|
OXYMASK ETCO2 KID OK-2125-8SLM
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
HCPCS A4620
|
| Hospital Charge Code |
5520691
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.01 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$97.97
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
Oxymetazoline Nasal Spray 15ml [Med]
|
Facility
|
OP
|
$6.00
|
|
| Hospital Charge Code |
2974905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.75 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Aetna Managed Medicare |
$1.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.49
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.68
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: NAPHCARE Commercial |
$3.74
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$4.06
|
| Rate for Payer: Quartz Medicare Advantage |
$3.74
|
| Rate for Payer: The Alliance Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Oxymetazoline Nasal Spray 15ml [Med]
|
Facility
|
IP
|
$6.00
|
|
| Hospital Charge Code |
2974905
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.06 |
| Max. Negotiated Rate |
$5.74 |
| Rate for Payer: Aetna Commercial |
$5.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.31
|
| Rate for Payer: Cash Price |
$1.80
|
| Rate for Payer: Cigna Commercial |
$5.74
|
| Rate for Payer: Health EOS Commercial |
$5.55
|
| Rate for Payer: HFN Commercial |
$5.74
|
| Rate for Payer: Multiplan Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$5.74
|
| Rate for Payer: Quartz Beloit One Network |
$3.06
|
| Rate for Payer: Quartz Commercial |
$3.74
|
| Rate for Payer: WEA Trust Commercial |
$3.43
|
| Rate for Payer: WPS Commercial |
$4.62
|
|
|
Oxytocin 20units/1ml vial [Med]
|
Facility
|
IP
|
$9.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2974967
|
|
Hospital Revenue Code
|
636
|
| 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
|
|
|
Oxytocin 20units/1ml vial [Med]
|
Facility
|
OP
|
$9.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
2974967
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.62 |
| Max. Negotiated Rate |
$8.61 |
| Rate for Payer: Aetna Commercial |
$8.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.05
|
| Rate for Payer: Aetna Managed Medicare |
$2.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.49
|
| 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: Dean Health DHI/DHP/ASO |
$5.24
|
| Rate for Payer: Health EOS Commercial |
$8.33
|
| Rate for Payer: HFN Commercial |
$8.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.02
|
| Rate for Payer: Multiplan Commercial |
$7.49
|
| Rate for Payer: NAPHCARE Commercial |
$5.62
|
| Rate for Payer: Preferred Network Access Commercial |
$8.61
|
| Rate for Payer: Quartz Beloit One Network |
$4.59
|
| Rate for Payer: Quartz Commercial |
$6.08
|
| Rate for Payer: Quartz Medicare Advantage |
$5.62
|
| Rate for Payer: The Alliance Commercial |
$4.68
|
| Rate for Payer: WEA Trust Commercial |
$5.15
|
| Rate for Payer: WPS Commercial |
$6.93
|
|
|
Oxytocin (Pitocin) 10units/ml [MED]
|
Facility
|
IP
|
$17.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
3260805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.37
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.27
|
| Rate for Payer: Health EOS Commercial |
$15.74
|
| Rate for Payer: HFN Commercial |
$16.27
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: Preferred Network Access Commercial |
$16.27
|
| Rate for Payer: Quartz Beloit One Network |
$8.66
|
| Rate for Payer: Quartz Commercial |
$10.61
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: WPS Commercial |
$13.10
|
|
|
Oxytocin (Pitocin) 10units/ml [MED]
|
Facility
|
OP
|
$17.00
|
|
|
Service Code
|
HCPCS J2590
|
| Hospital Charge Code |
3260805
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$4.95 |
| Max. Negotiated Rate |
$16.27 |
| Rate for Payer: Aetna Commercial |
$15.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15.20
|
| Rate for Payer: Aetna Managed Medicare |
$4.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.37
|
| Rate for Payer: Cash Price |
$5.10
|
| Rate for Payer: Cigna Commercial |
$16.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.89
|
| Rate for Payer: Health EOS Commercial |
$15.74
|
| Rate for Payer: HFN Commercial |
$16.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.26
|
| Rate for Payer: Multiplan Commercial |
$14.14
|
| Rate for Payer: NAPHCARE Commercial |
$10.61
|
| Rate for Payer: Preferred Network Access Commercial |
$16.27
|
| Rate for Payer: Quartz Beloit One Network |
$8.66
|
| Rate for Payer: Quartz Commercial |
$11.49
|
| Rate for Payer: Quartz Medicare Advantage |
$10.61
|
| Rate for Payer: The Alliance Commercial |
$8.84
|
| Rate for Payer: WEA Trust Commercial |
$9.72
|
| Rate for Payer: WPS Commercial |
$13.10
|
|
|
