$374.10
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.80
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cash Price |
$130.50
|
| Rate for Payer: Cigna Commercial |
$400.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$387.15
|
| Rate for Payer: HFN Commercial |
$400.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$348.00
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$400.20
|
| Rate for Payer: Quartz Beloit One Network |
$213.15
|
| Rate for Payer: Quartz Commercial |
$282.75
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$326.25
|
| Rate for Payer: WEA Trust Commercial |
$239.25
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$322.20
|
|
|
ICD Check Reprogram Multi
|
Facility
|
OP
|
$489.00
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
3052477
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$449.88 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.54
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$317.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$244.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.72
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$449.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$273.64
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$435.21
|
| Rate for Payer: HFN Commercial |
$449.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$449.88
|
| Rate for Payer: Quartz Beloit One Network |
$239.61
|
| Rate for Payer: Quartz Commercial |
$317.85
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$366.75
|
| Rate for Payer: WEA Trust Commercial |
$268.95
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$362.20
|
|
|
ICD Check Reprogram Multi
|
Facility
|
IP
|
$489.00
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
3052477
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$239.61 |
| Max. Negotiated Rate |
$449.88 |
| Rate for Payer: Aetna Commercial |
$440.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$259.17
|
| Rate for Payer: Cash Price |
$146.70
|
| Rate for Payer: Cigna Commercial |
$449.88
|
| Rate for Payer: Health EOS Commercial |
$435.21
|
| Rate for Payer: HFN Commercial |
$449.88
|
| Rate for Payer: Multiplan Commercial |
$391.20
|
| Rate for Payer: NAPHCARE Commercial |
$293.40
|
| Rate for Payer: Preferred Network Access Commercial |
$449.88
|
| Rate for Payer: Quartz Beloit One Network |
$239.61
|
| Rate for Payer: Quartz Commercial |
$293.40
|
| Rate for Payer: WEA Trust Commercial |
$268.95
|
| Rate for Payer: WPS Commercial |
$362.20
|
|
|
ICD Check Reprogram Single
|
Facility
|
OP
|
$434.00
|
|
|
Service Code
|
CPT 93282
|
| Hospital Charge Code |
3052475
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$37.27 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Aetna Managed Medicare |
$37.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$282.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$217.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$208.32
|
| Rate for Payer: Anthem Medicare Advantage |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.27
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$242.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37.27
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.27
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37.27
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37.27
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$55.90
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$282.10
|
| Rate for Payer: Quartz Medicare Advantage |
$37.27
|
| Rate for Payer: The Alliance Commercial |
$149.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.27
|
| Rate for Payer: United Healthcare PPO |
$325.50
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: Wellcare Medicare |
$37.27
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
ICD Check Reprogram Single
|
Facility
|
IP
|
$434.00
|
|
|
Service Code
|
CPT 93282
|
| Hospital Charge Code |
3052475
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$212.66 |
| Max. Negotiated Rate |
$399.28 |
| Rate for Payer: Aetna Commercial |
$390.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$373.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$230.02
|
| Rate for Payer: Cash Price |
$130.20
|
| Rate for Payer: Cigna Commercial |
$399.28
|
| Rate for Payer: Health EOS Commercial |
$386.26
|
| Rate for Payer: HFN Commercial |
$399.28
|
| Rate for Payer: Multiplan Commercial |
$347.20
|
| Rate for Payer: NAPHCARE Commercial |
$260.40
|
| Rate for Payer: Preferred Network Access Commercial |
$399.28
|
| Rate for Payer: Quartz Beloit One Network |
$212.66
|
| Rate for Payer: Quartz Commercial |
$260.40
|
| Rate for Payer: WEA Trust Commercial |
$238.70
|
| Rate for Payer: WPS Commercial |
$321.46
|
|
|
ICD Gen Change Dual Lead System
|
Facility
|
IP
|
$2,526.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
4308785
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,237.74 |
| Max. Negotiated Rate |
$2,323.92 |
| Rate for Payer: Aetna Commercial |
$2,273.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,172.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,338.78
