|
Pacemaker Check Reprogram Single
|
Facility
|
OP
|
$348.00
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
3052473
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$180.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$173.72
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$235.25
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: United Healthcare PPO |
$271.44
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
Pacemaker Check Reprogram Single
|
Facility
|
IP
|
$348.00
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
3052473
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$177.34 |
| Max. Negotiated Rate |
$332.97 |
| Rate for Payer: Aetna Commercial |
$325.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$311.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$191.82
|
| Rate for Payer: Cash Price |
$104.40
|
| Rate for Payer: Cigna Commercial |
$332.97
|
| Rate for Payer: Health EOS Commercial |
$322.11
|
| Rate for Payer: HFN Commercial |
$332.97
|
| Rate for Payer: Multiplan Commercial |
$289.54
|
| Rate for Payer: Preferred Network Access Commercial |
$332.97
|
| Rate for Payer: Quartz Beloit One Network |
$177.34
|
| Rate for Payer: Quartz Commercial |
$217.15
|
| Rate for Payer: WEA Trust Commercial |
$199.06
|
| Rate for Payer: WPS Commercial |
$268.06
|
|
|
Pacemaker Explant Leadless-Ventricular
|
Facility
|
IP
|
$6,415.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
5464769
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,269.08 |
| Max. Negotiated Rate |
$6,137.87 |
| Rate for Payer: Aetna Commercial |
$6,004.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,737.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,535.95
|
| Rate for Payer: Cash Price |
$1,924.50
|
| Rate for Payer: Cigna Commercial |
$6,137.87
|
| Rate for Payer: Health EOS Commercial |
$5,937.72
|
| Rate for Payer: HFN Commercial |
$6,137.87
|
| Rate for Payer: Multiplan Commercial |
$5,337.28
|
| Rate for Payer: Preferred Network Access Commercial |
$6,137.87
|
| Rate for Payer: Quartz Beloit One Network |
$3,269.08
|
| Rate for Payer: Quartz Commercial |
$4,002.96
|
| Rate for Payer: WEA Trust Commercial |
$3,669.38
|
| Rate for Payer: WPS Commercial |
$4,941.47
|
|
|
Pacemaker Explant Leadless-Ventricular
|
Facility
|
OP
|
$6,415.00
|
|
|
Service Code
|
CPT 33275
|
| Hospital Charge Code |
5464769
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,269.08 |
| Max. Negotiated Rate |
$13,291.62 |
| Rate for Payer: Aetna Commercial |
$6,004.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,737.58
|
| Rate for Payer: Aetna Managed Medicare |
$3,322.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,535.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,322.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,322.90
|
| 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: Cash Price |
$1,924.50
|
| Rate for Payer: Cigna Commercial |
$6,137.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,322.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,322.90
|
| Rate for Payer: Health EOS Commercial |
$5,937.72
|
| Rate for Payer: HFN Commercial |
$6,137.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,361.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,322.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,322.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,322.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,322.90
|
| Rate for Payer: Multiplan Commercial |
$5,337.28
|
| Rate for Payer: NAPHCARE Commercial |
$4,984.36
|
| Rate for Payer: Preferred Network Access Commercial |
$6,137.87
|
| Rate for Payer: Quartz Beloit One Network |
$3,269.08
|
| Rate for Payer: Quartz Commercial |
$4,336.54
|
| Rate for Payer: Quartz Medicare Advantage |
$3,322.90
|
| Rate for Payer: The Alliance Commercial |
$13,291.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,322.90
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$3,669.38
|
| Rate for Payer: Wellcare Medicare |
$3,322.90
|
| Rate for Payer: WPS Commercial |
$4,941.47
|
|
|
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 |
$3,083.08 |
| Max. Negotiated Rate |
$5,788.64 |
| Rate for Payer: Aetna Commercial |
$5,662.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,411.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,334.76
|
| Rate for Payer: Cash Price |
$1,815.00
|
| Rate for Payer: Cigna Commercial |
$5,788.64
|
| Rate for Payer: Health EOS Commercial |
$5,599.88
|
| Rate for Payer: HFN Commercial |
$5,788.64
|
| Rate for Payer: Multiplan Commercial |
$5,033.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,788.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,083.08
|
| Rate for Payer: Quartz Commercial |
$3,775.20
|
| Rate for Payer: WEA Trust Commercial |
$3,460.60
|
| Rate for Payer: WPS Commercial |
$4,660.31
|
|
|
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 |
$3,083.08 |
| Max. Negotiated Rate |
$81,083.18 |
| Rate for Payer: Aetna Commercial |
