|
PCA PUMP
|
Facility
|
IP
|
$565.00
|
|
| Hospital Charge Code |
3075869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$276.85 |
| Max. Negotiated Rate |
$519.80 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$339.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
PCA PUMP
|
Facility
|
OP
|
$565.00
|
|
| Hospital Charge Code |
3075869
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$158.20 |
| Max. Negotiated Rate |
$2,260.00 |
| Rate for Payer: Aetna Commercial |
$508.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$485.90
|
| Rate for Payer: Aetna Managed Medicare |
$158.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$282.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.45
|
| Rate for Payer: Cash Price |
$169.50
|
| Rate for Payer: Cigna Commercial |
$519.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.17
|
| Rate for Payer: Health EOS Commercial |
$502.85
|
| Rate for Payer: HFN Commercial |
$519.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$423.75
|
| Rate for Payer: Multiplan Commercial |
$452.00
|
| Rate for Payer: NAPHCARE Commercial |
$339.00
|
| Rate for Payer: Preferred Network Access Commercial |
$519.80
|
| Rate for Payer: Quartz Beloit One Network |
$276.85
|
| Rate for Payer: Quartz Commercial |
$367.25
|
| Rate for Payer: Quartz Medicare Advantage |
$339.00
|
| Rate for Payer: The Alliance Commercial |
$2,260.00
|
| Rate for Payer: WEA Trust Commercial |
$310.75
|
| Rate for Payer: WPS Commercial |
$418.50
|
|
|
PCA Pump - Devices and Equipment
|
Facility
|
OP
|
$543.00
|
|
| Hospital Charge Code |
3002377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$152.04 |
| Max. Negotiated Rate |
$2,172.00 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$152.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.86
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$407.25
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$325.80
|
| Rate for Payer: The Alliance Commercial |
$2,172.00
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
PCA Pump - Devices and Equipment
|
Facility
|
IP
|
$543.00
|
|
| Hospital Charge Code |
3002377
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
PCA SET TUBING Y-CONNECTOR DEHP-FREE 3ML 10800175
|
Facility
|
OP
|
$146.00
|
|
| Hospital Charge Code |
4089811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$40.88 |
| Max. Negotiated Rate |
$584.00 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Aetna Managed Medicare |
$40.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$94.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.70
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.50
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$94.90
|
| Rate for Payer: Quartz Medicare Advantage |
$87.60
|
| Rate for Payer: The Alliance Commercial |
$584.00
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
PCA SET TUBING Y-CONNECTOR DEHP-FREE 3ML 10800175
|
Facility
|
IP
|
$146.00
|
|
| Hospital Charge Code |
4089811
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.54 |
| Max. Negotiated Rate |
$134.32 |
| Rate for Payer: Aetna Commercial |
$131.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.38
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$134.32
|
| Rate for Payer: Health EOS Commercial |
$129.94
|
| Rate for Payer: HFN Commercial |
$134.32
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: NAPHCARE Commercial |
$87.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.32
|
| Rate for Payer: Quartz Beloit One Network |
$71.54
|
| Rate for Payer: Quartz Commercial |
$87.60
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
PCP Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.52 |
| Max. Negotiated Rate |
$44.16 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$28.80
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
PCP Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.44 |
| Max. Negotiated Rate |
$192.00 |
| Rate for Payer: Aetna Commercial |
$43.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Aetna Managed Medicare |
$13.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.44
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$44.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.86
|
| Rate for Payer: Health EOS Commercial |
$42.72
|
| Rate for Payer: HFN Commercial |
$44.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36.00
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.80
|
| Rate for Payer: Preferred Network Access Commercial |
$44.16
|
| Rate for Payer: Quartz Beloit One Network |
$23.52
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: Quartz Medicare Advantage |
$28.80
|
| Rate for Payer: The Alliance Commercial |
$192.00
|
| Rate for Payer: United Healthcare PPO |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
PCP Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942894
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$21.12 |
| Max. Negotiated Rate |
$45.60 |
| Rate for Payer: Aetna Commercial |
$45.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.28
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.80
|
| Rate for Payer: Health EOS Commercial |
$43.68
|
| Rate for Payer: HFN Commercial |
$45.60
|
| Rate for Payer: Multiplan Commercial |
$38.40
|
| Rate for Payer: Preferred Network Access Commercial |
$45.60
|
| Rate for Payer: Quartz Beloit One Network |
$21.12
|
| Rate for Payer: Quartz Commercial |
$27.36
|
