|
PULMONARY EMBOLISM
|
Facility
|
OP
|
$106.13
|
|
|
Service Code
|
EAPG 00586
|
| Min. Negotiated Rate |
$102.05 |
| Max. Negotiated Rate |
$106.13 |
| Rate for Payer: Anthem Medicaid |
$102.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$102.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$102.05
|
| Rate for Payer: Dean Health Medicaid |
$102.05
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$102.05
|
| Rate for Payer: Managed Health Services Medicaid |
$106.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$102.05
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$102.05
|
| Rate for Payer: United Healthcare Medicaid |
$102.05
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$10,697.34
|
|
|
Service Code
|
APR-DRG 1343
|
| Min. Negotiated Rate |
$9,502.04 |
| Max. Negotiated Rate |
$10,697.34 |
| Rate for Payer: Anthem Medicaid |
$10,243.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,243.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,243.29
|
| Rate for Payer: Dean Health Medicaid |
$10,243.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,502.04
|
| Rate for Payer: Managed Health Services Medicaid |
$10,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,243.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,243.29
|
| Rate for Payer: United Healthcare Medicaid |
$10,243.29
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$4,997.94
|
|
|
Service Code
|
APR-DRG 1341
|
| Min. Negotiated Rate |
$4,439.48 |
| Max. Negotiated Rate |
$4,997.94 |
| Rate for Payer: Anthem Medicaid |
$4,785.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,785.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,785.80
|
| Rate for Payer: Dean Health Medicaid |
$4,785.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,439.48
|
| Rate for Payer: Managed Health Services Medicaid |
$4,997.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,785.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,785.80
|
| Rate for Payer: United Healthcare Medicaid |
$4,785.80
|
|
|
PULMONARY EMBOLISM
|
Facility
|
IP
|
$6,751.60
|
|
|
Service Code
|
APR-DRG 1342
|
| Min. Negotiated Rate |
$5,997.19 |
| Max. Negotiated Rate |
$6,751.60 |
| Rate for Payer: Anthem Medicaid |
$6,465.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,465.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,465.03
|
| Rate for Payer: Dean Health Medicaid |
$6,465.03
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,997.19
|
| Rate for Payer: Managed Health Services Medicaid |
$6,751.60
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,465.03
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,465.03
|
| Rate for Payer: United Healthcare Medicaid |
$6,465.03
|
|
|
PULMONARY EMBOLISM WITH MCC OR ACUTE COR PULMONALE
|
Facility
|
IP
|
$39,125.84
|
|
|
Service Code
|
MSDRG 175
|
| Min. Negotiated Rate |
$11,026.08 |
| Max. Negotiated Rate |
$39,125.84 |
| Rate for Payer: Aetna Managed Medicare |
$11,026.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,970.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,972.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,825.30
|
| Rate for Payer: Anthem Medicare Advantage |
$11,026.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,026.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,026.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,026.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,228.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,026.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,452.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,026.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,026.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,026.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,026.08
|
| Rate for Payer: NAPHCARE Commercial |
$16,539.12
|
| Rate for Payer: Quartz Medicare Advantage |
$11,026.08
|
| Rate for Payer: The Alliance Commercial |
$39,125.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,026.08
|
| Rate for Payer: United Healthcare PPO |
$22,150.90
|
| Rate for Payer: Wellcare Medicare |
$11,026.08
|
|
|
PULMONARY EMBOLISM WITHOUT MCC
|
Facility
|
IP
|
$22,884.16
|
|
|
Service Code
|
MSDRG 176
|
| Min. Negotiated Rate |
$6,671.62 |
| Max. Negotiated Rate |
$22,884.16 |
| Rate for Payer: Aetna Managed Medicare |
$6,671.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,564.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,463.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,790.74
|
| Rate for Payer: Anthem Medicare Advantage |
