|
IV START KIT DYNDV1539B
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2962923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$39.69 |
| Max. Negotiated Rate |
$74.52 |
| Rate for Payer: Aetna Commercial |
$72.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$69.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$42.93
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$74.52
|
| Rate for Payer: Health EOS Commercial |
$72.09
|
| Rate for Payer: HFN Commercial |
$74.52
|
| Rate for Payer: Multiplan Commercial |
$64.80
|
| Rate for Payer: NAPHCARE Commercial |
$48.60
|
| Rate for Payer: Preferred Network Access Commercial |
$74.52
|
| Rate for Payer: Quartz Beloit One Network |
$39.69
|
| Rate for Payer: Quartz Commercial |
$48.60
|
| Rate for Payer: WEA Trust Commercial |
$44.55
|
| Rate for Payer: WPS Commercial |
$60.00
|
|
|
IVUS - AAA
|
Facility
|
IP
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,874.25 |
| Max. Negotiated Rate |
$3,519.00 |
| Rate for Payer: Aetna Commercial |
$3,442.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,289.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,027.25
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$3,519.00
|
| Rate for Payer: Health EOS Commercial |
$3,404.25
|
| Rate for Payer: HFN Commercial |
$3,519.00
|
| Rate for Payer: Multiplan Commercial |
$3,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,295.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,519.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,874.25
|
| Rate for Payer: Quartz Commercial |
$2,295.00
|
| Rate for Payer: WEA Trust Commercial |
$2,103.75
|
| Rate for Payer: WPS Commercial |
$2,833.18
|
|
|
IVUS - AAA
|
Professional
|
Both
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.00 |
| Max. Negotiated Rate |
$3,633.75 |
| Rate for Payer: Aetna Commercial |
$3,633.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,289.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$3,633.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,912.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,295.00
|
| Rate for Payer: Health EOS Commercial |
$3,480.75
|
| Rate for Payer: HFN Commercial |
$3,633.75
|
| Rate for Payer: Multiplan Commercial |
$3,060.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,633.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.00
|
| Rate for Payer: Quartz Commercial |
$2,180.25
|
| Rate for Payer: The Alliance Commercial |
$1,912.50
|
| Rate for Payer: WEA Trust Commercial |
$2,103.75
|
| Rate for Payer: WPS Commercial |
$2,833.18
|
|
|
IVUS - AAA
|
Facility
|
OP
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550986
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$15,300.00 |
| Rate for Payer: Aetna Commercial |
$3,442.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,289.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,071.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,486.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,912.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,836.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,027.25
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$3,519.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,140.47
|
| Rate for Payer: Health EOS Commercial |
$3,404.25
|
| Rate for Payer: HFN Commercial |
$3,519.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,868.75
|
| Rate for Payer: Multiplan Commercial |
$3,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,295.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,519.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,874.25
|
| Rate for Payer: Quartz Commercial |
$2,486.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,295.00
|
| Rate for Payer: The Alliance Commercial |
$15,300.00
|
| Rate for Payer: WEA Trust Commercial |
$2,103.75
|
| Rate for Payer: WPS Commercial |
$2,833.18
|
|
|
IV US Catheter AAA
|
Facility
|
OP
|
$8,232.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139308
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,304.96 |
| Max. Negotiated Rate |
$32,928.00 |
| Rate for Payer: Aetna Commercial |
$7,408.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,079.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,304.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,350.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,116.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,951.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,362.96
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cigna Commercial |
$7,573.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,606.63
|
| Rate for Payer: Health EOS Commercial |
$7,326.48
|
| Rate for Payer: HFN Commercial |
$7,573.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,174.00
|
| Rate for Payer: Multiplan Commercial |
$6,585.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,939.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,573.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,033.68
|
| Rate for Payer: Quartz Commercial |
$5,350.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,939.20
|
| Rate for Payer: The Alliance Commercial |
$32,928.00
|
| Rate for Payer: WEA Trust Commercial |
$4,527.60
|
| Rate for Payer: WPS Commercial |
$6,097.44
|
|
|
IV US Catheter AAA
|
Facility
|
IP
|
