|
PCP Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
PCP Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
PCR DNA Marker 3020insC
|
Professional
|
Both
|
$154.00
|
|
| Hospital Charge Code |
2778807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.76 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$146.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.40
|
| Rate for Payer: Health EOS Commercial |
$140.14
|
| Rate for Payer: HFN Commercial |
$146.30
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$146.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.76
|
| Rate for Payer: Quartz Commercial |
$87.78
|
| Rate for Payer: The Alliance Commercial |
$77.00
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker 3020insC
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
2778807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Aetna Managed Medicare |
$43.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.18
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$100.10
|
| Rate for Payer: Quartz Medicare Advantage |
$92.40
|
| Rate for Payer: The Alliance Commercial |
$616.00
|
| Rate for Payer: United Healthcare PPO |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker 3020insC
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
2778807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$141.68 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$92.40
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker C2104T
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
2778808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$141.68 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$92.40
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker C2104T
|
Professional
|
Both
|
$154.00
|
|
| Hospital Charge Code |
2778808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.76 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$146.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.40
|
| Rate for Payer: Health EOS Commercial |
$140.14
|
| Rate for Payer: HFN Commercial |
$146.30
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$146.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.76
|
| Rate for Payer: Quartz Commercial |
$87.78
|
| Rate for Payer: The Alliance Commercial |
$77.00
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker C2104T
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
2778808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Aetna Managed Medicare |
$43.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.18
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$100.10
|
| Rate for Payer: Quartz Medicare Advantage |
$92.40
|
| Rate for Payer: The Alliance Commercial |
$616.00
|
| Rate for Payer: United Healthcare PPO |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker G2722C
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
2778809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$141.68 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$92.40
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker G2722C
|
Professional
|
Both
|
$154.00
|
|
| Hospital Charge Code |
2778809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.76 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$146.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.40
|
| Rate for Payer: Health EOS Commercial |
$140.14
|
| Rate for Payer: HFN Commercial |
$146.30
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$146.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.76
|
| Rate for Payer: Quartz Commercial |
$87.78
|
| Rate for Payer: The Alliance Commercial |
$77.00
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker G2722C
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
2778809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Aetna Managed Medicare |
$43.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.18
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$100.10
|
| Rate for Payer: Quartz Medicare Advantage |
$92.40
|
| Rate for Payer: The Alliance Commercial |
$616.00
|
| Rate for Payer: United Healthcare PPO |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
Peak Plasma Blade
|
Facility
|
OP
|
$3,472.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4534618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$972.16 |
| Max. Negotiated Rate |
$13,888.00 |
| Rate for Payer: Aetna Commercial |
$3,124.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.92
|
| Rate for Payer: Aetna Managed Medicare |
$972.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,256.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,736.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,666.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,840.16
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cigna Commercial |
$3,194.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,942.93
|
| Rate for Payer: Health EOS Commercial |
$3,090.08
|
| Rate for Payer: HFN Commercial |
$3,194.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,604.00
|
| Rate for Payer: Multiplan Commercial |
$2,777.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,083.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,194.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.28
|
| Rate for Payer: Quartz Commercial |
$2,256.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,083.20
|
| Rate for Payer: The Alliance Commercial |
$13,888.00
|
| Rate for Payer: WEA Trust Commercial |
$1,909.60
|
| Rate for Payer: WPS Commercial |
$2,571.71
|
|
|
Peak Plasma Blade
|
Facility
|
IP
|
$3,472.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4534618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,701.28 |
| Max. Negotiated Rate |
$3,194.24 |
| Rate for Payer: Aetna Commercial |
$3,124.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,840.16
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cigna Commercial |
$3,194.24
|
| Rate for Payer: Health EOS Commercial |
$3,090.08
|
| Rate for Payer: HFN Commercial |
$3,194.24
|
| Rate for Payer: Multiplan Commercial |