$5,662.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,411.12
|
| 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 |
$3,334.76
|
| 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 |
$1,815.00
|
| 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 |
$5,788.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20,270.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20,270.80
|
| Rate for Payer: Health EOS Commercial |
$5,599.88
|
| Rate for Payer: HFN Commercial |
$5,788.64
|
| 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 |
$5,033.60
|
| Rate for Payer: NAPHCARE Commercial |
$30,406.19
|
| Rate for Payer: Preferred Network Access Commercial |
$5,788.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,083.08
|
| Rate for Payer: Quartz Commercial |
$4,089.80
|
| 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 |
$3,460.60
|
| Rate for Payer: Wellcare Medicare |
$20,270.80
|
| Rate for Payer: WPS Commercial |
$4,660.31
|
|
|
Pacemaker Pre/Post OP Adjust
|
Facility
|
OP
|
$349.00
|
|
|
Service Code
|
CPT 93286
|
| Hospital Charge Code |
3052479
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$101.63 |
| Max. Negotiated Rate |
$333.92 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Aetna Managed Medicare |
$101.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$235.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$181.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$174.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.12
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$272.22
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: NAPHCARE Commercial |
$217.78
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$235.92
|
| Rate for Payer: Quartz Medicare Advantage |
$217.78
|
| Rate for Payer: The Alliance Commercial |
$176.92
|
| Rate for Payer: United Healthcare PPO |
$272.22
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
Pacemaker Pre/Post OP Adjust
|
Facility
|
IP
|
$349.00
|
|
|
Service Code
|
CPT 93286
|
| Hospital Charge Code |
3052479
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$177.85 |
| Max. Negotiated Rate |
$333.92 |
| Rate for Payer: Aetna Commercial |
$326.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$312.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$192.37
|
| Rate for Payer: Cash Price |
$104.70
|
| Rate for Payer: Cigna Commercial |
$333.92
|
| Rate for Payer: Health EOS Commercial |
$323.03
|
| Rate for Payer: HFN Commercial |
$333.92
|
| Rate for Payer: Multiplan Commercial |
$290.37
|
| Rate for Payer: Preferred Network Access Commercial |
$333.92
|
| Rate for Payer: Quartz Beloit One Network |
$177.85
|
| Rate for Payer: Quartz Commercial |
$217.78
|
| Rate for Payer: WEA Trust Commercial |
$199.63
|
| Rate for Payer: WPS Commercial |
$268.83
|
|
|
Pacemaker Temporary
|
Facility
|
OP
|
$6,382.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
3052375
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,252.27 |
| Max. Negotiated Rate |
$34,835.72 |
| Rate for Payer: Aetna Commercial |
$5,973.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,708.06
|
| 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 |
$3,517.76
|
| 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 |
$1,914.60
|
| Rate for Payer: Cash Price |
$1,914.60
|
| Rate for Payer: Cash Price |
$1,914.60
|
| Rate for Payer: Cigna Commercial |
$6,106.30
|
| 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 |
$5,907.18
|
| Rate for Payer: HFN Commercial |
$6,106.30
|
| 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 |
$5,309.82
|
| Rate for Payer: NAPHCARE Commercial |
$13,063.39
|
| Rate for Payer: Preferred Network Access Commercial |
$6,106.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,252.27
|
| Rate for Payer: Quartz Commercial |
$4,314.23
|
| 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 |
$3,650.50
|
| Rate for Payer: Wellcare Medicare |
$8,708.93
|
| Rate for Payer: WPS Commercial |
$4,916.05
|
|
|
Pacemaker Temporary
|
Facility
|
IP
|
$6,382.00
|
|
|
Service Code
|
CPT 33210
|
| Hospital Charge Code |
3052375
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,252.27 |
| Max. Negotiated Rate |
$6,106.30 |
| Rate for Payer: Aetna Commercial |
$5,973.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,708.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,517.76
|
| Rate for Payer: Cash Price |
$1,914.60
|
| Rate for Payer: Cigna Commercial |
$6,106.30
|
| Rate for Payer: Health EOS Commercial |
$5,907.18
|
| Rate for Payer: HFN Commercial |
$6,106.30
|
| Rate for Payer: Multiplan Commercial |
$5,309.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6,106.30
|
| Rate for Payer: Quartz Beloit One Network |
$3,252.27
|
| Rate for Payer: Quartz Commercial |
$3,982.37
|
| Rate for Payer: WEA Trust Commercial |
$3,650.50
|
| Rate for Payer: WPS Commercial |
$4,916.05
|
|
|
PACEMAKER (TEMPORARY & PERMANENT)
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
PACEMAKER (TEMPORARY & PERMANENT)