$8,232.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139308
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,033.68 |
| Max. Negotiated Rate |
$7,573.44 |
| Rate for Payer: Aetna Commercial |
$7,408.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,079.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,362.96
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cigna Commercial |
$7,573.44
|
| Rate for Payer: Health EOS Commercial |
$7,326.48
|
| Rate for Payer: HFN Commercial |
$7,573.44
|
| Rate for Payer: Multiplan Commercial |
$6,585.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,939.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,573.44
|
| Rate for Payer: Quartz Beloit One Network |
$4,033.68
|
| Rate for Payer: Quartz Commercial |
$4,939.20
|
| Rate for Payer: WEA Trust Commercial |
$4,527.60
|
| Rate for Payer: WPS Commercial |
$6,097.44
|
|
|
IV US Catheter Coronary
|
Facility
|
OP
|
$6,861.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139309
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,921.08 |
| Max. Negotiated Rate |
$27,444.00 |
| Rate for Payer: Aetna Commercial |
$6,174.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,900.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,921.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,459.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,430.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,293.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,636.33
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cigna Commercial |
$6,312.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,839.42
|
| Rate for Payer: Health EOS Commercial |
$6,106.29
|
| Rate for Payer: HFN Commercial |
$6,312.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,145.75
|
| Rate for Payer: Multiplan Commercial |
$5,488.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,116.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,312.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,361.89
|
| Rate for Payer: Quartz Commercial |
$4,459.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,116.60
|
| Rate for Payer: The Alliance Commercial |
$27,444.00
|
| Rate for Payer: WEA Trust Commercial |
$3,773.55
|
| Rate for Payer: WPS Commercial |
$5,081.94
|
|
|
IV US Catheter Coronary
|
Facility
|
IP
|
$6,861.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139309
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,361.89 |
| Max. Negotiated Rate |
$6,312.12 |
| Rate for Payer: Aetna Commercial |
$6,174.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,900.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,636.33
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cigna Commercial |
$6,312.12
|
| Rate for Payer: Health EOS Commercial |
$6,106.29
|
| Rate for Payer: HFN Commercial |
$6,312.12
|
| Rate for Payer: Multiplan Commercial |
$5,488.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,116.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,312.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,361.89
|
| Rate for Payer: Quartz Commercial |
$4,116.60
|
| Rate for Payer: WEA Trust Commercial |
$3,773.55
|
| Rate for Payer: WPS Commercial |
$5,081.94
|
|
|
IVUS Coranary/BPG Ea Add Vessel +
|
Facility
|
IP
|
$1,747.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
3052472
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$856.03 |
| Max. Negotiated Rate |
$1,607.24 |
| Rate for Payer: Aetna Commercial |
$1,572.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,502.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$925.91
|
| Rate for Payer: Cash Price |
$524.10
|
| Rate for Payer: Cigna Commercial |
$1,607.24
|
| Rate for Payer: Health EOS Commercial |
$1,554.83
|
| Rate for Payer: HFN Commercial |
$1,607.24
|
| Rate for Payer: Multiplan Commercial |
$1,397.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,048.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.24
|
| Rate for Payer: Quartz Beloit One Network |
$856.03
|
| Rate for Payer: Quartz Commercial |
$1,048.20
|
| Rate for Payer: WEA Trust Commercial |
$960.85
|
| Rate for Payer: WPS Commercial |
$1,294.00
|
|
|
IVUS Coranary/BPG Ea Add Vessel +
|
Facility
|
OP
|
$1,747.00
|
|
|
Service Code
|
CPT 92979
|
| Hospital Charge Code |
3052472
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$489.16 |
| Max. Negotiated Rate |
$6,988.00 |
| Rate for Payer: Aetna Commercial |
$1,572.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,502.42
|
| Rate for Payer: Aetna Managed Medicare |
$489.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,135.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$873.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$838.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$925.91
|
| Rate for Payer: Cash Price |
$524.10
|
| Rate for Payer: Cigna Commercial |
$1,607.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$977.62
|
| Rate for Payer: Health EOS Commercial |
$1,554.83
|
| Rate for Payer: HFN Commercial |
$1,607.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,310.25
|
| Rate for Payer: Multiplan Commercial |
$1,397.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,048.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,607.24
|
| Rate for Payer: Quartz Beloit One Network |
$856.03
|
| Rate for Payer: Quartz Commercial |