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$2,323.92
|
| Rate for Payer: Health EOS Commercial |
$2,248.14
|
| Rate for Payer: HFN Commercial |
$2,323.92
|
| Rate for Payer: Multiplan Commercial |
$2,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,515.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,323.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,237.74
|
| Rate for Payer: Quartz Commercial |
$1,515.60
|
| Rate for Payer: WEA Trust Commercial |
$1,389.30
|
| Rate for Payer: WPS Commercial |
$1,871.01
|
|
|
ICD Gen Change Dual Lead System
|
Facility
|
OP
|
$3,158.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
3052399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,547.42 |
| Max. Negotiated Rate |
$93,192.60 |
| Rate for Payer: Aetna Commercial |
$2,842.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,715.88
|
| Rate for Payer: Aetna Managed Medicare |
$23,298.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$23,298.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,673.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,298.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,298.15
|
| Rate for Payer: Cash Price |
$947.40
|
| Rate for Payer: Cash Price |
$947.40
|
| Rate for Payer: Cash Price |
$947.40
|
| Rate for Payer: Cigna Commercial |
$2,905.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,298.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,298.15
|
| Rate for Payer: Health EOS Commercial |
$2,810.62
|
| Rate for Payer: HFN Commercial |
$2,905.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86,669.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,298.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,298.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,298.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,298.15
|
| Rate for Payer: Multiplan Commercial |
$2,526.40
|
| Rate for Payer: NAPHCARE Commercial |
$34,947.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,905.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,547.42
|
| Rate for Payer: Quartz Commercial |
$2,052.70
|
| Rate for Payer: Quartz Medicare Advantage |
$23,298.15
|
| Rate for Payer: The Alliance Commercial |
$93,192.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,298.15
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$1,736.90
|
| Rate for Payer: Wellcare Medicare |
$23,298.15
|
| Rate for Payer: WPS Commercial |
$2,339.13
|
|
|
ICD Gen Change Dual Lead System
|
Facility
|
IP
|
$3,158.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
3052399
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,547.42 |
| Max. Negotiated Rate |
$2,905.36 |
| Rate for Payer: Aetna Commercial |
$2,842.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,715.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,673.74
|
| Rate for Payer: Cash Price |
$947.40
|
| Rate for Payer: Cigna Commercial |
$2,905.36
|
| Rate for Payer: Health EOS Commercial |
$2,810.62
|
| Rate for Payer: HFN Commercial |
$2,905.36
|
| Rate for Payer: Multiplan Commercial |
$2,526.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,894.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,905.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,547.42
|
| Rate for Payer: Quartz Commercial |
$1,894.80
|
| Rate for Payer: WEA Trust Commercial |
$1,736.90
|
| Rate for Payer: WPS Commercial |
$2,339.13
|
|
|
ICD Gen Change Dual Lead System
|
Facility
|
OP
|
$2,526.00
|
|
|
Service Code
|
CPT 33263
|
| Hospital Charge Code |
4308785
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,237.74 |
| Max. Negotiated Rate |
$93,192.60 |
| Rate for Payer: Aetna Commercial |
$2,273.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,172.36
|
| Rate for Payer: Aetna Managed Medicare |
$23,298.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$23,298.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,338.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,298.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,298.15
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cash Price |
$757.80
|
| Rate for Payer: Cigna Commercial |
$2,323.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,298.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,298.15
|
| Rate for Payer: Health EOS Commercial |
$2,248.14
|
| Rate for Payer: HFN Commercial |
$2,323.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86,669.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,298.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,298.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,298.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,298.15
|
| Rate for Payer: Multiplan Commercial |
$2,020.80
|
| Rate for Payer: NAPHCARE Commercial |
$34,947.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,323.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,237.74
|
| Rate for Payer: Quartz Commercial |
$1,641.90
|
| Rate for Payer: Quartz Medicare Advantage |
$23,298.15
|
| Rate for Payer: The Alliance Commercial |
$93,192.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,298.15
