|
SMARTWIRE II XT (VOLCANO) 300cm #6613
|
Facility
|
OP
|
$5,035.00
|
|
| Hospital Charge Code |
2973639
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,466.19 |
| Max. Negotiated Rate |
$4,817.49 |
| Rate for Payer: Aetna Commercial |
$4,712.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,503.30
|
| Rate for Payer: Aetna Managed Medicare |
$1,466.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,403.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,618.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,513.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,775.29
|
| Rate for Payer: Cash Price |
$1,510.50
|
| Rate for Payer: Cigna Commercial |
$4,817.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,930.37
|
| Rate for Payer: Health EOS Commercial |
$4,660.40
|
| Rate for Payer: HFN Commercial |
$4,817.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,927.30
|
| Rate for Payer: Multiplan Commercial |
$4,189.12
|
| Rate for Payer: NAPHCARE Commercial |
$3,141.84
|
| Rate for Payer: Preferred Network Access Commercial |
$4,817.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,565.84
|
| Rate for Payer: Quartz Commercial |
$3,403.66
|
| Rate for Payer: Quartz Medicare Advantage |
$3,141.84
|
| Rate for Payer: The Alliance Commercial |
$2,618.20
|
| Rate for Payer: WEA Trust Commercial |
$2,880.02
|
| Rate for Payer: WPS Commercial |
$3,878.46
|
|
|
SMARTWIRE (VOLCANO) J-TIP 185cm 79034
|
Facility
|
OP
|
$6,407.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,865.72 |
| Max. Negotiated Rate |
$6,130.22 |
| Rate for Payer: Aetna Commercial |
$5,996.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,730.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,865.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,331.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,331.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,198.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,531.54
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$6,130.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,728.87
|
| Rate for Payer: Health EOS Commercial |
$5,930.32
|
| Rate for Payer: HFN Commercial |
$6,130.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,997.46
|
| Rate for Payer: Multiplan Commercial |
$5,330.62
|
| Rate for Payer: NAPHCARE Commercial |
$3,997.97
|
| Rate for Payer: Preferred Network Access Commercial |
$6,130.22
|
| Rate for Payer: Quartz Beloit One Network |
$3,265.01
|
| Rate for Payer: Quartz Commercial |
$4,331.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,997.97
|
| Rate for Payer: The Alliance Commercial |
$3,331.64
|
| Rate for Payer: WEA Trust Commercial |
$3,664.80
|
| Rate for Payer: WPS Commercial |
$4,935.31
|
|
|
SMARTWIRE (VOLCANO) J-TIP 185cm 79034
|
Facility
|
IP
|
$6,407.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973709
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,265.01 |
| Max. Negotiated Rate |
$6,130.22 |
| Rate for Payer: Aetna Commercial |
$5,996.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,730.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,531.54
|
| Rate for Payer: Cash Price |
$1,922.10
|
| Rate for Payer: Cigna Commercial |
$6,130.22
|
| Rate for Payer: Health EOS Commercial |
$5,930.32
|
| Rate for Payer: HFN Commercial |
$6,130.22
|
| Rate for Payer: Multiplan Commercial |
$5,330.62
|
| Rate for Payer: Preferred Network Access Commercial |
$6,130.22
|
| Rate for Payer: Quartz Beloit One Network |
$3,265.01
|
| Rate for Payer: Quartz Commercial |
$3,997.97
|
| Rate for Payer: WEA Trust Commercial |
$3,664.80
|
| Rate for Payer: WPS Commercial |
$4,935.31
|
|
|
SMARTWIRE (VOLCANO) J-TIP 300cm #7913J
|
Facility
|
OP
|
$5,445.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,585.58 |
| Max. Negotiated Rate |
$5,209.78 |
| Rate for Payer: Aetna Commercial |
$5,096.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,870.01
|
| Rate for Payer: Aetna Managed Medicare |
$1,585.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,680.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,831.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,718.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,001.28
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Cigna Commercial |
$5,209.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,168.99
|
| Rate for Payer: Health EOS Commercial |
$5,039.89
|
| Rate for Payer: HFN Commercial |
$5,209.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,247.10
|