$1,135.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,048.20
|
| Rate for Payer: The Alliance Commercial |
$6,988.00
|
| Rate for Payer: United Healthcare PPO |
$1,310.25
|
| Rate for Payer: WEA Trust Commercial |
$960.85
|
| Rate for Payer: WPS Commercial |
$1,294.00
|
|
|
IVUS Coronary/BPG +
|
Facility
|
OP
|
$3,636.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
3052471
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,018.08 |
| Max. Negotiated Rate |
$14,544.00 |
| Rate for Payer: Aetna Commercial |
$3,272.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,126.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,018.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,363.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,818.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,745.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,927.08
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: Cigna Commercial |
$3,345.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,034.71
|
| Rate for Payer: Health EOS Commercial |
$3,236.04
|
| Rate for Payer: HFN Commercial |
$3,345.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,727.00
|
| Rate for Payer: Multiplan Commercial |
$2,908.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,181.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,345.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,781.64
|
| Rate for Payer: Quartz Commercial |
$2,363.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,181.60
|
| Rate for Payer: The Alliance Commercial |
$14,544.00
|
| Rate for Payer: WEA Trust Commercial |
$1,999.80
|
| Rate for Payer: WPS Commercial |
$2,693.19
|
|
|
IVUS Coronary/BPG +
|
Facility
|
IP
|
$3,636.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
3052471
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,781.64 |
| Max. Negotiated Rate |
$3,345.12 |
| Rate for Payer: Aetna Commercial |
$3,272.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,126.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,927.08
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: Cigna Commercial |
$3,345.12
|
| Rate for Payer: Health EOS Commercial |
$3,236.04
|
| Rate for Payer: HFN Commercial |
$3,345.12
|
| Rate for Payer: Multiplan Commercial |
$2,908.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,181.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,345.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,781.64
|
| Rate for Payer: Quartz Commercial |
$2,181.60
|
| Rate for Payer: WEA Trust Commercial |
$1,999.80
|
| Rate for Payer: WPS Commercial |
$2,693.19
|
|
|
IVUS - Eagle Eye
|
Professional
|
Both
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,683.00 |
| Max. Negotiated Rate |
$3,633.75 |
| Rate for Payer: Aetna Commercial |
$3,633.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,289.50
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$3,633.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,912.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,295.00
|
| Rate for Payer: Health EOS Commercial |
$3,480.75
|
| Rate for Payer: HFN Commercial |
$3,633.75
|
| Rate for Payer: Multiplan Commercial |
$3,060.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,633.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.00
|
| Rate for Payer: Quartz Commercial |
$2,180.25
|
| Rate for Payer: The Alliance Commercial |
$1,912.50
|
| Rate for Payer: WEA Trust Commercial |
$2,103.75
|
| Rate for Payer: WPS Commercial |
$2,833.18
|
|
|
IVUS - Eagle Eye
|
Facility
|
OP
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,071.00 |
| Max. Negotiated Rate |
$15,300.00 |
| Rate for Payer: Aetna Commercial |
$3,442.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,289.50
|
| Rate for Payer: Aetna Managed Medicare |
$1,071.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,486.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,912.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,836.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,027.25
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$3,519.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,140.47
|
| Rate for Payer: Health EOS Commercial |
$3,404.25
|
| Rate for Payer: HFN Commercial |
$3,519.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,868.75
|
| Rate for Payer: Multiplan Commercial |
$3,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,295.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,519.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,874.25
|
| Rate for Payer: Quartz Commercial |
$2,486.25
|
| Rate for Payer: Quartz Medicare Advantage |
$2,295.00
|
| Rate for Payer: The Alliance Commercial |
$15,300.00
|
| Rate for Payer: WEA Trust Commercial |
$2,103.75
|
| Rate for Payer: WPS Commercial |
$2,833.18
|
|
|
IVUS - Eagle Eye
|
Facility
|
IP
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,874.25 |
| Max. Negotiated Rate |
$3,519.00 |
| Rate for Payer: Aetna Commercial |
$3,442.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,289.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,027.25
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$3,519.00
|
| Rate for Payer: Health EOS Commercial |
$3,404.25
|
| Rate for Payer: HFN Commercial |
$3,519.00
|
| Rate for Payer: Multiplan Commercial |
