|
I.V. Start Kit
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
3040292
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.59 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.96
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.61
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$5.62
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
IV START KIT DYNDV1539B
|
Facility
|
OP
|
$81.00
|
|
| Hospital Charge Code |
2962923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$23.59 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$23.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$54.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$63.18
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$50.54
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$50.54
|
| Rate for Payer: The Alliance Commercial |
$42.12
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
IV START KIT DYNDV1539B
|
Facility
|
IP
|
$81.00
|
|
| Hospital Charge Code |
2962923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
IVUS - AAA
|
Facility
|
OP
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550986
|
|
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 - AAA
|
Professional
|
Both
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550986
|
|
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 - AAA
|
Facility
|
IP
|
$3,825.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
2550986
|
|
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
|
|
|
IV US Catheter AAA
|
Facility
|
OP
|
$8,232.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139308
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,397.16 |
| Max. Negotiated Rate |
$7,876.38 |
| Rate for Payer: Aetna Commercial |
$7,705.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,362.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,397.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,564.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,280.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,109.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,537.48
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cigna Commercial |
$7,876.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,791.02
|
| Rate for Payer: Health EOS Commercial |
$7,619.54
|
| Rate for Payer: HFN Commercial |
$7,876.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,420.96
|
| Rate for Payer: Multiplan Commercial |
$6,849.02
|
| Rate for Payer: NAPHCARE Commercial |
$5,136.77
|
| Rate for Payer: Preferred Network Access Commercial |
$7,876.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,195.03
|
| Rate for Payer: Quartz Commercial |
$5,564.83
|
| Rate for Payer: Quartz Medicare Advantage |
$5,136.77
|
| Rate for Payer: The Alliance Commercial |
$4,280.64
|
| Rate for Payer: WEA Trust Commercial |
$4,708.70
|
| Rate for Payer: WPS Commercial |
$6,341.11
|
|
|
IV US Catheter AAA
|
Facility
|
IP
|
$8,232.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139308
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,195.03 |
| Max. Negotiated Rate |
$7,876.38 |
| Rate for Payer: Aetna Commercial |
$7,705.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,362.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,537.48
|
| Rate for Payer: Cash Price |
$2,469.60
|
| Rate for Payer: Cigna Commercial |
$7,876.38
|
| Rate for Payer: Health EOS Commercial |
$7,619.54
|
| Rate for Payer: HFN Commercial |
$7,876.38
|
| Rate for Payer: Multiplan Commercial |
$6,849.02
|
| Rate for Payer: Preferred Network Access Commercial |
$7,876.38
|
| Rate for Payer: Quartz Beloit One Network |
$4,195.03
|
| Rate for Payer: Quartz Commercial |
$5,136.77
|
| Rate for Payer: WEA Trust Commercial |
$4,708.70
|
| Rate for Payer: WPS Commercial |
$6,341.11
|
|
|
IV US Catheter Coronary
|
Facility
|
IP
|
$6,861.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139309
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,496.37 |
| Max. Negotiated Rate |
$6,564.60 |
| Rate for Payer: Aetna Commercial |
$6,421.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,136.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,781.78
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cigna Commercial |
$6,564.60
|
| Rate for Payer: Health EOS Commercial |
$6,350.54
|
| Rate for Payer: HFN Commercial |
$6,564.60
|
| Rate for Payer: Multiplan Commercial |
$5,708.35
|
| Rate for Payer: Preferred Network Access Commercial |
$6,564.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,496.37
|
| Rate for Payer: Quartz Commercial |
$4,281.26
|
| Rate for Payer: WEA Trust Commercial |
$3,924.49
|
| Rate for Payer: WPS Commercial |
$5,285.03
|
|
|
IV US Catheter Coronary
|
Facility
|
OP
|
$6,861.00
|
|
|
Service Code
|
HCPCS C1753
|
| Hospital Charge Code |
4139309
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,997.92 |
| Max. Negotiated Rate |
$6,564.60 |
| Rate for Payer: Aetna Commercial |
$6,421.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,136.48
|
| Rate for Payer: Aetna Managed Medicare |
$1,997.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,638.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,567.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,425.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,781.78
|
| Rate for Payer: Cash Price |
$2,058.30
|
| Rate for Payer: Cigna Commercial |
$6,564.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,993.10
|
| Rate for Payer: Health EOS Commercial |
$6,350.54
|
| Rate for Payer: HFN Commercial |
$6,564.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,351.58
|
| Rate for Payer: Multiplan Commercial |
$5,708.35
|
| Rate for Payer: NAPHCARE Commercial |
$4,281.26
|
| Rate for Payer: Preferred Network Access Commercial |
$6,564.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,496.37
|
| Rate for Payer: Quartz Commercial |
$4,638.04
|
| Rate for Payer: Quartz Medicare Advantage |
$4,281.26
|
| Rate for Payer: The Alliance Commercial |
$3,567.72
|
| Rate for Payer: WEA Trust Commercial |
$3,924.49
|
| Rate for Payer: WPS Commercial |
$5,285.03
|
|
|
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 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 |
$508.73 |
| 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: Aetna Managed Medicare |
$508.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,180.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$908.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$872.10
|
| 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: Dean Health DHI/DHP/ASO |
$1,016.75
|
| Rate for Payer: Health EOS Commercial |
$1,617.02
|
| Rate for Payer: HFN Commercial |
$1,671.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,362.66
|
| Rate for Payer: Multiplan Commercial |
$1,453.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,090.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,671.53
|
| Rate for Payer: Quartz Beloit One Network |
$890.27
|
| Rate for Payer: Quartz Commercial |
$1,180.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,090.13
|
| Rate for Payer: The Alliance Commercial |
$908.44
|
| Rate for Payer: United Healthcare PPO |
$1,362.66
|
| Rate for Payer: WEA Trust Commercial |
$999.28
|
| Rate for Payer: WPS Commercial |
$1,345.71
|
|
|
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 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 - 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 - 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
|
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 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 +
|
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 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
|
|
|
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
|
|
|
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
|
|