Pace Gen Change Dual Lead
|
Facility
|
OP
|
$2,891.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
3052390
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,473.25 |
| Max. Negotiated Rate |
$43,998.28 |
| Rate for Payer: Aetna Commercial |
$2,705.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,585.71
|
| Rate for Payer: Aetna Managed Medicare |
$10,999.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,593.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,999.57
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,766.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,999.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,999.57
|
| Rate for Payer: Health EOS Commercial |
$2,675.91
|
| Rate for Payer: HFN Commercial |
$2,766.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,918.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,999.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,999.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,999.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,999.57
|
| Rate for Payer: Multiplan Commercial |
$2,405.31
|
| Rate for Payer: NAPHCARE Commercial |
$16,499.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,766.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.25
|
| Rate for Payer: Quartz Commercial |
$1,954.32
|
| Rate for Payer: Quartz Medicare Advantage |
$10,999.57
|
| Rate for Payer: The Alliance Commercial |
$43,998.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,999.57
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$1,653.65
|
| Rate for Payer: Wellcare Medicare |
$10,999.57
|
| Rate for Payer: WPS Commercial |
$2,226.94
|
|
|
Pace Gen Change Dual Lead
|
Facility
|
IP
|
$2,891.00
|
|
|
Service Code
|
CPT 33228
|
| Hospital Charge Code |
3052390
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,473.25 |
| Max. Negotiated Rate |
$2,766.11 |
| Rate for Payer: Aetna Commercial |
$2,705.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,585.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,593.52
|
| Rate for Payer: Cash Price |
$867.30
|
| Rate for Payer: Cigna Commercial |
$2,766.11
|
| Rate for Payer: Health EOS Commercial |
$2,675.91
|
| Rate for Payer: HFN Commercial |
$2,766.11
|
| Rate for Payer: Multiplan Commercial |
$2,405.31
|
| Rate for Payer: Preferred Network Access Commercial |
$2,766.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,473.25
|
| Rate for Payer: Quartz Commercial |
$1,803.98
|
| Rate for Payer: WEA Trust Commercial |
$1,653.65
|
| Rate for Payer: WPS Commercial |
$2,226.94
|
|
|
Pace Gen Change Multi Lead System
|
Facility
|
IP
|
$2,475.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
4125705
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,261.26 |
| Max. Negotiated Rate |
$2,368.08 |
| Rate for Payer: Aetna Commercial |
$2,316.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,213.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,364.22
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$2,368.08
|
| Rate for Payer: Health EOS Commercial |
$2,290.86
|
| Rate for Payer: HFN Commercial |
$2,368.08
|
| Rate for Payer: Multiplan Commercial |
$2,059.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,368.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.26
|
| Rate for Payer: Quartz Commercial |
$1,544.40
|
| Rate for Payer: WEA Trust Commercial |
$1,415.70
|
| Rate for Payer: WPS Commercial |
$1,906.49
|
|
|
Pace Gen Change Multi Lead System
|
Facility
|
OP
|
$2,475.00
|
|
|
Service Code
|
CPT 33229
|
| Hospital Charge Code |
4125705
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,261.26 |
| Max. Negotiated Rate |
$81,083.18 |
| Rate for Payer: Aetna Commercial |
$2,316.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,213.64
|
| Rate for Payer: Aetna Managed Medicare |
$20,270.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Anthem Medicare Advantage |
$20,270.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,364.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20,270.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20,270.80
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$2,368.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,270.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,270.80
|
| Rate for Payer: Health EOS Commercial |
$2,290.86
|
| Rate for Payer: HFN Commercial |
$2,368.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75,407.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20,270.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20,270.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20,270.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20,270.80
|
| Rate for Payer: Multiplan Commercial |
$2,059.20
|
| Rate for Payer: NAPHCARE Commercial |
$30,406.19
|