$3,060.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,295.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,519.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,874.25
|
| Rate for Payer: Quartz Commercial |
$2,295.00
|
| Rate for Payer: WEA Trust Commercial |
$2,103.75
|
| Rate for Payer: WPS Commercial |
$2,833.18
|
|
|
Ivus Non Coronary Vessel +
|
Facility
|
OP
|
$5,001.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
3052457
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,400.28 |
| Max. Negotiated Rate |
$20,004.00 |
| Rate for Payer: Aetna Commercial |
$4,500.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,300.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,400.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,250.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,500.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,400.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,650.53
|
| Rate for Payer: Cash Price |
$1,500.30
|
| Rate for Payer: Cash Price |
$1,500.30
|
| Rate for Payer: Cigna Commercial |
$4,600.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$4,450.89
|
| Rate for Payer: HFN Commercial |
$4,600.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,750.75
|
| Rate for Payer: Multiplan Commercial |
$4,000.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,000.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,600.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,450.49
|
| Rate for Payer: Quartz Commercial |
$3,250.65
|
| Rate for Payer: Quartz Medicare Advantage |
$3,000.60
|
| Rate for Payer: The Alliance Commercial |
$20,004.00
|
| Rate for Payer: WEA Trust Commercial |
$2,750.55
|
| Rate for Payer: WPS Commercial |
$3,704.24
|
|
|
Ivus Non Coronary Vessel +
|
Facility
|
IP
|
$5,001.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
3052457
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,450.49 |
| Max. Negotiated Rate |
$4,600.92 |
| Rate for Payer: Aetna Commercial |
$4,500.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,300.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,650.53
|
| Rate for Payer: Cash Price |
$1,500.30
|
| Rate for Payer: Cigna Commercial |
$4,600.92
|
| Rate for Payer: Health EOS Commercial |
$4,450.89
|
| Rate for Payer: HFN Commercial |
$4,600.92
|
| Rate for Payer: Multiplan Commercial |
$4,000.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,000.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,600.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,450.49
|
| Rate for Payer: Quartz Commercial |
$3,000.60
|
| Rate for Payer: WEA Trust Commercial |
$2,750.55
|
| Rate for Payer: WPS Commercial |
$3,704.24
|
|
|
Ivus Non Coronary Vessel Ea Add +
|
Facility
|
OP
|
$4,991.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
3052458
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,397.48 |
| Max. Negotiated Rate |
$19,964.00 |
| Rate for Payer: Aetna Commercial |
$4,491.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,292.26
|
| Rate for Payer: Aetna Managed Medicare |
$1,397.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,244.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,495.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,395.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,645.23
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cigna Commercial |
$4,591.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Health EOS Commercial |
$4,441.99
|
| Rate for Payer: HFN Commercial |
$4,591.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,743.25
|
| Rate for Payer: Multiplan Commercial |
$3,992.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,994.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,591.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,445.59
|
| Rate for Payer: Quartz Commercial |
$3,244.15
|
| Rate for Payer: Quartz Medicare Advantage |
$2,994.60
|
| Rate for Payer: The Alliance Commercial |
$19,964.00
|
| Rate for Payer: WEA Trust Commercial |
$2,745.05
|
| Rate for Payer: WPS Commercial |
$3,696.83
|
|
|
Ivus Non Coronary Vessel Ea Add +
|
Facility
|
IP
|
$4,991.00
|
|
|
Service Code
|
CPT 37253
|
| Hospital Charge Code |
3052458
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,445.59 |
| Max. Negotiated Rate |
$4,591.72 |
| Rate for Payer: Aetna Commercial |
$4,491.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,292.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,645.23
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cigna Commercial |
$4,591.72
|
| Rate for Payer: Health EOS Commercial |
$4,441.99
|
| Rate for Payer: HFN Commercial |
$4,591.72
|
| Rate for Payer: Multiplan Commercial |
$3,992.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,994.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,591.72
|
| Rate for Payer: Quartz Beloit One Network |
$2,445.59
|
| Rate for Payer: Quartz Commercial |
$2,994.60
|
| Rate for Payer: WEA Trust Commercial |
$2,745.05
|
| Rate for Payer: WPS Commercial |
$3,696.83
|
|
|
Jackson-Rees Circuit Dryden
|
Facility
|
OP
|
$145.00
|
|
| Hospital Charge Code |
3101733
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$40.60 |
| Max. Negotiated Rate |
$580.00 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.70
|
| Rate for Payer: Aetna Managed Medicare |
$40.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$72.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.85