$6,671.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,671.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,671.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,671.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,198.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,671.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,540.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,671.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,671.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,671.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,671.62
|
| Rate for Payer: NAPHCARE Commercial |
$10,007.43
|
| Rate for Payer: Quartz Medicare Advantage |
$6,671.62
|
| Rate for Payer: The Alliance Commercial |
$22,884.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,671.62
|
| Rate for Payer: United Healthcare PPO |
$12,876.88
|
| Rate for Payer: Wellcare Medicare |
$6,671.62
|
|
|
PULMONARY FUNCTION TESTS
|
Facility
|
OP
|
$195.23
|
|
|
Service Code
|
EAPG 00060
|
| Min. Negotiated Rate |
$187.73 |
| Max. Negotiated Rate |
$195.23 |
| Rate for Payer: Anthem Medicaid |
$187.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$187.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$187.73
|
| Rate for Payer: Dean Health Medicaid |
$187.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$187.73
|
| Rate for Payer: Managed Health Services Medicaid |
$195.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$187.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$187.73
|
| Rate for Payer: United Healthcare Medicaid |
$187.73
|
|
|
PULMONARY INFECTION DIAGNOSES INCLUDING PNEUMONIA
|
Facility
|
OP
|
$114.00
|
|
|
Service Code
|
EAPG 00581
|
| Min. Negotiated Rate |
$109.61 |
| Max. Negotiated Rate |
$114.00 |
| Rate for Payer: Anthem Medicaid |
$109.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$109.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.61
|
| Rate for Payer: Dean Health Medicaid |
$109.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$109.61
|
| Rate for Payer: Managed Health Services Medicaid |
$114.00
|
| Rate for Payer: Molina Healthcare Medicaid |
$109.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$109.61
|
| Rate for Payer: United Healthcare Medicaid |
$109.61
|
|
|
Pulmonary Stress Test - 6 min walk - Pulmonary Function Test Charge
|
Facility
|
IP
|
$198.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
5381709
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$100.90 |
| Max. Negotiated Rate |
$189.45 |
| Rate for Payer: Aetna Commercial |
$185.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.14
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$189.45
|
| Rate for Payer: Health EOS Commercial |
$183.27
|
| Rate for Payer: HFN Commercial |
$189.45
|
| Rate for Payer: Multiplan Commercial |
$164.74
|
| Rate for Payer: Preferred Network Access Commercial |
$189.45
|
| Rate for Payer: Quartz Beloit One Network |
$100.90
|
| Rate for Payer: Quartz Commercial |
$123.55
|
| Rate for Payer: WEA Trust Commercial |
$113.26
|
| Rate for Payer: WPS Commercial |
$152.52
|
|
|
Pulmonary Stress Test - 6 min walk - Pulmonary Function Test Charge
|
Facility
|
OP
|
$198.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
5381709
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$98.84 |
| Max. Negotiated Rate |
$560.06 |
| Rate for Payer: Aetna Commercial |
$185.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$177.09
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$133.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$102.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$98.84
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$109.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cash Price |
$59.40
|
| Rate for Payer: Cigna Commercial |
$189.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$183.27
|
| Rate for Payer: HFN Commercial |
$189.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$164.74
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$189.45
|
| Rate for Payer: Quartz Beloit One Network |
$100.90
|
| Rate for Payer: Quartz Commercial |
$133.85
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$154.44
|
| Rate for Payer: WEA Trust Commercial |
$113.26
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$152.52
|
|
|
Pulmonary Stress Testing 94618
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
1152824
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.63 |
| Max. Negotiated Rate |
$460.41 |
| Rate for Payer: Aetna Commercial |
$460.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$36.95
|
| Rate for Payer: Anthem Medicare Advantage |
$36.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.95
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$460.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.95
|
| Rate for Payer: Health EOS Commercial |
$441.02
|
| Rate for Payer: HFN Commercial |
$460.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$118.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$118.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.95