| Rate for Payer: Preferred Network Access Commercial |
$2,368.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,261.26
|
| Rate for Payer: Quartz Commercial |
$1,673.10
|
| Rate for Payer: Quartz Medicare Advantage |
$20,270.80
|
| Rate for Payer: The Alliance Commercial |
$81,083.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20,270.80
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$1,415.70
|
| Rate for Payer: Wellcare Medicare |
$20,270.80
|
| Rate for Payer: WPS Commercial |
$1,906.49
|
|
|
Pace Gen Change Single Lead System
|
Facility
|
OP
|
$2,796.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
4294731
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,424.84 |
| Max. Negotiated Rate |
$34,835.72 |
| Rate for Payer: Aetna Commercial |
$2,617.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,500.74
|
| Rate for Payer: Aetna Managed Medicare |
$8,708.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,541.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,708.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,708.93
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cigna Commercial |
$2,675.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,708.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,708.93
|
| Rate for Payer: Health EOS Commercial |
$2,587.98
|
| Rate for Payer: HFN Commercial |
$2,675.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,397.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,708.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,708.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,708.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,708.93
|
| Rate for Payer: Multiplan Commercial |
$2,326.27
|
| Rate for Payer: NAPHCARE Commercial |
$13,063.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,675.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,424.84
|
| Rate for Payer: Quartz Commercial |
$1,890.10
|
| Rate for Payer: Quartz Medicare Advantage |
$8,708.93
|
| Rate for Payer: The Alliance Commercial |
$34,835.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,708.93
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$1,599.31
|
| Rate for Payer: Wellcare Medicare |
$8,708.93
|
| Rate for Payer: WPS Commercial |
$2,153.76
|
|
|
Pace Gen Change Single Lead System
|
Facility
|
IP
|
$2,796.00
|
|
|
Service Code
|
CPT 33227
|
| Hospital Charge Code |
4294731
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,424.84 |
| Max. Negotiated Rate |
$2,675.21 |
| Rate for Payer: Aetna Commercial |
$2,617.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,500.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,541.16
|
| Rate for Payer: Cash Price |
$838.80
|
| Rate for Payer: Cigna Commercial |
$2,675.21
|
| Rate for Payer: Health EOS Commercial |
$2,587.98
|
| Rate for Payer: HFN Commercial |
$2,675.21
|
| Rate for Payer: Multiplan Commercial |
$2,326.27
|
| Rate for Payer: Preferred Network Access Commercial |
$2,675.21
|
| Rate for Payer: Quartz Beloit One Network |
$1,424.84
|
| Rate for Payer: Quartz Commercial |
$1,744.70
|
| Rate for Payer: WEA Trust Commercial |
$1,599.31
|
| Rate for Payer: WPS Commercial |
$2,153.76
|
|
|
Pace Gen INS/Rep Plus Atrial Lead
|
Facility
|
IP
|
$6,812.00
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
3052372
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,471.40 |
| Max. Negotiated Rate |
$6,517.72 |
| Rate for Payer: Aetna Commercial |
$6,376.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,092.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,754.77
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cigna Commercial |
$6,517.72
|
| Rate for Payer: Health EOS Commercial |
$6,305.19
|
| Rate for Payer: HFN Commercial |
$6,517.72
|
| Rate for Payer: Multiplan Commercial |
$5,667.58
|
| Rate for Payer: Preferred Network Access Commercial |
$6,517.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,471.40
|
| Rate for Payer: Quartz Commercial |
$4,250.69
|
| Rate for Payer: WEA Trust Commercial |
$3,896.46
|
| Rate for Payer: WPS Commercial |
$5,247.28
|
|
|
Pace Gen INS/Rep Plus Atrial Lead
|
Facility
|
OP
|
$6,812.00
|
|
|
Service Code
|
CPT 33206
|
| Hospital Charge Code |
3052372
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,471.40 |
| Max. Negotiated Rate |
$43,998.28 |
| Rate for Payer: Aetna Commercial |
$6,376.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,092.65
|
| Rate for Payer: Aetna Managed Medicare |
$10,999.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,754.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,999.57
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cash Price |
$2,043.60
|
| Rate for Payer: Cigna Commercial |
$6,517.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,999.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,999.57