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960300
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Pace Pocket Rev/Relocation
|
Facility
|
IP
|
$2,712.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
3052384
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,382.04 |
| Max. Negotiated Rate |
$2,594.84 |
| Rate for Payer: Aetna Commercial |
$2,538.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,425.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,494.85
|
| Rate for Payer: Cash Price |
$813.60
|
| Rate for Payer: Cigna Commercial |
$2,594.84
|
| Rate for Payer: Health EOS Commercial |
$2,510.23
|
| Rate for Payer: HFN Commercial |
$2,594.84
|
| Rate for Payer: Multiplan Commercial |
$2,256.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,594.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,382.04
|
| Rate for Payer: Quartz Commercial |
$1,692.29
|
| Rate for Payer: WEA Trust Commercial |
$1,551.26
|
| Rate for Payer: WPS Commercial |
$2,089.05
|
|
|
Pace Pocket Rev/Relocation
|
Facility
|
OP
|
$2,712.00
|
|
|
Service Code
|
CPT 33222
|
| Hospital Charge Code |
3052384
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,382.04 |
| Max. Negotiated Rate |
$8,685.50 |
| Rate for Payer: Aetna Commercial |
$2,538.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,425.61
|
| Rate for Payer: Aetna Managed Medicare |
$2,171.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,494.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,171.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,171.37
|
| 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 |
$2,594.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,171.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,171.37
|
| Rate for Payer: Health EOS Commercial |
$2,510.23
|
| Rate for Payer: HFN Commercial |
$2,594.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,077.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,171.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,171.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,171.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,171.37
|
| Rate for Payer: Multiplan Commercial |
$2,256.38
|
| Rate for Payer: NAPHCARE Commercial |
$3,257.06
|
| Rate for Payer: Preferred Network Access Commercial |
$2,594.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,382.04
|
| Rate for Payer: Quartz Commercial |
$1,833.31
|
| Rate for Payer: Quartz Medicare Advantage |
$2,171.37
|
| Rate for Payer: The Alliance Commercial |
$8,685.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,171.37
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: WEA Trust Commercial |
$1,551.26
|
| Rate for Payer: Wellcare Medicare |
$2,171.37
|
| Rate for Payer: WPS Commercial |
$2,089.05
|
|
|
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 |
$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
|
|
|
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 |
$45.72 |
| Max. Negotiated Rate |
$150.22 |
| Rate for Payer: Aetna Commercial |
$146.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.42
|
| Rate for Payer: Aetna Managed Medicare |
$45.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.54
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$150.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.37
|
| Rate for Payer: Health EOS Commercial |
$145.32
|
| Rate for Payer: HFN Commercial |
$150.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.46
|
| Rate for Payer: Multiplan Commercial |
$130.62
|
| Rate for Payer: NAPHCARE Commercial |
$97.97
|
| Rate for Payer: Preferred Network Access Commercial |
$150.22
|
| Rate for Payer: Quartz Beloit One Network |
$80.01
|
| Rate for Payer: Quartz Commercial |
$106.13
|
| Rate for Payer: Quartz Medicare Advantage |
$97.97
|
| Rate for Payer: The Alliance Commercial |
$116.98
|
| Rate for Payer: United Healthcare PPO |
$122.46
|
| Rate for Payer: WEA Trust Commercial |
$89.80
|
| Rate for Payer: WPS Commercial |
$120.94
|
|
|
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 |
$611.01 |
| Max. Negotiated Rate |
$34,835.72 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| 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 |
$660.89
|
| 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 |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| 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 |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| 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 |
$997.57
|
| Rate for Payer: NAPHCARE Commercial |
$13,063.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$810.52
|
| 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 |
$685.83
|
| Rate for Payer: Wellcare Medicare |
$8,708.93
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
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 |
$611.01 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$748.18
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
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 |
$611.01 |
