|
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 |
$890.27 |
| Max. Negotiated Rate |
$1,671.53 |
| Rate for Payer: Aetna Commercial |
$1,635.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,562.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$962.95
|
| Rate for Payer: Cash Price |
$524.10
|
| Rate for Payer: Cigna Commercial |
$1,671.53
|
| Rate for Payer: Health EOS Commercial |
$1,617.02
|
| Rate for Payer: HFN Commercial |
$1,671.53
|
| Rate for Payer: Multiplan Commercial |
$1,453.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,671.53
|
| Rate for Payer: Quartz Beloit One Network |
$890.27
|
| Rate for Payer: Quartz Commercial |
$1,090.13
|
| Rate for Payer: WEA Trust Commercial |
$999.28
|
| Rate for Payer: WPS Commercial |
$1,345.71
|
|
|
IVUS Coronary/BPG +
|
Facility
|
OP
|
$3,636.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
3052471
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,058.80 |
| Max. Negotiated Rate |
$3,478.92 |
| Rate for Payer: Aetna Commercial |
$3,403.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,252.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,058.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,457.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,890.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,815.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,004.16
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: Cigna Commercial |
$3,478.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,116.15
|
| Rate for Payer: Health EOS Commercial |
$3,365.48
|
| Rate for Payer: HFN Commercial |
$3,478.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,836.08
|
| Rate for Payer: Multiplan Commercial |
$3,025.15
|
| Rate for Payer: NAPHCARE Commercial |
$2,268.86
|
| Rate for Payer: Preferred Network Access Commercial |
$3,478.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,852.91
|
| Rate for Payer: Quartz Commercial |
$2,457.94
|
| Rate for Payer: Quartz Medicare Advantage |
$2,268.86
|
| Rate for Payer: The Alliance Commercial |
$1,890.72
|
| Rate for Payer: WEA Trust Commercial |
$2,079.79
|
| Rate for Payer: WPS Commercial |
$2,800.81
|
|
|
IVUS Coronary/BPG +
|
Facility
|
IP
|
$3,636.00
|
|
|
Service Code
|
CPT 92978
|
| Hospital Charge Code |
3052471
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,852.91 |
| Max. Negotiated Rate |
$3,478.92 |
| Rate for Payer: Aetna Commercial |
$3,403.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,252.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,004.16
|
| Rate for Payer: Cash Price |
$1,090.80
|
| Rate for Payer: Cigna Commercial |
$3,478.92
|
| Rate for Payer: Health EOS Commercial |
$3,365.48
|
| Rate for Payer: HFN Commercial |
$3,478.92
|
| Rate for Payer: Multiplan Commercial |
$3,025.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,478.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,852.91
|
| Rate for Payer: Quartz Commercial |
$2,268.86
|
| Rate for Payer: WEA Trust Commercial |
$2,079.79
|
| Rate for Payer: WPS Commercial |
$2,800.81
|
|
|
IVUS - Eagle Eye
|
Facility
|
OP
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,113.84 |
| Max. Negotiated Rate |
$3,659.76 |
| Rate for Payer: Aetna Commercial |
$3,580.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,421.08
|
| Rate for Payer: Aetna Managed Medicare |
$1,113.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,585.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,989.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,909.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,108.34
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$3,659.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,226.15
|
| Rate for Payer: Health EOS Commercial |
$3,540.42
|
| Rate for Payer: HFN Commercial |
$3,659.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,983.50
|
| Rate for Payer: Multiplan Commercial |
$3,182.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,386.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,659.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,949.22
|
| Rate for Payer: Quartz Commercial |
$2,585.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,386.80
|
| Rate for Payer: The Alliance Commercial |
$1,989.00
|
| Rate for Payer: WEA Trust Commercial |
$2,187.90
|
| Rate for Payer: WPS Commercial |
$2,946.40
|
|
|
IVUS - Eagle Eye
|
Professional
|
Both
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,750.32 |
| Max. Negotiated Rate |
$3,779.10 |
| Rate for Payer: Aetna Commercial |
$3,779.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,421.08
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$3,779.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,989.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,386.80
|
| Rate for Payer: Health EOS Commercial |
$3,619.98
|
| Rate for Payer: HFN Commercial |
$3,779.10
|
| Rate for Payer: Multiplan Commercial |
$3,182.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,779.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,750.32
|
| Rate for Payer: Quartz Commercial |
$2,267.46
|
| Rate for Payer: The Alliance Commercial |
$1,989.00
|
| Rate for Payer: WEA Trust Commercial |
$2,187.90
|
| Rate for Payer: WPS Commercial |
$2,946.40
|
|
|
IVUS - Eagle Eye
|
Facility
|
IP
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550988
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,949.22 |