|
| Rate for Payer: Health EOS Commercial |
$6,305.19
|
| Rate for Payer: HFN Commercial |
$6,517.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,918.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,999.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,999.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,999.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,999.57
|
| Rate for Payer: Multiplan Commercial |
$5,667.58
|
| Rate for Payer: NAPHCARE Commercial |
$16,499.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,517.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,471.40
|
| Rate for Payer: Quartz Commercial |
$4,604.91
|
| Rate for Payer: Quartz Medicare Advantage |
$10,999.57
|
| Rate for Payer: The Alliance Commercial |
$43,998.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,999.57
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$3,896.46
|
| Rate for Payer: Wellcare Medicare |
$10,999.57
|
| Rate for Payer: WPS Commercial |
$5,247.28
|
|
|
Pace Gen Ins/Rep Plus AV + CS Leads
|
Facility
|
IP
|
$3,854.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
4308712
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,964.00 |
| Max. Negotiated Rate |
$3,687.51 |
| Rate for Payer: Aetna Commercial |
$3,607.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,447.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,124.32
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cigna Commercial |
$3,687.51
|
| Rate for Payer: Health EOS Commercial |
$3,567.26
|
| Rate for Payer: HFN Commercial |
$3,687.51
|
| Rate for Payer: Multiplan Commercial |
$3,206.53
|
| Rate for Payer: Preferred Network Access Commercial |
$3,687.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,964.00
|
| Rate for Payer: Quartz Commercial |
$2,404.90
|
| Rate for Payer: WEA Trust Commercial |
$2,204.49
|
| Rate for Payer: WPS Commercial |
$2,968.74
|
|
|
Pace Gen Ins/Rep Plus AV + CS Leads
|
Facility
|
OP
|
$3,854.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
4308712
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,964.00 |
| Max. Negotiated Rate |
$43,998.28 |
| Rate for Payer: Aetna Commercial |
$3,607.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,447.02
|
| Rate for Payer: Aetna Managed Medicare |
$10,999.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,999.57
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cigna Commercial |
$3,687.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,999.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,999.57
|
| Rate for Payer: Health EOS Commercial |
$3,567.26
|
| Rate for Payer: HFN Commercial |
$3,687.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,918.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,999.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,999.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,999.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,999.57
|
| Rate for Payer: Multiplan Commercial |
$3,206.53
|
| Rate for Payer: NAPHCARE Commercial |
$16,499.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,687.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,964.00
|
| Rate for Payer: Quartz Commercial |
$2,605.30
|
| Rate for Payer: Quartz Medicare Advantage |
$10,999.57
|
| Rate for Payer: The Alliance Commercial |
$43,998.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,999.57
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$2,204.49
|
| Rate for Payer: Wellcare Medicare |
$10,999.57
|
| Rate for Payer: WPS Commercial |
$2,968.74
|
|
|
Pace Gen Ins/Rep Plus AV Leads
|
Facility
|
IP
|
$3,854.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
4308833
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,964.00 |
| Max. Negotiated Rate |
$3,687.51 |
| Rate for Payer: Aetna Commercial |
$3,607.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,447.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,124.32
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cigna Commercial |
$3,687.51
|
| Rate for Payer: Health EOS Commercial |
$3,567.26
|
| Rate for Payer: HFN Commercial |
$3,687.51
|
| Rate for Payer: Multiplan Commercial |
$3,206.53
|
| Rate for Payer: Preferred Network Access Commercial |
$3,687.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,964.00
|
| Rate for Payer: Quartz Commercial |
$2,404.90
|
| Rate for Payer: WEA Trust Commercial |
$2,204.49
|
| Rate for Payer: WPS Commercial |
$2,968.74
|
|
|
Pace Gen Ins/Rep Plus AV Leads
|
Facility
|
OP
|
$3,854.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
4308833
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,964.00 |
| Max. Negotiated Rate |
$43,998.28 |
| Rate for Payer: Aetna Commercial |
$3,607.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,447.02
|
| Rate for Payer: Aetna Managed Medicare |