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$55.43
|
| Rate for Payer: Preferred Network Access Commercial |
$460.41
|
| Rate for Payer: Quartz Beloit One Network |
$213.24
|
| Rate for Payer: Quartz Commercial |
$276.24
|
| Rate for Payer: Quartz Medicare Advantage |
$36.95
|
| Rate for Payer: The Alliance Commercial |
$92.38
|
| Rate for Payer: United Healthcare Medicaid |
$27.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.95
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$147.80
|
|
|
Pulmonary Stress Test - Resp
|
Facility
|
IP
|
$1,137.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
4830606
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$579.42 |
| Max. Negotiated Rate |
$1,087.88 |
| Rate for Payer: Aetna Commercial |
$1,064.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$626.71
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cigna Commercial |
$1,087.88
|
| Rate for Payer: Health EOS Commercial |
$1,052.41
|
| Rate for Payer: HFN Commercial |
$1,087.88
|
| Rate for Payer: Multiplan Commercial |
$945.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,087.88
|
| Rate for Payer: Quartz Beloit One Network |
$579.42
|
| Rate for Payer: Quartz Commercial |
$709.49
|
| Rate for Payer: WEA Trust Commercial |
$650.36
|
| Rate for Payer: WPS Commercial |
$875.83
|
|
|
Pulmonary Stress Test - Resp
|
Facility
|
OP
|
$1,137.00
|
|
|
Service Code
|
CPT 94618
|
| Hospital Charge Code |
4830606
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$1,087.88 |
| Rate for Payer: Aetna Commercial |
$1,064.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,016.93
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$768.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$591.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$567.59
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$626.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cash Price |
$341.10
|
| Rate for Payer: Cigna Commercial |
$1,087.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$661.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$1,052.41
|
| Rate for Payer: HFN Commercial |
$1,087.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$945.98
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,087.88
|
| Rate for Payer: Quartz Beloit One Network |
$579.42
|
| Rate for Payer: Quartz Commercial |
$768.61
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: United Healthcare PPO |
$886.86
|
| Rate for Payer: WEA Trust Commercial |
$650.36
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$875.83
|
|
|
Pulmonary Stress Test/Simple 9461826
|
Professional
|
Both
|
$466.00
|
|
|
Service Code
|
CPT 94618 26
|
| Hospital Charge Code |
5366631
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$460.41 |
| Rate for Payer: Aetna Commercial |
$460.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$416.79
|
| Rate for Payer: Aetna Managed Medicare |
$22.86
|
| Rate for Payer: Anthem Medicare Advantage |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22.86
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cash Price |
$139.80
|
| Rate for Payer: Cigna Commercial |
$460.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.86
|
| Rate for Payer: Health EOS Commercial |
$441.02
|
| Rate for Payer: HFN Commercial |
$460.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22.86
|
| Rate for Payer: Multiplan Commercial |
$387.71
|
| Rate for Payer: NAPHCARE Commercial |
$34.29
|
| Rate for Payer: Preferred Network Access Commercial |
$460.41
|
| Rate for Payer: Quartz Beloit One Network |
$213.24
|
| Rate for Payer: Quartz Commercial |
$276.24
|
| Rate for Payer: Quartz Medicare Advantage |
$22.86
|
| Rate for Payer: The Alliance Commercial |
$57.15
|
| Rate for Payer: United Healthcare Medicaid |
$18.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22.86
|
| Rate for Payer: WEA Trust Commercial |
$266.55
|
| Rate for Payer: WPS Commercial |
$91.44
|
|
|
Pulse Oximetry Monitor - Daily Charges
|
Facility
|
IP
|
$958.00
|
|
| Hospital Charge Code |
3003956
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$488.20 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$597.79
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
Pulse Oximetry Monitor - Daily Charges
|
Facility
|
OP
|
$958.00
|
|
| Hospital Charge Code |
3003956
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$278.97 |
| Max. Negotiated Rate |
$916.61 |
| Rate for Payer: Aetna Commercial |
$896.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$856.84
|
| Rate for Payer: Aetna Managed Medicare |
$278.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$647.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$498.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$478.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$528.05
