|
SafeSheath 9Fr
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
2550960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.24 |
| Max. Negotiated Rate |
$304.95 |
| Rate for Payer: Aetna Commercial |
$304.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$304.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$192.60
|
| Rate for Payer: Health EOS Commercial |
$292.11
|
| Rate for Payer: HFN Commercial |
$304.95
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: Preferred Network Access Commercial |
$304.95
|
| Rate for Payer: Quartz Beloit One Network |
$141.24
|
| Rate for Payer: Quartz Commercial |
$182.97
|
| Rate for Payer: The Alliance Commercial |
$160.50
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
SafeSheath 9Fr
|
Facility
|
IP
|
$321.00
|
|
|
Service Code
|
HCPCS C1892
|
| Hospital Charge Code |
2550960
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.29 |
| Max. Negotiated Rate |
$295.32 |
| Rate for Payer: Aetna Commercial |
$288.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$170.13
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$295.32
|
| Rate for Payer: Health EOS Commercial |
$285.69
|
| Rate for Payer: HFN Commercial |
$295.32
|
| Rate for Payer: Multiplan Commercial |
$256.80
|
| Rate for Payer: NAPHCARE Commercial |
$192.60
|
| Rate for Payer: Preferred Network Access Commercial |
$295.32
|
| Rate for Payer: Quartz Beloit One Network |
$157.29
|
| Rate for Payer: Quartz Commercial |
$192.60
|
| Rate for Payer: WEA Trust Commercial |
$176.55
|
| Rate for Payer: WPS Commercial |
$237.76
|
|
|
SAFETY BLADE #10 BARD-PARKER 373910
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
5384676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
SAFETY BLADE #10 BARD-PARKER 373910
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
5384676
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
SAFETY BLADE #11 BARD-PARKER 373911
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
5384678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
SAFETY BLADE #11 BARD-PARKER 373911
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
5384678
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
SAFETY BLADE #15 BARD-PARKER 373915
|
Facility
|
IP
|
$44.00
|
|
| Hospital Charge Code |
5384677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$40.48 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$26.40
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
SAFETY BLADE #15 BARD-PARKER 373915
|
Facility
|
OP
|
$44.00
|
|
| Hospital Charge Code |
5384677
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$176.00 |
| Rate for Payer: Aetna Commercial |
$39.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.84
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.32
|
| Rate for Payer: Cash Price |
$13.20
|
| Rate for Payer: Cigna Commercial |
$40.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.62
|
| Rate for Payer: Health EOS Commercial |
$39.16
|
| Rate for Payer: HFN Commercial |
$40.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.00
|
| Rate for Payer: Multiplan Commercial |
$35.20
|
| Rate for Payer: NAPHCARE Commercial |
$26.40
|
| Rate for Payer: Preferred Network Access Commercial |
$40.48
|
| Rate for Payer: Quartz Beloit One Network |
$21.56
|
| Rate for Payer: Quartz Commercial |
$28.60
|
| Rate for Payer: Quartz Medicare Advantage |
$26.40
|
| Rate for Payer: The Alliance Commercial |
$176.00
|
| Rate for Payer: WEA Trust Commercial |
$24.20
|
| Rate for Payer: WPS Commercial |
$32.59
|
|
|
SAFETY PIN #3 STERILE PACK2 STAINLESS STEEL SKLAR 96-1668
|
Facility
|
OP
|
$45.86
|
|
| Hospital Charge Code |
6246180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$12.84 |
| Max. Negotiated Rate |
$183.44 |
| Rate for Payer: Aetna Commercial |
$41.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.44
|
| Rate for Payer: Aetna Managed Medicare |
$12.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.31
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cigna Commercial |
$42.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.66
|
| Rate for Payer: Health EOS Commercial |
$40.82
|
| Rate for Payer: HFN Commercial |
$42.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.40
|
| Rate for Payer: Multiplan Commercial |
$36.69
|
| Rate for Payer: NAPHCARE Commercial |
$27.52
|
| Rate for Payer: Preferred Network Access Commercial |
$42.19
|
| Rate for Payer: Quartz Beloit One Network |
$22.47
|
| Rate for Payer: Quartz Commercial |
$29.81
|
| Rate for Payer: Quartz Medicare Advantage |
$27.52
|
| Rate for Payer: The Alliance Commercial |
$183.44
|
| Rate for Payer: WEA Trust Commercial |
$25.22
|
| Rate for Payer: WPS Commercial |
$33.97
|
|
|
SAFETY PIN #3 STERILE PACK2 STAINLESS STEEL SKLAR 96-1668