| Rate for Payer: The Alliance Commercial |
$24.00
|
| Rate for Payer: WEA Trust Commercial |
$26.40
|
| Rate for Payer: WPS Commercial |
$35.55
|
|
|
PCR DNA Marker 3020insC
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
2778807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$141.68 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$92.40
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker 3020insC
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
2778807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Aetna Managed Medicare |
$43.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.18
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$100.10
|
| Rate for Payer: Quartz Medicare Advantage |
$92.40
|
| Rate for Payer: The Alliance Commercial |
$616.00
|
| Rate for Payer: United Healthcare PPO |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker 3020insC
|
Professional
|
Both
|
$154.00
|
|
| Hospital Charge Code |
2778807
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.76 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$146.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.40
|
| Rate for Payer: Health EOS Commercial |
$140.14
|
| Rate for Payer: HFN Commercial |
$146.30
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$146.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.76
|
| Rate for Payer: Quartz Commercial |
$87.78
|
| Rate for Payer: The Alliance Commercial |
$77.00
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker C2104T
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
2778808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Aetna Managed Medicare |
$43.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.18
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$100.10
|
| Rate for Payer: Quartz Medicare Advantage |
$92.40
|
| Rate for Payer: The Alliance Commercial |
$616.00
|
| Rate for Payer: United Healthcare PPO |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker C2104T
|
Professional
|
Both
|
$154.00
|
|
| Hospital Charge Code |
2778808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.76 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$146.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.40
|
| Rate for Payer: Health EOS Commercial |
$140.14
|
| Rate for Payer: HFN Commercial |
$146.30
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$146.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.76
|
| Rate for Payer: Quartz Commercial |
$87.78
|
| Rate for Payer: The Alliance Commercial |
$77.00
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker C2104T
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
2778808
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$141.68 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$92.40
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker G2722C
|
Facility
|
OP
|
$154.00
|
|
| Hospital Charge Code |
2778809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.12 |
| Max. Negotiated Rate |
$616.00 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Aetna Managed Medicare |
$43.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$77.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.18
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115.50
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$100.10
|
| Rate for Payer: Quartz Medicare Advantage |
$92.40
|
| Rate for Payer: The Alliance Commercial |
$616.00
|
| Rate for Payer: United Healthcare PPO |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker G2722C
|
Facility
|
IP
|
$154.00
|
|
| Hospital Charge Code |
2778809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$75.46 |
| Max. Negotiated Rate |
$141.68 |
| Rate for Payer: Aetna Commercial |
$138.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.62
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$141.68
|
| Rate for Payer: Health EOS Commercial |
$137.06
|
| Rate for Payer: HFN Commercial |
$141.68
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: NAPHCARE Commercial |
$92.40
|
| Rate for Payer: Preferred Network Access Commercial |
$141.68
|
| Rate for Payer: Quartz Beloit One Network |
$75.46
|
| Rate for Payer: Quartz Commercial |
$92.40
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
PCR DNA Marker G2722C
|
Professional
|
Both
|
$154.00
|
|
| Hospital Charge Code |
2778809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$67.76 |
| Max. Negotiated Rate |
$146.30 |
| Rate for Payer: Aetna Commercial |
$146.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$132.44
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$146.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.40
|
| Rate for Payer: Health EOS Commercial |
$140.14
|
| Rate for Payer: HFN Commercial |
$146.30
|
| Rate for Payer: Multiplan Commercial |
$123.20
|
| Rate for Payer: Preferred Network Access Commercial |
$146.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.76
|
| Rate for Payer: Quartz Commercial |
$87.78
|
| Rate for Payer: The Alliance Commercial |
$77.00
|
| Rate for Payer: WEA Trust Commercial |
$84.70
|
| Rate for Payer: WPS Commercial |
$114.07
|
|
|
Peak Plasma Blade
|
Facility
|
IP
|
$3,472.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4534618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,701.28 |
| Max. Negotiated Rate |
$3,194.24 |
| Rate for Payer: Aetna Commercial |
$3,124.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,840.16