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$916.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$557.56
|
| Rate for Payer: Health EOS Commercial |
$886.72
|
| Rate for Payer: HFN Commercial |
$916.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$747.24
|
| Rate for Payer: Multiplan Commercial |
$797.06
|
| Rate for Payer: NAPHCARE Commercial |
$597.79
|
| Rate for Payer: Preferred Network Access Commercial |
$916.61
|
| Rate for Payer: Quartz Beloit One Network |
$488.20
|
| Rate for Payer: Quartz Commercial |
$647.61
|
| Rate for Payer: Quartz Medicare Advantage |
$597.79
|
| Rate for Payer: The Alliance Commercial |
$498.16
|
| Rate for Payer: WEA Trust Commercial |
$547.98
|
| Rate for Payer: WPS Commercial |
$737.95
|
|
|
Pulse Oximetry Monitor - Nursery Daily Charges
|
Facility
|
OP
|
$411.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
3003948
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$16.39 |
| Max. Negotiated Rate |
$393.24 |
| Rate for Payer: Aetna Commercial |
$384.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.60
|
| Rate for Payer: Aetna Managed Medicare |
$119.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$205.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.54
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna Commercial |
$393.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$380.42
|
| Rate for Payer: HFN Commercial |
$393.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.58
|
| Rate for Payer: Multiplan Commercial |
$341.95
|
| Rate for Payer: NAPHCARE Commercial |
$256.46
|
| Rate for Payer: Preferred Network Access Commercial |
$393.24
|
| Rate for Payer: Quartz Beloit One Network |
$209.45
|
| Rate for Payer: Quartz Commercial |
$277.84
|
| Rate for Payer: Quartz Medicare Advantage |
$256.46
|
| Rate for Payer: The Alliance Commercial |
$16.39
|
| Rate for Payer: United Healthcare PPO |
$320.58
|
| Rate for Payer: WEA Trust Commercial |
$235.09
|
| Rate for Payer: WPS Commercial |
$316.59
|
|
|
Pulse Oximetry Monitor - Nursery Daily Charges
|
Facility
|
IP
|
$411.00
|
|
|
Service Code
|
CPT 94761
|
| Hospital Charge Code |
3003948
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$209.45 |
| Max. Negotiated Rate |
$393.24 |
| Rate for Payer: Aetna Commercial |
$384.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.54
|
| Rate for Payer: Cash Price |
$123.30
|
| Rate for Payer: Cigna Commercial |
$393.24
|
| Rate for Payer: Health EOS Commercial |
$380.42
|
| Rate for Payer: HFN Commercial |
$393.24
|
| Rate for Payer: Multiplan Commercial |
$341.95
|
| Rate for Payer: Preferred Network Access Commercial |
$393.24
|
| Rate for Payer: Quartz Beloit One Network |
$209.45
|
| Rate for Payer: Quartz Commercial |
$256.46
|
| Rate for Payer: WEA Trust Commercial |
$235.09
|
| Rate for Payer: WPS Commercial |
$316.59
|
|
|
PUMP BOTTLE BIOFREEZE 32oz 081697408
|
Facility
|
OP
|
$598.00
|
|
| Hospital Charge Code |
2969785
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$174.14 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Aetna Managed Medicare |
$174.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$404.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$310.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$298.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.04
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$466.44
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: NAPHCARE Commercial |
$373.15
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$404.25
|
| Rate for Payer: Quartz Medicare Advantage |
$373.15
|
| Rate for Payer: The Alliance Commercial |
$310.96
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
PUMP BOTTLE BIOFREEZE 32oz 081697408
|
Facility
|
IP
|
$598.00
|
|
| Hospital Charge Code |
2969785
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$304.74 |
| Max. Negotiated Rate |
$572.17 |
| Rate for Payer: Aetna Commercial |
$559.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$534.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$329.62
|
| Rate for Payer: Cash Price |
$179.40
|
| Rate for Payer: Cigna Commercial |
$572.17
|
| Rate for Payer: Health EOS Commercial |
$553.51
|
| Rate for Payer: HFN Commercial |
$572.17
|
| Rate for Payer: Multiplan Commercial |
$497.54
|
| Rate for Payer: Preferred Network Access Commercial |
$572.17
|
| Rate for Payer: Quartz Beloit One Network |
$304.74
|
| Rate for Payer: Quartz Commercial |
$373.15
|
| Rate for Payer: WEA Trust Commercial |
$342.06
|
| Rate for Payer: WPS Commercial |
$460.64
|
|
|
PUMP MENDA PURE TOUCH LIQUED
|
Facility
|
IP
|
$5,137.00
|
|
| Hospital Charge Code |
2971453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,617.82 |
| Max. Negotiated Rate |
$4,915.08 |
| Rate for Payer: Aetna Commercial |