| Max. Negotiated Rate |
$1,147.20 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$660.89
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| Rate for Payer: Health EOS Commercial |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| Rate for Payer: Multiplan Commercial |
$997.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$748.18
|
| Rate for Payer: WEA Trust Commercial |
$685.83
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
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 |
$611.01 |
| Max. Negotiated Rate |
$34,835.72 |
| Rate for Payer: Aetna Commercial |
$1,122.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,072.39
|
| 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 |
$660.89
|
| 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 |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cash Price |
$359.70
|
| Rate for Payer: Cigna Commercial |
$1,147.20
|
| 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 |
$1,109.79
|
| Rate for Payer: HFN Commercial |
$1,147.20
|
| 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 |
$997.57
|
| Rate for Payer: NAPHCARE Commercial |
$13,063.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,147.20
|
| Rate for Payer: Quartz Beloit One Network |
$611.01
|
| Rate for Payer: Quartz Commercial |
$810.52
|
| 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 |
$685.83
|
| Rate for Payer: Wellcare Medicare |
$8,708.93
|
| Rate for Payer: WPS Commercial |
$923.59
|
|
|
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 |
$1,544.09 |
| Max. Negotiated Rate |
$2,899.10 |
| Rate for Payer: Aetna Commercial |
$2,836.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,670.14
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$2,899.10
|
| Rate for Payer: Health EOS Commercial |
$2,804.57
|
| Rate for Payer: HFN Commercial |
$2,899.10
|
| Rate for Payer: Multiplan Commercial |
$2,520.96
|
| Rate for Payer: Preferred Network Access Commercial |
$2,899.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.09
|
| Rate for Payer: Quartz Commercial |
$1,890.72
|
| Rate for Payer: WEA Trust Commercial |
$1,733.16
|
| Rate for Payer: WPS Commercial |
$2,334.01
|
|
|
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 |
$1,544.09 |
| Max. Negotiated Rate |
$43,998.28 |
| Rate for Payer: Aetna Commercial |
$2,836.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,710.03
|
| 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 |
$1,670.14
|
| 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 |
$909.00
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cash Price |
$909.00
|
| Rate for Payer: Cigna Commercial |
$2,899.10
|
| 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 |
$2,804.57
|
| Rate for Payer: HFN Commercial |
$2,899.10
|
| 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 |
$2,520.96
|
| Rate for Payer: NAPHCARE Commercial |
$16,499.36
|
| Rate for Payer: Preferred Network Access Commercial |
$2,899.10
|
| Rate for Payer: Quartz Beloit One Network |
$1,544.09
|
| Rate for Payer: Quartz Commercial |
$2,048.28
|
| 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 |
$1,733.16
|
| Rate for Payer: Wellcare Medicare |
$10,999.57
|
| Rate for Payer: WPS Commercial |
$2,334.01
|
|
|
PACIFIER NEWBORN NATURAL SCNT
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
2963208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.02 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Aetna Managed Medicare |
$16.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.01
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.90
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: NAPHCARE Commercial |
$34.32
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$37.18
|
| Rate for Payer: Quartz Medicare Advantage |
$34.32
|
| Rate for Payer: The Alliance Commercial |
$28.60
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
PACIFIER NEWBORN NATURAL SCNT
|
Facility
|
IP
|
$55.00
|
|
| Hospital Charge Code |
2963208
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.03 |
| Max. Negotiated Rate |
$52.62 |
| Rate for Payer: Aetna Commercial |
$51.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.32
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$52.62
|
| Rate for Payer: Health EOS Commercial |
$50.91
|
| Rate for Payer: HFN Commercial |
$52.62
|
| Rate for Payer: Multiplan Commercial |
$45.76
|
| Rate for Payer: Preferred Network Access Commercial |
$52.62
|
| Rate for Payer: Quartz Beloit One Network |
$28.03
|
| Rate for Payer: Quartz Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$31.46
|
| Rate for Payer: WPS Commercial |
$42.37
|
|
|
PACIFIER WEESOOTHIE PREMIE 96003-N
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
2963209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.16 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.03
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$66.02
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$43.06
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