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cigna Commercial |
$3,194.24
|
| Rate for Payer: Health EOS Commercial |
$3,090.08
|
| Rate for Payer: HFN Commercial |
$3,194.24
|
| Rate for Payer: Multiplan Commercial |
$2,777.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,083.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,194.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.28
|
| Rate for Payer: Quartz Commercial |
$2,083.20
|
| Rate for Payer: WEA Trust Commercial |
$1,909.60
|
| Rate for Payer: WPS Commercial |
$2,571.71
|
|
|
Peak Plasma Blade
|
Facility
|
OP
|
$3,472.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
4534618
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$972.16 |
| Max. Negotiated Rate |
$13,888.00 |
| Rate for Payer: Aetna Commercial |
$3,124.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,985.92
|
| Rate for Payer: Aetna Managed Medicare |
$972.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,256.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,736.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,666.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,840.16
|
| Rate for Payer: Cash Price |
$1,041.60
|
| Rate for Payer: Cigna Commercial |
$3,194.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,942.93
|
| Rate for Payer: Health EOS Commercial |
$3,090.08
|
| Rate for Payer: HFN Commercial |
$3,194.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,604.00
|
| Rate for Payer: Multiplan Commercial |
$2,777.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,083.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,194.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,701.28
|
| Rate for Payer: Quartz Commercial |
$2,256.80
|
| Rate for Payer: Quartz Medicare Advantage |
$2,083.20
|
| Rate for Payer: The Alliance Commercial |
$13,888.00
|
| Rate for Payer: WEA Trust Commercial |
$1,909.60
|
| Rate for Payer: WPS Commercial |
$2,571.71
|
|
|
Pedal Access Kit
|
Facility
|
IP
|
$789.00
|
|
| Hospital Charge Code |
4534608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$386.61 |
| Max. Negotiated Rate |
$725.88 |
| Rate for Payer: Aetna Commercial |
$710.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.17
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna Commercial |
$725.88
|
| Rate for Payer: Health EOS Commercial |
$702.21
|
| Rate for Payer: HFN Commercial |
$725.88
|
| Rate for Payer: Multiplan Commercial |
$631.20
|
| Rate for Payer: NAPHCARE Commercial |
$473.40
|
| Rate for Payer: Preferred Network Access Commercial |
$725.88
|
| Rate for Payer: Quartz Beloit One Network |
$386.61
|
| Rate for Payer: Quartz Commercial |
$473.40
|
| Rate for Payer: WEA Trust Commercial |
$433.95
|
| Rate for Payer: WPS Commercial |
$584.41
|
|
|
Pedal Access Kit
|
Facility
|
OP
|
$789.00
|
|
| Hospital Charge Code |
4534608
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$220.92 |
| Max. Negotiated Rate |
$3,156.00 |
| Rate for Payer: Aetna Commercial |
$710.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$678.54
|
| Rate for Payer: Aetna Managed Medicare |
$220.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$512.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$394.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$378.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$418.17
|
| Rate for Payer: Cash Price |
$236.70
|
| Rate for Payer: Cigna Commercial |
$725.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$441.52
|
| Rate for Payer: Health EOS Commercial |
$702.21
|
| Rate for Payer: HFN Commercial |
$725.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$591.75
|
| Rate for Payer: Multiplan Commercial |
$631.20
|
| Rate for Payer: NAPHCARE Commercial |
$473.40
|
| Rate for Payer: Preferred Network Access Commercial |
$725.88
|
| Rate for Payer: Quartz Beloit One Network |
$386.61
|
| Rate for Payer: Quartz Commercial |
$512.85
|
| Rate for Payer: Quartz Medicare Advantage |
$473.40
|
| Rate for Payer: The Alliance Commercial |
$3,156.00
|
| Rate for Payer: WEA Trust Commercial |
$433.95
|
| Rate for Payer: WPS Commercial |
$584.41
|
|
|
PED Breathing Unit
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
3101732
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
PED Breathing Unit
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
3101732
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
Ped Combo Pad
|
Facility
|
OP
|
$55.00
|
|
| Hospital Charge Code |
3040334
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.40 |
| Max. Negotiated Rate |
$220.00 |
| Rate for Payer: Aetna Commercial |
$49.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.15
|
| Rate for Payer: Cash Price |
$16.50
|
| Rate for Payer: Cigna Commercial |
$50.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.78
|
| Rate for Payer: Health EOS Commercial |
$48.95
|
| Rate for Payer: HFN Commercial |
$50.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.25
|
| Rate for Payer: Multiplan Commercial |
$44.00
|
| Rate for Payer: NAPHCARE Commercial |
$33.00
|
| Rate for Payer: Preferred Network Access Commercial |
$50.60
|
| Rate for Payer: Quartz Beloit One Network |
$26.95
|
| Rate for Payer: Quartz Commercial |
$35.75
|
| Rate for Payer: Quartz Medicare Advantage |
$33.00
|
| Rate for Payer: The Alliance Commercial |
$220.00
|
| Rate for Payer: WEA Trust Commercial |
$30.25
|
| Rate for Payer: WPS Commercial |
$40.74
|
|
