|
Pacemaker Explant Leadless-Ventricular
|
Facility
|
OP
|
$6,415.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
5464769
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,143.35 |
| Max. Negotiated Rate |
$12,602.12 |
| Rate for Payer: Aetna Commercial |
$5,773.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,516.90
|
| Rate for Payer: Aetna Managed Medicare |
$3,150.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,399.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,150.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,150.53
|
| Rate for Payer: Cash Price |
$1,924.50
|
| Rate for Payer: Cash Price |
$1,924.50
|
| Rate for Payer: Cash Price |
$1,924.50
|
| Rate for Payer: Cigna Commercial |
$5,901.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,150.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,150.53
|
| Rate for Payer: Health EOS Commercial |
$5,709.35
|
| Rate for Payer: HFN Commercial |
$5,901.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,719.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,150.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,150.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,150.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,150.53
|
| Rate for Payer: Multiplan Commercial |
$5,132.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,725.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,901.80
|
| Rate for Payer: Quartz Beloit One Network |
$3,143.35
|
| Rate for Payer: Quartz Commercial |
$4,169.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,150.53
|
| Rate for Payer: The Alliance Commercial |
$12,602.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,150.53
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: WEA Trust Commercial |
$3,528.25
|
| Rate for Payer: Wellcare Medicare |
$3,150.53
|
| Rate for Payer: WPS Commercial |
$4,751.59
|
|
|
Pacemaker Insertion-Rep Leadless-Ventricular
|
Facility
|
OP
|
$6,050.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
5464768
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,964.50 |
| Max. Negotiated Rate |
$77,037.28 |
| Rate for Payer: Aetna Commercial |
$5,445.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,203.00
|
| Rate for Payer: Aetna Managed Medicare |
$19,259.32
|
| 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 |
$19,259.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,206.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19,259.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19,259.32
|
| Rate for Payer: Cash Price |
$1,815.00
|
| Rate for Payer: Cash Price |
$1,815.00
|
| Rate for Payer: Cash Price |
$1,815.00
|
| Rate for Payer: Cigna Commercial |
$5,566.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19,259.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19,259.32
|
| Rate for Payer: Health EOS Commercial |
$5,384.50
|
| Rate for Payer: HFN Commercial |
$5,566.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71,644.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19,259.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19,259.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19,259.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19,259.32
|
| Rate for Payer: Multiplan Commercial |
$4,840.00
|
| Rate for Payer: NAPHCARE Commercial |
$28,888.98
|
| Rate for Payer: Preferred Network Access Commercial |
$5,566.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,964.50
|
| Rate for Payer: Quartz Commercial |
$3,932.50
|
| Rate for Payer: Quartz Medicare Advantage |
$19,259.32
|
| Rate for Payer: The Alliance Commercial |
$77,037.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19,259.32
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$3,327.50
|
| Rate for Payer: Wellcare Medicare |
$19,259.32
|
| Rate for Payer: WPS Commercial |
$4,481.24
|
|
|
Pacemaker Insertion-Rep Leadless-Ventricular
|
Facility
|
IP
|
$6,050.00
|
|
|
Service Code
|
CPT 33274
|
| Hospital Charge Code |
5464768
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,964.50 |
| Max. Negotiated Rate |
$5,566.00 |
| Rate for Payer: Aetna Commercial |
$5,445.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,203.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,206.50
|
| Rate for Payer: Cash Price |
$1,815.00
|
| Rate for Payer: Cigna Commercial |
$5,566.00
|
| Rate for Payer: Health EOS Commercial |
$5,384.50
|
| Rate for Payer: HFN Commercial |
$5,566.00
|
| Rate for Payer: Multiplan Commercial |
$4,840.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,630.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,566.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,964.50
|
| Rate for Payer: Quartz Commercial |
$3,630.00
|
| Rate for Payer: WEA Trust Commercial |
$3,327.50
|
| Rate for Payer: WPS Commercial |
$4,481.24
|
|
|
Pacemaker Pre/Post OP Adjust
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 93286
|
| Hospital Charge Code |
3052479
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$97.72 |
| Max. Negotiated Rate |
$1,396.00 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Aetna Managed Medicare |
$97.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.30
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.75
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$209.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$226.85
|
| Rate for Payer: Quartz Medicare Advantage |
$209.40
|
| Rate for Payer: The Alliance Commercial |
$1,396.00
|
| Rate for Payer: United Healthcare PPO |
$261.75
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
Pacemaker Pre/Post OP Adjust
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 93286
|
| Hospital Charge Code |
3052479
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$171.01 |
| Max. Negotiated Rate |
$321.08 |
| Rate for Payer: Aetna Commercial |