| Max. Negotiated Rate |
$3,659.76 |
| Rate for Payer: Aetna Commercial |
$3,580.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,421.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,108.34
|
| Rate for Payer: Cash Price |
$1,147.50
|
| Rate for Payer: Cigna Commercial |
$3,659.76
|
| Rate for Payer: Health EOS Commercial |
$3,540.42
|
| Rate for Payer: HFN Commercial |
$3,659.76
|
| Rate for Payer: Multiplan Commercial |
$3,182.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,659.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,949.22
|
| Rate for Payer: Quartz Commercial |
$2,386.80
|
| Rate for Payer: WEA Trust Commercial |
$2,187.90
|
| Rate for Payer: WPS Commercial |
$2,946.40
|
|
|
Ivus Non Coronary Vessel +
|
Facility
|
OP
|
$5,001.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
3052457
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$292.32 |
| Max. Negotiated Rate |
$4,784.96 |
| Rate for Payer: Aetna Commercial |
$4,680.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,472.89
|
| Rate for Payer: Aetna Managed Medicare |
$1,456.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,380.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,600.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,496.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,756.55
|
| Rate for Payer: Cash Price |
$1,500.30
|
| Rate for Payer: Cash Price |
$1,500.30
|
| Rate for Payer: Cigna Commercial |
$4,784.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$4,628.93
|
| Rate for Payer: HFN Commercial |
$4,784.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,900.78
|
| Rate for Payer: Multiplan Commercial |
$4,160.83
|
| Rate for Payer: NAPHCARE Commercial |
$3,120.62
|
| Rate for Payer: Preferred Network Access Commercial |
$4,784.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.51
|
| Rate for Payer: Quartz Commercial |
$3,380.68
|
| Rate for Payer: Quartz Medicare Advantage |
$3,120.62
|
| Rate for Payer: The Alliance Commercial |
$292.32
|
| Rate for Payer: WEA Trust Commercial |
$2,860.57
|
| Rate for Payer: WPS Commercial |
$3,852.27
|
|
|
Ivus Non Coronary Vessel +
|
Facility
|
IP
|
$5,001.00
|
|
|
Service Code
|
CPT 37252
|
| Hospital Charge Code |
3052457
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,548.51 |
| Max. Negotiated Rate |
$4,784.96 |
| Rate for Payer: Aetna Commercial |
$4,680.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,472.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,756.55
|
| Rate for Payer: Cash Price |
$1,500.30
|
| Rate for Payer: Cigna Commercial |
$4,784.96
|
| Rate for Payer: Health EOS Commercial |
$4,628.93
|
| Rate for Payer: HFN Commercial |
$4,784.96
|
| Rate for Payer: Multiplan Commercial |
$4,160.83
|
| Rate for Payer: Preferred Network Access Commercial |
$4,784.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,548.51
|
| Rate for Payer: Quartz Commercial |
$3,120.62
|
| Rate for Payer: WEA Trust Commercial |
$2,860.57
|
| Rate for Payer: WPS Commercial |
$3,852.27
|
|
|
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 |
$2,543.41 |
| Max. Negotiated Rate |
$4,775.39 |
| Rate for Payer: Aetna Commercial |
$4,671.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,463.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.04
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cigna Commercial |
$4,775.39
|
| Rate for Payer: Health EOS Commercial |
$4,619.67
|
| Rate for Payer: HFN Commercial |
$4,775.39
|
| Rate for Payer: Multiplan Commercial |
$4,152.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,775.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.41
|
| Rate for Payer: Quartz Commercial |
$3,114.38
|
| Rate for Payer: WEA Trust Commercial |
$2,854.85
|
| Rate for Payer: WPS Commercial |
$3,844.57
|
|
|
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 |
$231.80 |
| Max. Negotiated Rate |
$4,775.39 |
| Rate for Payer: Aetna Commercial |
$4,671.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,463.95
|
| Rate for Payer: Aetna Managed Medicare |
$1,453.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,373.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,595.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,491.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,751.04
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cash Price |
$1,497.30
|
| Rate for Payer: Cigna Commercial |
$4,775.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Health EOS Commercial |
$4,619.67
|
| Rate for Payer: HFN Commercial |
$4,775.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,892.98
|
| Rate for Payer: Multiplan Commercial |
$4,152.51
|
| Rate for Payer: NAPHCARE Commercial |
$3,114.38
|
| Rate for Payer: Preferred Network Access Commercial |
$4,775.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,543.41
|
| Rate for Payer: Quartz Commercial |
$3,373.92
|
| Rate for Payer: Quartz Medicare Advantage |
$3,114.38
|
| Rate for Payer: The Alliance Commercial |
$231.80
|
| Rate for Payer: WEA Trust Commercial |
$2,854.85
|
| Rate for Payer: WPS Commercial |
$3,844.57
|
|
|
Jackson-Rees Circuit Dryden
|
Facility
|
OP
|
$145.00
|
|
| Hospital Charge Code |
3101733
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$42.22 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Aetna Managed Medicare |
$42.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$98.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.39