$10,999.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,124.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,999.57
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cash Price |
$1,156.20
|
| Rate for Payer: Cigna Commercial |
$3,687.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,999.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,999.57
|
| Rate for Payer: Health EOS Commercial |
$3,567.26
|
| Rate for Payer: HFN Commercial |
$3,687.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,918.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,999.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,999.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,999.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,999.57
|
| Rate for Payer: Multiplan Commercial |
$3,206.53
|
| Rate for Payer: NAPHCARE Commercial |
$16,499.36
|
| Rate for Payer: Preferred Network Access Commercial |
$3,687.51
|
| Rate for Payer: Quartz Beloit One Network |
$1,964.00
|
| Rate for Payer: Quartz Commercial |
$2,605.30
|
| Rate for Payer: Quartz Medicare Advantage |
$10,999.57
|
| Rate for Payer: The Alliance Commercial |
$43,998.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,999.57
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$2,204.49
|
| Rate for Payer: Wellcare Medicare |
$10,999.57
|
| Rate for Payer: WPS Commercial |
$2,968.74
|
|
|
Pace Gen INS/Rep Plus A/V Leads
|
Facility
|
OP
|
$12,394.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
3052374
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,315.98 |
| Max. Negotiated Rate |
$43,998.28 |
| Rate for Payer: Aetna Commercial |
$11,600.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,085.19
|
| Rate for Payer: Aetna Managed Medicare |
$10,999.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,831.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,999.57
|
| Rate for Payer: Cash Price |
$3,718.20
|
| Rate for Payer: Cash Price |
$3,718.20
|
| Rate for Payer: Cash Price |
$3,718.20
|
| Rate for Payer: Cigna Commercial |
$11,858.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,999.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,999.57
|
| Rate for Payer: Health EOS Commercial |
$11,471.89
|
| Rate for Payer: HFN Commercial |
$11,858.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,918.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,999.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,999.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,999.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,999.57
|
| Rate for Payer: Multiplan Commercial |
$10,311.81
|
| Rate for Payer: NAPHCARE Commercial |
$16,499.36
|
| Rate for Payer: Preferred Network Access Commercial |
$11,858.58
|
| Rate for Payer: Quartz Beloit One Network |
$6,315.98
|
| Rate for Payer: Quartz Commercial |
$8,378.34
|
| Rate for Payer: Quartz Medicare Advantage |
$10,999.57
|
| Rate for Payer: The Alliance Commercial |
$43,998.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,999.57
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$7,089.37
|
| Rate for Payer: Wellcare Medicare |
$10,999.57
|
| Rate for Payer: WPS Commercial |
$9,547.10
|
|
|
Pace Gen INS/Rep Plus A/V Leads
|
Facility
|
IP
|
$12,394.00
|
|
|
Service Code
|
CPT 33208
|
| Hospital Charge Code |
3052374
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$6,315.98 |
| Max. Negotiated Rate |
$11,858.58 |
| Rate for Payer: Aetna Commercial |
$11,600.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,085.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,831.57
|
| Rate for Payer: Cash Price |
$3,718.20
|
| Rate for Payer: Cigna Commercial |
$11,858.58
|
| Rate for Payer: Health EOS Commercial |
$11,471.89
|
| Rate for Payer: HFN Commercial |
$11,858.58
|
| Rate for Payer: Multiplan Commercial |
$10,311.81
|
| Rate for Payer: Preferred Network Access Commercial |
$11,858.58
|
| Rate for Payer: Quartz Beloit One Network |
$6,315.98
|
| Rate for Payer: Quartz Commercial |
$7,733.86
|
| Rate for Payer: WEA Trust Commercial |
$7,089.37
|
| Rate for Payer: WPS Commercial |
$9,547.10
|
|
|
Pace Gen Ins/Rep Plus Vent Lead
|
Facility
|
IP
|
$4,203.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
4308818
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,141.85 |
| Max. Negotiated Rate |
$4,021.43 |
| Rate for Payer: Aetna Commercial |
$3,934.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,759.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,316.69
|
| Rate for Payer: Cash Price |
$1,260.90
|
| Rate for Payer: Cigna Commercial |
$4,021.43
|
| Rate for Payer: Health EOS Commercial |
$3,890.30
|
| Rate for Payer: HFN Commercial |
$4,021.43
|
| Rate for Payer: Multiplan Commercial |