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$133.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.14
|
| Rate for Payer: Health EOS Commercial |
$129.05
|
| Rate for Payer: HFN Commercial |
$133.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.75
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: NAPHCARE Commercial |
$87.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.40
|
| Rate for Payer: Quartz Beloit One Network |
$71.05
|
| Rate for Payer: Quartz Commercial |
$94.25
|
| Rate for Payer: Quartz Medicare Advantage |
$87.00
|
| Rate for Payer: The Alliance Commercial |
$580.00
|
| Rate for Payer: WEA Trust Commercial |
$79.75
|
| Rate for Payer: WPS Commercial |
$107.40
|
|
|
Jackson-Rees Circuit Dryden
|
Facility
|
IP
|
$145.00
|
|
| Hospital Charge Code |
3101733
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$71.05 |
| Max. Negotiated Rate |
$133.40 |
| Rate for Payer: Aetna Commercial |
$130.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$76.85
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$133.40
|
| Rate for Payer: Health EOS Commercial |
$129.05
|
| Rate for Payer: HFN Commercial |
$133.40
|
| Rate for Payer: Multiplan Commercial |
$116.00
|
| Rate for Payer: NAPHCARE Commercial |
$87.00
|
| Rate for Payer: Preferred Network Access Commercial |
$133.40
|
| Rate for Payer: Quartz Beloit One Network |
$71.05
|
| Rate for Payer: Quartz Commercial |
$87.00
|
| Rate for Payer: WEA Trust Commercial |
$79.75
|
| Rate for Payer: WPS Commercial |
$107.40
|
|
|
JAGWIRE 038
|
Facility
|
IP
|
$614.00
|
|
| Hospital Charge Code |
2973103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$300.86 |
| Max. Negotiated Rate |
$564.88 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$368.40
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
JAGWIRE 038
|
Facility
|
OP
|
$614.00
|
|
| Hospital Charge Code |
2973103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.92 |
| Max. Negotiated Rate |
$2,456.00 |
| Rate for Payer: Aetna Commercial |
$552.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$528.04
|
| Rate for Payer: Aetna Managed Medicare |
$171.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$399.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$307.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$294.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$325.42
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$564.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$343.59
|
| Rate for Payer: Health EOS Commercial |
$546.46
|
| Rate for Payer: HFN Commercial |
$564.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.50
|
| Rate for Payer: Multiplan Commercial |
$491.20
|
| Rate for Payer: NAPHCARE Commercial |
$368.40
|
| Rate for Payer: Preferred Network Access Commercial |
$564.88
|
| Rate for Payer: Quartz Beloit One Network |
$300.86
|
| Rate for Payer: Quartz Commercial |
$399.10
|
| Rate for Payer: Quartz Medicare Advantage |
$368.40
|
| Rate for Payer: The Alliance Commercial |
$2,456.00
|
| Rate for Payer: WEA Trust Commercial |
$337.70
|
| Rate for Payer: WPS Commercial |
$454.79
|
|
|
JAGWIRE GUIDEWIRE STR .025 260CM M00556461
|
Facility
|
IP
|
$1,712.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3211486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$838.88 |
| Max. Negotiated Rate |
$1,575.04 |
| Rate for Payer: Aetna Commercial |
$1,540.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,472.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.36
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,575.04
|
| Rate for Payer: Health EOS Commercial |
$1,523.68
|
| Rate for Payer: HFN Commercial |
$1,575.04
|
| Rate for Payer: Multiplan Commercial |
$1,369.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.04
|
| Rate for Payer: Quartz Beloit One Network |
$838.88
|
| Rate for Payer: Quartz Commercial |
$1,027.20
|
| Rate for Payer: WEA Trust Commercial |
$941.60
|
| Rate for Payer: WPS Commercial |
$1,268.08
|
|
|
JAGWIRE GUIDEWIRE STR .025 260CM M00556461
|
Facility
|
OP
|
$1,712.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
3211486
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$479.36 |
| Max. Negotiated Rate |
$6,848.00 |
| Rate for Payer: Aetna Commercial |
$1,540.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,472.32
|
| Rate for Payer: Aetna Managed Medicare |
$479.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,112.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$856.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$821.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.36
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,575.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$958.04
|
| Rate for Payer: Health EOS Commercial |
$1,523.68
|
| Rate for Payer: HFN Commercial |
$1,575.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,284.00
|
| Rate for Payer: Multiplan Commercial |
$1,369.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,575.04
|
| Rate for Payer: Quartz Beloit One Network |
$838.88
|
| Rate for Payer: Quartz Commercial |
$1,112.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.20
|
| Rate for Payer: The Alliance Commercial |
$6,848.00
|
| Rate for Payer: WEA Trust Commercial |
$941.60
|
| Rate for Payer: WPS Commercial |
$1,268.08
|
|