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$1,389.30
|
| Rate for Payer: Wellcare Medicare |
$23,298.15
|
| Rate for Payer: WPS Commercial |
$1,871.01
|
|
|
ICD Gen Change Multi Lead System
|
Facility
|
OP
|
$3,277.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
3052400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,605.73 |
| Max. Negotiated Rate |
$130,070.76 |
| Rate for Payer: Aetna Commercial |
$2,949.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,818.22
|
| Rate for Payer: Aetna Managed Medicare |
$32,517.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$32,517.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,736.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,517.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,517.69
|
| Rate for Payer: Cash Price |
$983.10
|
| Rate for Payer: Cash Price |
$983.10
|
| Rate for Payer: Cash Price |
$983.10
|
| Rate for Payer: Cigna Commercial |
$3,014.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,517.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,517.69
|
| Rate for Payer: Health EOS Commercial |
$2,916.53
|
| Rate for Payer: HFN Commercial |
$3,014.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120,965.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,517.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,517.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,517.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,517.69
|
| Rate for Payer: Multiplan Commercial |
$2,621.60
|
| Rate for Payer: NAPHCARE Commercial |
$48,776.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,014.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,605.73
|
| Rate for Payer: Quartz Commercial |
$2,130.05
|
| Rate for Payer: Quartz Medicare Advantage |
$32,517.69
|
| Rate for Payer: The Alliance Commercial |
$130,070.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,517.69
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$1,802.35
|
| Rate for Payer: Wellcare Medicare |
$32,517.69
|
| Rate for Payer: WPS Commercial |
$2,427.27
|
|
|
ICD Gen Change Multi Lead System
|
Facility
|
IP
|
$3,277.00
|
|
|
Service Code
|
CPT 33264
|
| Hospital Charge Code |
3052400
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,605.73 |
| Max. Negotiated Rate |
$3,014.84 |
| Rate for Payer: Aetna Commercial |
$2,949.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,818.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,736.81
|
| Rate for Payer: Cash Price |
$983.10
|
| Rate for Payer: Cigna Commercial |
$3,014.84
|
| Rate for Payer: Health EOS Commercial |
$2,916.53
|
| Rate for Payer: HFN Commercial |
$3,014.84
|
| Rate for Payer: Multiplan Commercial |
$2,621.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,966.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,014.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,605.73
|
| Rate for Payer: Quartz Commercial |
$1,966.20
|
| Rate for Payer: WEA Trust Commercial |
$1,802.35
|
| Rate for Payer: WPS Commercial |
$2,427.27
|
|
|
ICD Gen Change Single Lead System
|
Facility
|
OP
|
$3,037.00
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
3052398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,488.13 |
| Max. Negotiated Rate |
$93,192.60 |
| Rate for Payer: Aetna Commercial |
$2,733.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,611.82
|
| Rate for Payer: Aetna Managed Medicare |
$23,298.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$23,298.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,609.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,298.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,298.15
|
| Rate for Payer: Cash Price |
$911.10
|
| Rate for Payer: Cash Price |
$911.10
|
| Rate for Payer: Cash Price |
$911.10
|
| Rate for Payer: Cigna Commercial |
$2,794.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,298.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,298.15
|
| Rate for Payer: Health EOS Commercial |
$2,702.93
|
| Rate for Payer: HFN Commercial |
$2,794.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86,669.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,298.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,298.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,298.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,298.15
|
| Rate for Payer: Multiplan Commercial |
$2,429.60
|
| Rate for Payer: NAPHCARE Commercial |
$34,947.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,794.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,488.13
|
| Rate for Payer: Quartz Commercial |
$1,974.05
|
| Rate for Payer: Quartz Medicare Advantage |
$23,298.15
|
| Rate for Payer: The Alliance Commercial |
$93,192.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,298.15
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$1,670.35
|
| Rate for Payer: Wellcare Medicare |
$23,298.15
|
| Rate for Payer: WPS Commercial |
$2,249.51
|
|
|
ICD Gen Change Single Lead System
|
Facility
|
IP
|
$3,037.00
|
|
|
Service Code
|
CPT 33262
|
| Hospital Charge Code |
3052398