$2,777.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,083.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,194.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.28
|
| Rate for Payer: Quartz Commercial |
$2,083.20
|
| Rate for Payer: WEA Trust Commercial |
$1,909.60
|
| Rate for Payer: WPS Commercial |
$2,571.71
|
|
|
Pedal Access Kit
|
Facility
|
IP
|
$789.00
|
|
| Hospital Charge Code |
4534608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.61 |
| Max. Negotiated Rate |
$725.88 |
| Rate for Payer: Aetna Commercial |
$710.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.17
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna Commercial |
$725.88
|
| Rate for Payer: Health EOS Commercial |
$702.21
|
| Rate for Payer: HFN Commercial |
$725.88
|
| Rate for Payer: Multiplan Commercial |
$631.20
|
| Rate for Payer: NAPHCARE Commercial |
$473.40
|
| Rate for Payer: Preferred Network Access Commercial |
$725.88
|
| Rate for Payer: Quartz Beloit One Network |
$386.61
|
| Rate for Payer: Quartz Commercial |
$473.40
|
| Rate for Payer: WEA Trust Commercial |
$433.95
|
| Rate for Payer: WPS Commercial |
$584.41
|
|
|
Pedal Access Kit
|
Facility
|
OP
|
$789.00
|
|
| Hospital Charge Code |
4534608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.92 |
| Max. Negotiated Rate |
$3,156.00 |
| Rate for Payer: Aetna Commercial |
$710.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.54
|
| Rate for Payer: Aetna Managed Medicare |
$220.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$512.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$394.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$378.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.17
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna Commercial |
$725.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.52
|
| Rate for Payer: Health EOS Commercial |
$702.21
|
| Rate for Payer: HFN Commercial |
$725.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.75
|
| Rate for Payer: Multiplan Commercial |
$631.20
|
| Rate for Payer: NAPHCARE Commercial |
$473.40
|
| Rate for Payer: Preferred Network Access Commercial |
$725.88
|
| Rate for Payer: Quartz Beloit One Network |
$386.61
|
| Rate for Payer: Quartz Commercial |
$512.85
|
| Rate for Payer: Quartz Medicare Advantage |
$473.40
|
| Rate for Payer: The Alliance Commercial |
$3,156.00
|
| Rate for Payer: WEA Trust Commercial |
$433.95
|
| Rate for Payer: WPS Commercial |
$584.41
|
|
|
PED Breathing Unit
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
3101732
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
PED Breathing Unit
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
3101732
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
Ped Combo Pad
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
3040334
|
|
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
|
|
|
Ped Combo Pad
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
3040334
|
|
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
|
|
|
Pediasure
|
Facility
|
IP
|
$8.00
|
|
|
Service Code
|
HCPCS B4160
|
| Hospital Charge Code |
3031448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Pediasure
|
Facility
|
OP
|
$8.00
|
|
|
Service Code
|
HCPCS B4160
|
| Hospital Charge Code |
3031448
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
Pediatric airway stabilization collar - Endotracheal Tube Status
|
Facility
|
OP
|
$1,291.00
|
|
|
Service Code
|
HCPCS L0174
|
| Hospital Charge Code |
3025910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$206.13 |
| Max. Negotiated Rate |
$5,164.00 |
| Rate for Payer: Aetna Commercial |
$1,161.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.26
|
| Rate for Payer: Aetna Managed Medicare |
$361.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$206.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$206.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.23
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cigna Commercial |
$1,187.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$722.44
|
| Rate for Payer: Health EOS Commercial |
$1,148.99
|
| Rate for Payer: HFN Commercial |
$1,187.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.25
|
| Rate for Payer: Multiplan Commercial |
$1,032.80
|
| Rate for Payer: NAPHCARE Commercial |
$774.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,187.72
|
| Rate for Payer: Quartz Beloit One Network |
$632.59
|
| Rate for Payer: Quartz Commercial |
$839.15
|
| Rate for Payer: Quartz Medicare Advantage |
$774.60
|
| Rate for Payer: The Alliance Commercial |
$5,164.00
|
| Rate for Payer: WEA Trust Commercial |
$710.05
|
| Rate for Payer: WPS Commercial |
$956.24
|
|
|
Pediatric airway stabilization collar - Endotracheal Tube Status
|
Facility
|
IP
|
$1,291.00
|
|
|
Service Code
|
HCPCS L0174
|
| Hospital Charge Code |
3025910
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$632.59 |
| Max. Negotiated Rate |
$1,187.72 |
| Rate for Payer: Aetna Commercial |
$1,161.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,110.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$684.23
|
| Rate for Payer: Cash Price |
$387.30
|
| Rate for Payer: Cigna Commercial |
$1,187.72
|
| Rate for Payer: Health EOS Commercial |
$1,148.99
|
| Rate for Payer: HFN Commercial |
$1,187.72
|
| Rate for Payer: Multiplan Commercial |
$1,032.80
|
| Rate for Payer: NAPHCARE Commercial |
$774.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,187.72
|
| Rate for Payer: Quartz Beloit One Network |
$632.59
|
| Rate for Payer: Quartz Commercial |
$774.60
|
| Rate for Payer: WEA Trust Commercial |
$710.05
|
| Rate for Payer: WPS Commercial |
$956.24
|
|
|
Pediatric Cannuals
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
3040336
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Managed Medicare |
$2.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.04
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.40
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
Pediatric Cannuals
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
3040336
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.40
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