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.10
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: NAPHCARE Commercial |
$90.48
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$98.02
|
| Rate for Payer: Quartz Medicare Advantage |
$90.48
|
| Rate for Payer: The Alliance Commercial |
$75.40
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Jackson-Rees Circuit Dryden
|
Facility
|
IP
|
$145.00
|
|
| Hospital Charge Code |
3101733
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.89 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
JAGWIRE 038
|
Facility
|
OP
|
$614.00
|
|
| Hospital Charge Code |
2973103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$178.80 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Aetna Managed Medicare |
$178.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$415.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$319.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$306.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$357.35
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$478.92
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: NAPHCARE Commercial |
$383.14
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$415.06
|
| Rate for Payer: Quartz Medicare Advantage |
$383.14
|
| Rate for Payer: The Alliance Commercial |
$319.28
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
JAGWIRE 038
|
Facility
|
IP
|
$614.00
|
|
| Hospital Charge Code |
2973103
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$312.89 |
| Max. Negotiated Rate |
$587.48 |
| Rate for Payer: Aetna Commercial |
$574.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$549.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$338.44
|
| Rate for Payer: Cash Price |
$184.20
|
| Rate for Payer: Cigna Commercial |
$587.48
|
| Rate for Payer: Health EOS Commercial |
$568.32
|
| Rate for Payer: HFN Commercial |
$587.48
|
| Rate for Payer: Multiplan Commercial |
$510.85
|
| Rate for Payer: Preferred Network Access Commercial |
$587.48
|
| Rate for Payer: Quartz Beloit One Network |
$312.89
|
| Rate for Payer: Quartz Commercial |
$383.14
|
| Rate for Payer: WEA Trust Commercial |
$351.21
|
| Rate for Payer: WPS Commercial |
$472.96
|
|
|
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 |
$498.53 |
| Max. Negotiated Rate |
$1,638.04 |
| Rate for Payer: Aetna Commercial |
$1,602.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,531.21
|
| Rate for Payer: Aetna Managed Medicare |
$498.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,157.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$890.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$854.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.65
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,638.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$996.38
|
| Rate for Payer: Health EOS Commercial |
$1,584.63
|
| Rate for Payer: HFN Commercial |
$1,638.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,335.36
|
| Rate for Payer: Multiplan Commercial |
$1,424.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,068.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.04
|
| Rate for Payer: Quartz Beloit One Network |
$872.44
|
| Rate for Payer: Quartz Commercial |
$1,157.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,068.29
|
| Rate for Payer: The Alliance Commercial |
$890.24
|
| Rate for Payer: WEA Trust Commercial |
$979.26
|
| Rate for Payer: WPS Commercial |
$1,318.75
|
|
|
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 |
$872.44 |
| Max. Negotiated Rate |
$1,638.04 |
| Rate for Payer: Aetna Commercial |
$1,602.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,531.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.65
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,638.04
|
| Rate for Payer: Health EOS Commercial |
$1,584.63
|
| Rate for Payer: HFN Commercial |
$1,638.04
|
| Rate for Payer: Multiplan Commercial |
$1,424.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.04
|
| Rate for Payer: Quartz Beloit One Network |
$872.44
|
| Rate for Payer: Quartz Commercial |
$1,068.29
|
| Rate for Payer: WEA Trust Commercial |
$979.26
|
| Rate for Payer: WPS Commercial |
$1,318.75
|
|
|
JAGWIRE GUIDEWIRE STR .025 450CM M00556561
|
Facility
|
OP
|
$1,712.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$498.53 |
| Max. Negotiated Rate |
$1,638.04 |
| Rate for Payer: Aetna Commercial |
$1,602.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,531.21
|
| Rate for Payer: Aetna Managed Medicare |
$498.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,157.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$890.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$854.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.65
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,638.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$996.38
|
| Rate for Payer: Health EOS Commercial |
$1,584.63
|
| Rate for Payer: HFN Commercial |
$1,638.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,335.36
|
| Rate for Payer: Multiplan Commercial |
$1,424.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,068.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.04
|
| Rate for Payer: Quartz Beloit One Network |
$872.44
|
| Rate for Payer: Quartz Commercial |
$1,157.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,068.29
|
| Rate for Payer: The Alliance Commercial |