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,488.13 |
| Max. Negotiated Rate |
$2,794.04 |
| Rate for Payer: Aetna Commercial |
$2,733.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,611.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,609.61
|
| Rate for Payer: Cash Price |
$911.10
|
| Rate for Payer: Cigna Commercial |
$2,794.04
|
| Rate for Payer: Health EOS Commercial |
$2,702.93
|
| Rate for Payer: HFN Commercial |
$2,794.04
|
| Rate for Payer: Multiplan Commercial |
$2,429.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,822.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,794.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,488.13
|
| Rate for Payer: Quartz Commercial |
$1,822.20
|
| Rate for Payer: WEA Trust Commercial |
$1,670.35
|
| Rate for Payer: WPS Commercial |
$2,249.51
|
|
|
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 |
$3,364.83 |
| Max. Negotiated Rate |
$130,070.76 |
| Rate for Payer: Aetna Commercial |
$6,180.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,905.62
|
| Rate for Payer: Aetna Managed Medicare |
$32,517.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$32,517.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,639.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,517.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,517.69
|
| 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 |
$6,317.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,517.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,517.69
|
| Rate for Payer: Health EOS Commercial |
$6,111.63
|
| Rate for Payer: HFN Commercial |
$6,317.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120,965.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,517.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,517.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,517.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,517.69
|
| Rate for Payer: Multiplan Commercial |
$5,493.60
|
| Rate for Payer: NAPHCARE Commercial |
$48,776.54
|
| Rate for Payer: Preferred Network Access Commercial |
$6,317.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,364.83
|
| Rate for Payer: Quartz Commercial |
$4,463.55
|
| Rate for Payer: Quartz Medicare Advantage |
$32,517.69
|
| Rate for Payer: The Alliance Commercial |
$130,070.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,517.69
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$3,776.85
|
| Rate for Payer: Wellcare Medicare |
$32,517.69
|
| Rate for Payer: WPS Commercial |
$5,086.39
|
|
|
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 |
$3,364.83 |
| Max. Negotiated Rate |
$6,317.64 |
| Rate for Payer: Aetna Commercial |
$6,180.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,905.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,639.51
|
| Rate for Payer: Cash Price |
$2,060.10
|
| Rate for Payer: Cigna Commercial |
$6,317.64
|
| Rate for Payer: Health EOS Commercial |
$6,111.63
|
| Rate for Payer: HFN Commercial |
$6,317.64
|
| Rate for Payer: Multiplan Commercial |
$5,493.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,120.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6,317.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,364.83
|
| Rate for Payer: Quartz Commercial |
$4,120.20
|
| Rate for Payer: WEA Trust Commercial |
$3,776.85
|
| Rate for Payer: WPS Commercial |
$5,086.39
|
|
|
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 |
$4,205.67 |
| Max. Negotiated Rate |
$130,070.76 |
| Rate for Payer: Aetna Commercial |
$7,724.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,381.38
|
| Rate for Payer: Aetna Managed Medicare |
$32,517.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$32,517.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,548.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32,517.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32,517.69
|
| 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 |
$7,896.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$32,517.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$32,517.69
|
| Rate for Payer: Health EOS Commercial |
$7,638.87
|
| Rate for Payer: HFN Commercial |
$7,896.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$120,965.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$32,517.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32,517.69
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$32,517.69
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$32,517.69
|
| Rate for Payer: Multiplan Commercial |
$6,866.40
|
| Rate for Payer: NAPHCARE Commercial |
$48,776.54
|
| Rate for Payer: Preferred Network Access Commercial |
$7,896.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,205.67
|
| Rate for Payer: Quartz Commercial |
$5,578.95
|
| Rate for Payer: Quartz Medicare Advantage |
$32,517.69
|
| Rate for Payer: The Alliance Commercial |
$130,070.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32,517.69
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$4,720.65
|
| Rate for Payer: Wellcare Medicare |
$32,517.69
|
| Rate for Payer: WPS Commercial |
$6,357.43
|
|