$314.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$300.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.97
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$321.08
|
| Rate for Payer: Health EOS Commercial |
$310.61
|
| Rate for Payer: HFN Commercial |
$321.08
|
| Rate for Payer: Multiplan Commercial |
$279.20
|
| Rate for Payer: NAPHCARE Commercial |
$209.40
|
| Rate for Payer: Preferred Network Access Commercial |
$321.08
|
| Rate for Payer: Quartz Beloit One Network |
$171.01
|
| Rate for Payer: Quartz Commercial |
$209.40
|
| Rate for Payer: WEA Trust Commercial |
$191.95
|
| Rate for Payer: WPS Commercial |
$258.50
|
|
|
Pacemaker Temporary
|
Facility
|
IP
|
$6,382.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
3052375
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,127.18 |
| Max. Negotiated Rate |
$5,871.44 |
| Rate for Payer: Aetna Commercial |
$5,743.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,488.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,382.46
|
| Rate for Payer: Cash Price |
$1,914.60
|
| Rate for Payer: Cigna Commercial |
$5,871.44
|
| Rate for Payer: Health EOS Commercial |
$5,679.98
|
| Rate for Payer: HFN Commercial |
$5,871.44
|
| Rate for Payer: Multiplan Commercial |
$5,105.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,829.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,871.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,127.18
|
| Rate for Payer: Quartz Commercial |
$3,829.20
|
| Rate for Payer: WEA Trust Commercial |
$3,510.10
|
| Rate for Payer: WPS Commercial |
$4,727.15
|
|
|
Pacemaker Temporary
|
Facility
|
OP
|
$6,382.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
3052375
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,127.18 |
| Max. Negotiated Rate |
$33,588.76 |
| Rate for Payer: Aetna Commercial |
$5,743.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,488.52
|
| Rate for Payer: Aetna Managed Medicare |
$8,397.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,382.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,397.19
|
| Rate for Payer: Cash Price |
$1,914.60
|
| Rate for Payer: Cash Price |
$1,914.60
|
| Rate for Payer: Cash Price |
$1,914.60
|
| Rate for Payer: Cigna Commercial |
$5,871.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,397.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,397.19
|
| Rate for Payer: Health EOS Commercial |
$5,679.98
|
| Rate for Payer: HFN Commercial |
$5,871.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,237.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,397.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,397.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,397.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,397.19
|
| Rate for Payer: Multiplan Commercial |
$5,105.60
|
| Rate for Payer: NAPHCARE Commercial |
$12,595.78
|
| Rate for Payer: Preferred Network Access Commercial |
$5,871.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,127.18
|
| Rate for Payer: Quartz Commercial |
$4,148.30
|
| Rate for Payer: Quartz Medicare Advantage |
$8,397.19
|
| Rate for Payer: The Alliance Commercial |
$33,588.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,397.19
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$3,510.10
|
| Rate for Payer: Wellcare Medicare |
$8,397.19
|
| Rate for Payer: WPS Commercial |
$4,727.15
|
|
|
PACEMAKER (TEMPORARY & PERMANENT)
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
PACEMAKER (TEMPORARY & PERMANENT)
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Pace Pocket Rev/Relocation
|
Facility
|
OP
|
$2,712.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
3052384
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,328.88 |
| Max. Negotiated Rate |
$7,209.92 |
| Rate for Payer: Aetna Commercial |
$2,440.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,332.32
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,437.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,802.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,802.48
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna Commercial |
$2,495.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,802.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,802.48
|
| Rate for Payer: Health EOS Commercial |
$2,413.68
|
| Rate for Payer: HFN Commercial |
$2,495.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,705.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,802.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,802.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,802.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,802.48
|
| Rate for Payer: Multiplan Commercial |
$2,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,703.72
|
| Rate for Payer: Preferred Network Access Commercial |
$2,495.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,328.88
|
| Rate for Payer: Quartz Commercial |
$1,762.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,802.48
|
| Rate for Payer: The Alliance Commercial |
$7,209.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,802.48
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$1,491.60
|
| Rate for Payer: Wellcare Medicare |
$1,802.48
|
| Rate for Payer: WPS Commercial |
$2,008.78
|
|
|
Pace Pocket Rev/Relocation
|
Facility
|
IP
|
$2,712.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
3052384
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,328.88 |
| Max. Negotiated Rate |
$2,495.04 |
| Rate for Payer: Aetna Commercial |
$2,440.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,332.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,437.36
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna Commercial |
$2,495.04
|
| Rate for Payer: Health EOS Commercial |
$2,413.68
|
| Rate for Payer: HFN Commercial |
$2,495.04
|
| Rate for Payer: Multiplan Commercial |