$4,808.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,594.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,831.51
|
| Rate for Payer: Cash Price |
$1,541.10
|
| Rate for Payer: Cigna Commercial |
$4,915.08
|
| Rate for Payer: Health EOS Commercial |
$4,754.81
|
| Rate for Payer: HFN Commercial |
$4,915.08
|
| Rate for Payer: Multiplan Commercial |
$4,273.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,915.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,617.82
|
| Rate for Payer: Quartz Commercial |
$3,205.49
|
| Rate for Payer: WEA Trust Commercial |
$2,938.36
|
| Rate for Payer: WPS Commercial |
$3,957.03
|
|
|
PUMP MENDA PURE TOUCH LIQUED
|
Facility
|
OP
|
$5,137.00
|
|
| Hospital Charge Code |
2971453
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,495.89 |
| Max. Negotiated Rate |
$4,915.08 |
| Rate for Payer: Aetna Commercial |
$4,808.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,594.53
|
| Rate for Payer: Aetna Managed Medicare |
$1,495.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,472.61
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,671.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,564.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,831.51
|
| Rate for Payer: Cash Price |
$1,541.10
|
| Rate for Payer: Cigna Commercial |
$4,915.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,989.73
|
| Rate for Payer: Health EOS Commercial |
$4,754.81
|
| Rate for Payer: HFN Commercial |
$4,915.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,006.86
|
| Rate for Payer: Multiplan Commercial |
$4,273.98
|
| Rate for Payer: NAPHCARE Commercial |
$3,205.49
|
| Rate for Payer: Preferred Network Access Commercial |
$4,915.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,617.82
|
| Rate for Payer: Quartz Commercial |
$3,472.61
|
| Rate for Payer: Quartz Medicare Advantage |
$3,205.49
|
| Rate for Payer: The Alliance Commercial |
$2,671.24
|
| Rate for Payer: WEA Trust Commercial |
$2,938.36
|
| Rate for Payer: WPS Commercial |
$3,957.03
|
|
|
PUMP SET POSITIVE W/PRE-PIERCD #W21137
|
Facility
|
OP
|
$272.00
|
|
| Hospital Charge Code |
2973133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.21 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Aetna Managed Medicare |
$79.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$183.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$141.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$158.30
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.16
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: NAPHCARE Commercial |
$169.73
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$183.87
|
| Rate for Payer: Quartz Medicare Advantage |
$169.73
|
| Rate for Payer: The Alliance Commercial |
$141.44
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
PUMP SET POSITIVE W/PRE-PIERCD #W21137
|
Facility
|
IP
|
$272.00
|
|
| Hospital Charge Code |
2973133
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$138.61 |
| Max. Negotiated Rate |
$260.25 |
| Rate for Payer: Aetna Commercial |
$254.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$243.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$149.93
|
| Rate for Payer: Cash Price |
$81.60
|
| Rate for Payer: Cigna Commercial |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$251.76
|
| Rate for Payer: HFN Commercial |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$226.30
|
| Rate for Payer: Preferred Network Access Commercial |
$260.25
|
| Rate for Payer: Quartz Beloit One Network |
$138.61
|
| Rate for Payer: Quartz Commercial |
$169.73
|
| Rate for Payer: WEA Trust Commercial |
$155.58
|
| Rate for Payer: WPS Commercial |
$209.52
|
|
|
PUMP TUBE ID3.2
|
Facility
|
OP
|
$577.00
|
|
| Hospital Charge Code |
2973553
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$168.02 |
| Max. Negotiated Rate |
$552.07 |
| Rate for Payer: Aetna Commercial |
$540.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$168.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$390.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$300.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$288.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$318.04
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$552.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$335.81
|
| Rate for Payer: Health EOS Commercial |
$534.07
|
| Rate for Payer: HFN Commercial |
$552.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$450.06
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$360.05
|
| Rate for Payer: Preferred Network Access Commercial |
$552.07
|
| Rate for Payer: Quartz Beloit One Network |
$294.04
|
| Rate for Payer: Quartz Commercial |
$390.05
|
| Rate for Payer: Quartz Medicare Advantage |
$360.05
|
| Rate for Payer: The Alliance Commercial |
$300.04
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$444.46
|
|