$3,496.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,021.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,141.85
|
| Rate for Payer: Quartz Commercial |
$2,622.67
|
| Rate for Payer: WEA Trust Commercial |
$2,404.12
|
| Rate for Payer: WPS Commercial |
$3,237.57
|
|
|
Pace Gen Ins/Rep Plus Vent Lead
|
Facility
|
OP
|
$4,203.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
4308818
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,141.85 |
| Max. Negotiated Rate |
$43,998.28 |
| Rate for Payer: Aetna Commercial |
$3,934.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,759.16
|
| Rate for Payer: Aetna Managed Medicare |
$10,999.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,316.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,999.57
|
| Rate for Payer: Cash Price |
$1,260.90
|
| Rate for Payer: Cash Price |
$1,260.90
|
| Rate for Payer: Cash Price |
$1,260.90
|
| Rate for Payer: Cigna Commercial |
$4,021.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,999.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,999.57
|
| Rate for Payer: Health EOS Commercial |
$3,890.30
|
| Rate for Payer: HFN Commercial |
$4,021.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,918.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,999.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,999.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,999.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,999.57
|
| Rate for Payer: Multiplan Commercial |
$3,496.90
|
| Rate for Payer: NAPHCARE Commercial |
$16,499.36
|
| Rate for Payer: Preferred Network Access Commercial |
$4,021.43
|
| Rate for Payer: Quartz Beloit One Network |
$2,141.85
|
| Rate for Payer: Quartz Commercial |
$2,841.23
|
| Rate for Payer: Quartz Medicare Advantage |
$10,999.57
|
| Rate for Payer: The Alliance Commercial |
$43,998.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,999.57
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$2,404.12
|
| Rate for Payer: Wellcare Medicare |
$10,999.57
|
| Rate for Payer: WPS Commercial |
$3,237.57
|
|
|
Pace Gen INS/Rep Plus Vent Lead
|
Facility
|
OP
|
$5,254.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
3052373
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,677.44 |
| Max. Negotiated Rate |
$43,998.28 |
| Rate for Payer: Aetna Commercial |
$4,917.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,699.18
|
| Rate for Payer: Aetna Managed Medicare |
$10,999.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,896.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,999.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,999.57
|
| Rate for Payer: Cash Price |
$1,576.20
|
| Rate for Payer: Cash Price |
$1,576.20
|
| Rate for Payer: Cash Price |
$1,576.20
|
| Rate for Payer: Cigna Commercial |
$5,027.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,999.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,999.57
|
| Rate for Payer: Health EOS Commercial |
$4,863.10
|
| Rate for Payer: HFN Commercial |
$5,027.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,918.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,999.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,999.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,999.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,999.57
|
| Rate for Payer: Multiplan Commercial |
$4,371.33
|
| Rate for Payer: NAPHCARE Commercial |
$16,499.36
|
| Rate for Payer: Preferred Network Access Commercial |
$5,027.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,677.44
|
| Rate for Payer: Quartz Commercial |
$3,551.70
|
| Rate for Payer: Quartz Medicare Advantage |
$10,999.57
|
| Rate for Payer: The Alliance Commercial |
$43,998.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,999.57
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$3,005.29
|
| Rate for Payer: Wellcare Medicare |
$10,999.57
|
| Rate for Payer: WPS Commercial |
$4,047.16
|
|
|
Pace Gen INS/Rep Plus Vent Lead
|
Facility
|
IP
|
$5,254.00
|
|
|
Service Code
|
CPT 33207
|
| Hospital Charge Code |
3052373
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,677.44 |
| Max. Negotiated Rate |
$5,027.03 |
| Rate for Payer: Aetna Commercial |
$4,917.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,699.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,896.00
|
| Rate for Payer: Cash Price |
$1,576.20
|
| Rate for Payer: Cigna Commercial |
$5,027.03
|
| Rate for Payer: Health EOS Commercial |
$4,863.10
|
| Rate for Payer: HFN Commercial |
$5,027.03
|
| Rate for Payer: Multiplan Commercial |
$4,371.33
|
| Rate for Payer: Preferred Network Access Commercial |
$5,027.03
|
| Rate for Payer: Quartz Beloit One Network |
$2,677.44
|
| Rate for Payer: Quartz Commercial |
$3,278.50
|
| Rate for Payer: WEA Trust Commercial |
$3,005.29
|
| Rate for Payer: WPS Commercial |
$4,047.16
|
|
