|
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
|
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 & 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
|
|
|
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
|
|
|
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 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 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 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 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
|
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 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 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
|
|
|
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
|
|
|
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 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 WEESOOTHIE PREMIE 96003-N
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
2963209
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.09 |
| Max. Negotiated Rate |
$66.02 |
| Rate for Payer: Aetna Commercial |
$64.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$61.71
|
| Rate for Payer: Aetna Managed Medicare |
$20.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.44
|
| 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: Dean Health DHI/DHP/ASO |
$40.16
|
| Rate for Payer: Health EOS Commercial |
$63.87
|
| Rate for Payer: HFN Commercial |
$66.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.82
|
| Rate for Payer: Multiplan Commercial |
$57.41
|
| Rate for Payer: NAPHCARE Commercial |
$43.06
|
| Rate for Payer: Preferred Network Access Commercial |
$66.02
|
| Rate for Payer: Quartz Beloit One Network |
$35.16
|
| Rate for Payer: Quartz Commercial |
$46.64
|
| Rate for Payer: Quartz Medicare Advantage |
$43.06
|
| Rate for Payer: The Alliance Commercial |
$35.88
|
| Rate for Payer: WEA Trust Commercial |
$39.47
|
| Rate for Payer: WPS Commercial |
$53.15
|
|
|
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
|
|
|
PACK 0.9 45DEG KELMAN ULTRA 8065752087
|
Facility
|
IP
|
$3,564.00
|
|
| Hospital Charge Code |
2964177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,816.21 |
| Max. Negotiated Rate |
$3,410.04 |
| Rate for Payer: Aetna Commercial |
$3,335.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.48
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,410.04
|
| Rate for Payer: Health EOS Commercial |
$3,298.84
|
| Rate for Payer: HFN Commercial |
$3,410.04
|
| Rate for Payer: Multiplan Commercial |
$2,965.25
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.21
|
| Rate for Payer: Quartz Commercial |
$2,223.94
|
| Rate for Payer: WEA Trust Commercial |
$2,038.61
|
| Rate for Payer: WPS Commercial |
$2,745.35
|
|
|
PACK 0.9 45DEG KELMAN ULTRA 8065752087
|
Facility
|
OP
|
$3,564.00
|
|
| Hospital Charge Code |
2964177
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,037.84 |
| Max. Negotiated Rate |
$3,410.04 |
| Rate for Payer: Aetna Commercial |
$3,335.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,187.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,037.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,409.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,853.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,779.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,964.48
|
| Rate for Payer: Cash Price |
$1,069.20
|
| Rate for Payer: Cigna Commercial |
$3,410.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,074.25
|
| Rate for Payer: Health EOS Commercial |
$3,298.84
|
| Rate for Payer: HFN Commercial |
$3,410.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,779.92
|
| Rate for Payer: Multiplan Commercial |
$2,965.25
|
| Rate for Payer: NAPHCARE Commercial |
$2,223.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,410.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,816.21
|
| Rate for Payer: Quartz Commercial |
$2,409.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,223.94
|
| Rate for Payer: The Alliance Commercial |
$1,853.28
|
| Rate for Payer: WEA Trust Commercial |
$2,038.61
|
| Rate for Payer: WPS Commercial |
$2,745.35
|
|
|
PACK ADULT PUMP X-COATED FX 71875-01
|
Facility
|
OP
|
$6,658.00
|
|
| Hospital Charge Code |
2962887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,938.81 |
| Max. Negotiated Rate |
$6,370.37 |
| Rate for Payer: Aetna Commercial |
$6,231.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,954.92
|
| Rate for Payer: Aetna Managed Medicare |
$1,938.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,500.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,462.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,323.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,669.89
|
| Rate for Payer: Cash Price |
$1,997.40
|
| Rate for Payer: Cigna Commercial |
$6,370.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,874.96
|
| Rate for Payer: Health EOS Commercial |
$6,162.64
|
| Rate for Payer: HFN Commercial |
$6,370.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,193.24
|
| Rate for Payer: Multiplan Commercial |
$5,539.46
|
| Rate for Payer: NAPHCARE Commercial |
$4,154.59
|
| Rate for Payer: Preferred Network Access Commercial |
$6,370.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,392.92
|
| Rate for Payer: Quartz Commercial |
$4,500.81
|
| Rate for Payer: Quartz Medicare Advantage |
$4,154.59
|
| Rate for Payer: The Alliance Commercial |
$3,462.16
|
| Rate for Payer: WEA Trust Commercial |
$3,808.38
|
| Rate for Payer: WPS Commercial |
$5,128.66
|
|
|
PACK ADULT PUMP X-COATED FX 71875-01
|
Facility
|
IP
|
$6,658.00
|
|
| Hospital Charge Code |
2962887
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,392.92 |
| Max. Negotiated Rate |
$6,370.37 |
| Rate for Payer: Aetna Commercial |
$6,231.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,954.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,669.89
|
| Rate for Payer: Cash Price |
$1,997.40
|
| Rate for Payer: Cigna Commercial |
$6,370.37
|
| Rate for Payer: Health EOS Commercial |
$6,162.64
|
| Rate for Payer: HFN Commercial |
$6,370.37
|
| Rate for Payer: Multiplan Commercial |
$5,539.46
|
| Rate for Payer: Preferred Network Access Commercial |
$6,370.37
|
| Rate for Payer: Quartz Beloit One Network |
$3,392.92
|
| Rate for Payer: Quartz Commercial |
$4,154.59
|
| Rate for Payer: WEA Trust Commercial |
$3,808.38
|
| Rate for Payer: WPS Commercial |
$5,128.66
|
|
|
PACK BIRTHING ROOM
|
Facility
|
OP
|
$337.00
|
|
| Hospital Charge Code |
2963430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.13 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$98.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.13
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.86
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$210.29
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$227.81
|
| Rate for Payer: Quartz Medicare Advantage |
$210.29
|
| Rate for Payer: The Alliance Commercial |
$175.24
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
PACK BIRTHING ROOM
|
Facility
|
IP
|
$337.00
|
|
| Hospital Charge Code |
2963430
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$210.29
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
PACK CARDIOPLEGIA 027770201
|
Facility
|
OP
|
$1,691.00
|
|
| Hospital Charge Code |
2962886
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$492.42 |
| Max. Negotiated Rate |
$1,617.95 |
| Rate for Payer: Aetna Commercial |
$1,582.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,512.43
|
| Rate for Payer: Aetna Managed Medicare |
$492.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,143.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$879.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$844.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$932.08
|
| Rate for Payer: Cash Price |
$507.30
|
| Rate for Payer: Cigna Commercial |
$1,617.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$984.16
|
| Rate for Payer: Health EOS Commercial |
$1,565.19
|
| Rate for Payer: HFN Commercial |
$1,617.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,318.98
|
| Rate for Payer: Multiplan Commercial |
$1,406.91
|
| Rate for Payer: NAPHCARE Commercial |
$1,055.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,617.95
|
| Rate for Payer: Quartz Beloit One Network |
$861.73
|
| Rate for Payer: Quartz Commercial |
$1,143.12
|
| Rate for Payer: Quartz Medicare Advantage |
$1,055.18
|
| Rate for Payer: The Alliance Commercial |
$879.32
|
| Rate for Payer: WEA Trust Commercial |
$967.25
|
| Rate for Payer: WPS Commercial |
$1,302.58
|
|