|
Facility
|
IP
|
$45.86
|
|
| Hospital Charge Code |
6246180
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$22.47 |
| Max. Negotiated Rate |
$42.19 |
| Rate for Payer: Aetna Commercial |
$41.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24.31
|
| Rate for Payer: Cash Price |
$13.76
|
| Rate for Payer: Cigna Commercial |
$42.19
|
| Rate for Payer: Health EOS Commercial |
$40.82
|
| Rate for Payer: HFN Commercial |
$42.19
|
| Rate for Payer: Multiplan Commercial |
$36.69
|
| Rate for Payer: NAPHCARE Commercial |
$27.52
|
| Rate for Payer: Preferred Network Access Commercial |
$42.19
|
| Rate for Payer: Quartz Beloit One Network |
$22.47
|
| Rate for Payer: Quartz Commercial |
$27.52
|
| Rate for Payer: WEA Trust Commercial |
$25.22
|
| Rate for Payer: WPS Commercial |
$33.97
|
|
|
SAFETY PINS STAINLESS STEEL #2 STERILE 188744
|
Facility
|
OP
|
$64.06
|
|
| Hospital Charge Code |
6246201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17.94 |
| Max. Negotiated Rate |
$256.24 |
| Rate for Payer: Aetna Commercial |
$57.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.09
|
| Rate for Payer: Aetna Managed Medicare |
$17.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.95
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna Commercial |
$58.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.85
|
| Rate for Payer: Health EOS Commercial |
$57.01
|
| Rate for Payer: HFN Commercial |
$58.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.04
|
| Rate for Payer: Multiplan Commercial |
$51.25
|
| Rate for Payer: NAPHCARE Commercial |
$38.44
|
| Rate for Payer: Preferred Network Access Commercial |
$58.94
|
| Rate for Payer: Quartz Beloit One Network |
$31.39
|
| Rate for Payer: Quartz Commercial |
$41.64
|
| Rate for Payer: Quartz Medicare Advantage |
$38.44
|
| Rate for Payer: The Alliance Commercial |
$256.24
|
| Rate for Payer: WEA Trust Commercial |
$35.23
|
| Rate for Payer: WPS Commercial |
$47.45
|
|
|
SAFETY PINS STAINLESS STEEL #2 STERILE 188744
|
Facility
|
IP
|
$64.06
|
|
| Hospital Charge Code |
6246201
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$31.39 |
| Max. Negotiated Rate |
$58.94 |
| Rate for Payer: Aetna Commercial |
$57.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$55.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.95
|
| Rate for Payer: Cash Price |
$19.22
|
| Rate for Payer: Cigna Commercial |
$58.94
|
| Rate for Payer: Health EOS Commercial |
$57.01
|
| Rate for Payer: HFN Commercial |
$58.94
|
| Rate for Payer: Multiplan Commercial |
$51.25
|
| Rate for Payer: NAPHCARE Commercial |
$38.44
|
| Rate for Payer: Preferred Network Access Commercial |
$58.94
|
| Rate for Payer: Quartz Beloit One Network |
$31.39
|
| Rate for Payer: Quartz Commercial |
$38.44
|
| Rate for Payer: WEA Trust Commercial |
$35.23
|
| Rate for Payer: WPS Commercial |
$47.45
|
|
|
Salicylate Level
|
Facility
|
IP
|
$157.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
1037119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$76.93 |
| Max. Negotiated Rate |
$144.44 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$94.20
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Salicylate Level
|
Professional
|
Both
|
$157.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
1037119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.08 |
| Max. Negotiated Rate |
$149.15 |
| Rate for Payer: Aetna Commercial |
$149.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$149.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$78.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.20
|
| Rate for Payer: Health EOS Commercial |
$142.87
|
| Rate for Payer: HFN Commercial |
$149.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: Preferred Network Access Commercial |
$149.15
|
| Rate for Payer: Quartz Beloit One Network |
$69.08
|
| Rate for Payer: Quartz Commercial |
$89.49
|
| Rate for Payer: The Alliance Commercial |
$78.50
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Salicylate Level
|
Facility
|
IP
|
$163.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
633829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Salicylate Level
|
Facility
|
OP
|
$157.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
1037119
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$43.96 |
| Max. Negotiated Rate |
$628.00 |
| Rate for Payer: Aetna Commercial |
$141.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$135.02
|
| Rate for Payer: Aetna Managed Medicare |
$43.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$102.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$83.21
|
| Rate for Payer: Cash Price |
$47.10
|
| Rate for Payer: Cigna Commercial |
$144.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.86