$2,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,627.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,495.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,328.88
|
| Rate for Payer: Quartz Commercial |
$1,627.20
|
| Rate for Payer: WEA Trust Commercial |
$1,491.60
|
| Rate for Payer: WPS Commercial |
$2,008.78
|
|
|
Pace Remote Eval w/o Program 90 day
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 93294
|
| Hospital Charge Code |
3052486
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: United Healthcare PPO |
$117.75
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Pace Remote Eval w/o Program 90 day
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 93294
|
| Hospital Charge Code |
3052486
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Pace Rem&Rep Gen + AV + CS Leads
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
4308848
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$587.51 |
| Max. Negotiated Rate |
$1,103.08 |
| Rate for Payer: Aetna Commercial |
$1,079.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.47
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,103.08
|
| Rate for Payer: Health EOS Commercial |
$1,067.11
|
| Rate for Payer: HFN Commercial |
$1,103.08
|
| Rate for Payer: Multiplan Commercial |
$959.20
|
| Rate for Payer: NAPHCARE Commercial |
$719.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.08
|
| Rate for Payer: Quartz Beloit One Network |
$587.51
|
| Rate for Payer: Quartz Commercial |
$719.40
|
| Rate for Payer: WEA Trust Commercial |
$659.45
|
| Rate for Payer: WPS Commercial |
$888.10
|
|
|
Pace Rem&Rep Gen + AV + CS Leads
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
4308848
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$587.51 |
| Max. Negotiated Rate |
$33,588.76 |
| Rate for Payer: Aetna Commercial |
$1,079.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.14
|
| Rate for Payer: Aetna Managed Medicare |
$8,397.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,397.19
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,103.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,397.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,397.19
|
| Rate for Payer: Health EOS Commercial |
$1,067.11
|
| Rate for Payer: HFN Commercial |
$1,103.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,237.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,397.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,397.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,397.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,397.19
|
| Rate for Payer: Multiplan Commercial |
$959.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,595.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.08
|
| Rate for Payer: Quartz Beloit One Network |
$587.51
|
| Rate for Payer: Quartz Commercial |
$779.35
|
| Rate for Payer: Quartz Medicare Advantage |
$8,397.19
|
| Rate for Payer: The Alliance Commercial |
$33,588.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,397.19
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$659.45
|
| Rate for Payer: Wellcare Medicare |
$8,397.19
|
| Rate for Payer: WPS Commercial |
$888.10
|
|
|
Pace Rem&Rep Gen + Single Lead
|
Facility
|
IP
|
$1,199.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
4308825
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$587.51 |
| Max. Negotiated Rate |
$1,103.08 |
| Rate for Payer: Aetna Commercial |
$1,079.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.47
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,103.08
|
| Rate for Payer: Health EOS Commercial |
$1,067.11
|
| Rate for Payer: HFN Commercial |
$1,103.08
|
| Rate for Payer: Multiplan Commercial |
$959.20
|
| Rate for Payer: NAPHCARE Commercial |
$719.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.08
|
| Rate for Payer: Quartz Beloit One Network |
$587.51
|
| Rate for Payer: Quartz Commercial |
$719.40
|
| Rate for Payer: WEA Trust Commercial |
$659.45
|
| Rate for Payer: WPS Commercial |
$888.10
|
|
|
Pace Rem&Rep Gen + Single Lead
|
Facility
|
OP
|
$1,199.00
|
|
|
Service Code
|
CPT 33233
|
| Hospital Charge Code |
4308825
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$587.51 |
| Max. Negotiated Rate |
$33,588.76 |
| Rate for Payer: Aetna Commercial |
$1,079.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.14
|
| Rate for Payer: Aetna Managed Medicare |
$8,397.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,397.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,397.19
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,103.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,397.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,397.19
|
| Rate for Payer: Health EOS Commercial |
$1,067.11
|
| Rate for Payer: HFN Commercial |
$1,103.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,237.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,397.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,397.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,397.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,397.19
|
| Rate for Payer: Multiplan Commercial |
$959.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,595.78
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.08
|
| Rate for Payer: Quartz Beloit One Network |
$587.51
|
| Rate for Payer: Quartz Commercial |
$779.35
|
| Rate for Payer: Quartz Medicare Advantage |
$8,397.19
|
| Rate for Payer: The Alliance Commercial |
$33,588.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,397.19
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$659.45
|
| Rate for Payer: Wellcare Medicare |
$8,397.19
|
| Rate for Payer: WPS Commercial |
$888.10
|
|
|
Pace Upgrade Single to Dual
|
Facility
|
IP
|
$3,030.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
3052378
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,484.70 |
| Max. Negotiated Rate |