$890.24
|
| Rate for Payer: WEA Trust Commercial |
$979.26
|
| Rate for Payer: WPS Commercial |
$1,318.75
|
|
|
JAGWIRE GUIDEWIRE STR .025 450CM M00556561
|
Facility
|
IP
|
$1,712.00
|
|
|
Service Code
|
HCPCS C1769
|
| Hospital Charge Code |
2973105
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$872.44 |
| Max. Negotiated Rate |
$1,638.04 |
| Rate for Payer: Aetna Commercial |
$1,602.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,531.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$943.65
|
| Rate for Payer: Cash Price |
$513.60
|
| Rate for Payer: Cigna Commercial |
$1,638.04
|
| Rate for Payer: Health EOS Commercial |
$1,584.63
|
| Rate for Payer: HFN Commercial |
$1,638.04
|
| Rate for Payer: Multiplan Commercial |
$1,424.38
|
| Rate for Payer: Preferred Network Access Commercial |
$1,638.04
|
| Rate for Payer: Quartz Beloit One Network |
$872.44
|
| Rate for Payer: Quartz Commercial |
$1,068.29
|
| Rate for Payer: WEA Trust Commercial |
$979.26
|
| Rate for Payer: WPS Commercial |
$1,318.75
|
|
|
JAK2 Exon 12 Mutations
|
Professional
|
Both
|
$285.00
|
|
| Hospital Charge Code |
2942930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$130.42 |
| Max. Negotiated Rate |
$281.58 |
| Rate for Payer: Aetna Commercial |
$281.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$281.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$148.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.84
|
| Rate for Payer: Health EOS Commercial |
$269.72
|
| Rate for Payer: HFN Commercial |
$281.58
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$281.58
|
| Rate for Payer: Quartz Beloit One Network |
$130.42
|
| Rate for Payer: Quartz Commercial |
$168.95
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
JAK2 Exon 12 Mutations
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2942930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
JAK2 Exon 12 Mutations
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2942930
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: United Healthcare PPO |
$222.30
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
Jak2 Interp & Report
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
2776830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.47 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Aetna Managed Medicare |
$17.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.92
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.80
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: NAPHCARE Commercial |
$37.44
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$40.56
|
| Rate for Payer: Quartz Medicare Advantage |
$37.44
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: United Healthcare PPO |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Jak2 Interp & Report
|
Professional
|
Both
|
$60.00
|
|
| Hospital Charge Code |
2776830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.46 |
| Max. Negotiated Rate |
$59.28 |
| Rate for Payer: Aetna Commercial |
$59.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$59.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.44
|
| Rate for Payer: Health EOS Commercial |
$56.78
|
| Rate for Payer: HFN Commercial |
$59.28
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$59.28
|
| Rate for Payer: Quartz Beloit One Network |
$27.46
|
| Rate for Payer: Quartz Commercial |
$35.57
|
| Rate for Payer: The Alliance Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Jak2 Interp & Report
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
2776830
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$30.58 |
| Max. Negotiated Rate |
$57.41 |
| Rate for Payer: Aetna Commercial |
$56.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$53.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.07
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$57.41
|
| Rate for Payer: Health EOS Commercial |
$55.54
|
| Rate for Payer: HFN Commercial |
$57.41
|
| Rate for Payer: Multiplan Commercial |
$49.92
|
| Rate for Payer: Preferred Network Access Commercial |
$57.41
|
| Rate for Payer: Quartz Beloit One Network |
$30.58
|
| Rate for Payer: Quartz Commercial |
$37.44
|
| Rate for Payer: WEA Trust Commercial |
$34.32
|
| Rate for Payer: WPS Commercial |
$46.22
|
|
|
Jak2 Separation
|
Facility
|
OP
|
$79.00
|
|
| Hospital Charge Code |
2776831
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.00 |
| Max. Negotiated Rate |
$75.59 |
| Rate for Payer: Aetna Commercial |
$73.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$70.66
|
| Rate for Payer: Aetna Managed Medicare |
$23.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.54
|
| Rate for Payer: Cash Price |
$23.70
|
| Rate for Payer: Cigna Commercial |
$75.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.98
|
| Rate for Payer: Health EOS Commercial |
$73.12
|
| Rate for Payer: HFN Commercial |
$75.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$61.62
|
| Rate for Payer: Multiplan Commercial |
$65.73
|
| Rate for Payer: NAPHCARE Commercial |
$49.30
|
| Rate for Payer: Preferred Network Access Commercial |
$75.59
|
| Rate for Payer: Quartz Beloit One Network |
$40.26
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: Quartz Medicare Advantage |
$49.30
|
| Rate for Payer: The Alliance Commercial |
$41.08
|
| Rate for Payer: United Healthcare PPO |
$61.62
|
| Rate for Payer: WEA Trust Commercial |
$45.19
|
| Rate for Payer: WPS Commercial |
$60.85
|
|