|
| Rate for Payer: Health EOS Commercial |
$139.73
|
| Rate for Payer: HFN Commercial |
$144.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.75
|
| Rate for Payer: Multiplan Commercial |
$125.60
|
| Rate for Payer: NAPHCARE Commercial |
$94.20
|
| Rate for Payer: Preferred Network Access Commercial |
$144.44
|
| Rate for Payer: Quartz Beloit One Network |
$76.93
|
| Rate for Payer: Quartz Commercial |
$102.05
|
| Rate for Payer: Quartz Medicare Advantage |
$94.20
|
| Rate for Payer: The Alliance Commercial |
$628.00
|
| Rate for Payer: United Healthcare PPO |
$117.75
|
| Rate for Payer: WEA Trust Commercial |
$86.35
|
| Rate for Payer: WPS Commercial |
$116.29
|
|
|
Salicylate Level
|
Facility
|
OP
|
$163.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
633829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$45.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.21
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.25
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$97.80
|
| Rate for Payer: The Alliance Commercial |
$652.00
|
| Rate for Payer: United Healthcare PPO |
$122.25
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Salicylate Level
|
Professional
|
Both
|
$163.00
|
|
|
Service Code
|
CPT 80329
|
| Hospital Charge Code |
633829
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.72 |
| Max. Negotiated Rate |
$154.85 |
| Rate for Payer: Aetna Commercial |
$154.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$154.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.80
|
| Rate for Payer: Health EOS Commercial |
$148.33
|
| Rate for Payer: HFN Commercial |
$154.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: Preferred Network Access Commercial |
$154.85
|
| Rate for Payer: Quartz Beloit One Network |
$71.72
|
| Rate for Payer: Quartz Commercial |
$92.91
|
| Rate for Payer: The Alliance Commercial |
$81.50
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Salicylates Screen
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
2942882
|
|
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
|
|
|
Salicylates Screen
|
Professional
|
Both
|
$48.00
|
|
| Hospital Charge Code |
2942882
|
|
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
|
|
|
Salicylates Screen
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
2942882
|
|
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
|
|
|
SALIVARY GLAND PROCEDURES
|
Facility
|
IP
|
$31,897.00
|
|
|
Service Code
|
MSDRG 139
|
| Min. Negotiated Rate |
$11,473.59 |
| Max. Negotiated Rate |
$31,897.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,473.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,966.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,136.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,180.82
|
| Rate for Payer: Anthem Medicare Advantage |
$11,473.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,473.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,473.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,473.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,182.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,473.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,160.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,473.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,473.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,473.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,473.59
|
| Rate for Payer: NAPHCARE Commercial |
$17,210.38
|
| Rate for Payer: Quartz Medicare Advantage |
$11,473.59
|
| Rate for Payer: The Alliance Commercial |
$31,897.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,473.59
|
| Rate for Payer: United Healthcare PPO |
$18,030.47
|
| Rate for Payer: Wellcare Medicare |
$11,473.59
|
|
|
SALPINGO-OOPHORECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
SALPINGO-OOPHORECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960361
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
SalT
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
CPT 87147
|
| Hospital Charge Code |
297691
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$17.60 |
| Max. Negotiated Rate |
$38.00 |
| Rate for Payer: Aetna Commercial |
$38.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34.40
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.00
|
| Rate for Payer: Health EOS Commercial |
$36.40
|
| Rate for Payer: HFN Commercial |
$38.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.29
|
| Rate for Payer: Multiplan Commercial |
$32.00
|
| Rate for Payer: Preferred Network Access Commercial |
$38.00
|
| Rate for Payer: Quartz Beloit One Network |
$17.60
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$22.00
|
| Rate for Payer: WPS Commercial |
$29.63
|
|