$2,787.60 |
| Rate for Payer: Aetna Commercial |
$2,727.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,605.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,605.90
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$2,787.60
|
| Rate for Payer: Health EOS Commercial |
$2,696.70
|
| Rate for Payer: HFN Commercial |
$2,787.60
|
| Rate for Payer: Multiplan Commercial |
$2,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,818.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,787.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,484.70
|
| Rate for Payer: Quartz Commercial |
$1,818.00
|
| Rate for Payer: WEA Trust Commercial |
$1,666.50
|
| Rate for Payer: WPS Commercial |
$2,244.32
|
|
|
Pace Upgrade Single to Dual
|
Facility
|
OP
|
$3,030.00
|
|
|
Service Code
|
CPT 33214
|
| Hospital Charge Code |
3052378
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,484.70 |
| Max. Negotiated Rate |
$42,217.88 |
| Rate for Payer: Aetna Commercial |
$2,727.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,605.80
|
| Rate for Payer: Aetna Managed Medicare |
$10,554.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,605.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,554.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,554.47
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$2,787.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,554.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,554.47
|
| Rate for Payer: Health EOS Commercial |
$2,696.70
|
| Rate for Payer: HFN Commercial |
$2,787.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,262.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,554.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,554.47
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,554.47
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,554.47
|
| Rate for Payer: Multiplan Commercial |
$2,424.00
|
| Rate for Payer: NAPHCARE Commercial |
$15,831.70
|
| Rate for Payer: Preferred Network Access Commercial |
$2,787.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,484.70
|
| Rate for Payer: Quartz Commercial |
$1,969.50
|
| Rate for Payer: Quartz Medicare Advantage |
$10,554.47
|
| Rate for Payer: The Alliance Commercial |
$42,217.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,554.47
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$1,666.50
|
| Rate for Payer: Wellcare Medicare |
$10,554.47
|
| Rate for Payer: WPS Commercial |
$2,244.32
|
|
|
PACIFIER NEWBORN NATURAL SCNT
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
2963208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$33.00
|
| Rate for Payer: The Alliance Commercial |
$220.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
PACIFIER NEWBORN NATURAL SCNT
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
2963208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$26.95 |
| Max. Negotiated Rate |
$50.60 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$33.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
|
PACIFIER WEESOOTHIE PREMIE 96003-N
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
2963209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$41.40
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
PACIFIER WEESOOTHIE PREMIE 96003-N
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
2963209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.61
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$44.85
|
| Rate for Payer: Quartz Medicare Advantage |
$41.40
|
| Rate for Payer: The Alliance Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
PACK 0.9 45DEG KELMAN ULTRA 8065752087
|
Facility
|
OP
|
$3,564.00
|
|
| Hospital Charge Code |
2964177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$997.92 |
| Max. Negotiated Rate |
$14,256.00 |
| Rate for Payer: Aetna Commercial |
$3,207.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,065.04
|
| Rate for Payer: Aetna Managed Medicare |
$997.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,316.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,782.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,710.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.92
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,278.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,994.41
|
| Rate for Payer: Health EOS Commercial |
$3,171.96
|
| Rate for Payer: HFN Commercial |
$3,278.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,673.00
|
| Rate for Payer: Multiplan Commercial |
$2,851.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,138.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,278.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,746.36
|
| Rate for Payer: Quartz Commercial |
$2,316.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,138.40
|
| Rate for Payer: The Alliance Commercial |
$14,256.00
|
| Rate for Payer: WEA Trust Commercial |
$1,960.20
|
| Rate for Payer: WPS Commercial |
$2,639.85
|
|
|
PACK 0.9 45DEG KELMAN ULTRA 8065752087
|
Facility
|
IP
|
$3,564.00
|
|
| Hospital Charge Code |
2964177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,746.36 |
| Max. Negotiated Rate |
$3,278.88 |
| Rate for Payer: Aetna Commercial |
$3,207.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,065.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,888.92
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,278.88
|
| Rate for Payer: Health EOS Commercial |
$3,171.96
|
| Rate for Payer: HFN Commercial |
$3,278.88
|
| Rate for Payer: Multiplan Commercial |
$2,851.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,138.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,278.88
|
| Rate for Payer: Quartz Beloit One Network |
$1,746.36
|
| Rate for Payer: Quartz Commercial |
$2,138.40
|
| Rate for Payer: WEA Trust Commercial |
$1,960.20
|
| Rate for Payer: WPS Commercial |
$2,639.85
|
|