| Rate for Payer: Multiplan Commercial |
$4,530.24
|
| Rate for Payer: NAPHCARE Commercial |
$3,397.68
|
| Rate for Payer: Preferred Network Access Commercial |
$5,209.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,774.77
|
| Rate for Payer: Quartz Commercial |
$3,680.82
|
| Rate for Payer: Quartz Medicare Advantage |
$3,397.68
|
| Rate for Payer: The Alliance Commercial |
$2,831.40
|
| Rate for Payer: WEA Trust Commercial |
$3,114.54
|
| Rate for Payer: WPS Commercial |
$4,194.28
|
|
|
SMARTWIRE (VOLCANO) J-TIP 300cm #7913J
|
Facility
|
IP
|
$5,445.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
2973657
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,774.77 |
| Max. Negotiated Rate |
$5,209.78 |
| Rate for Payer: Aetna Commercial |
$5,096.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,870.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,001.28
|
| Rate for Payer: Cash Price |
$1,633.50
|
| Rate for Payer: Cigna Commercial |
$5,209.78
|
| Rate for Payer: Health EOS Commercial |
$5,039.89
|
| Rate for Payer: HFN Commercial |
$5,209.78
|
| Rate for Payer: Multiplan Commercial |
$4,530.24
|
| Rate for Payer: Preferred Network Access Commercial |
$5,209.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,774.77
|
| Rate for Payer: Quartz Commercial |
$3,397.68
|
| Rate for Payer: WEA Trust Commercial |
$3,114.54
|
| Rate for Payer: WPS Commercial |
$4,194.28
|
|
|
SMIC-101
|
Facility
|
OP
|
$137.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
5313490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.93
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.00
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$92.61
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: United Healthcare PPO |
$106.86
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: Wellcare Medicare |
$9.00
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
SMIC-101
|
Facility
|
IP
|
$137.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
5313490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$69.82 |
| Max. Negotiated Rate |
$131.08 |
| Rate for Payer: Aetna Commercial |
$128.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.51
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$131.08
|
| Rate for Payer: Health EOS Commercial |
$126.81
|
| Rate for Payer: HFN Commercial |
$131.08
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: Preferred Network Access Commercial |
$131.08
|
| Rate for Payer: Quartz Beloit One Network |
$69.82
|
| Rate for Payer: Quartz Commercial |
$85.49
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$105.53
|
|
|
SMIC-101
|
Professional
|
Both
|
$137.00
|
|
|
Service Code
|
CPT 87186
|
| Hospital Charge Code |
5313490
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.00 |
| Max. Negotiated Rate |
$135.36 |
| Rate for Payer: Aetna Commercial |
$135.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.53
|
| Rate for Payer: Aetna Managed Medicare |
$9.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.00
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cash Price |
$41.10
|
| Rate for Payer: Cigna Commercial |
$135.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9.00
|
| Rate for Payer: Health EOS Commercial |
$129.66
|
| Rate for Payer: HFN Commercial |
$135.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$113.98
|
| Rate for Payer: NAPHCARE Commercial |
$13.49
|
| Rate for Payer: Preferred Network Access Commercial |
$135.36
|
| Rate for Payer: Quartz Beloit One Network |
$62.69
|
| Rate for Payer: Quartz Commercial |
$81.21
|
| Rate for Payer: Quartz Medicare Advantage |
$9.00
|
| Rate for Payer: The Alliance Commercial |
$35.53
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$78.36
|
| Rate for Payer: WPS Commercial |
$39.58
|
|
|
SMOKE EVAC SLEEVE 125MM FOR 4 IN ELECTRODE 0703-005-125
|
Facility
|
OP
|
$158.00
|
|
| Hospital Charge Code |
4520035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$46.01 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Aetna Managed Medicare |
$46.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$106.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.96
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.24
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: NAPHCARE Commercial |
$98.59
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$106.81
|
| Rate for Payer: Quartz Medicare Advantage |
$98.59
|
| Rate for Payer: The Alliance Commercial |
$82.16
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
SMOKE EVAC SLEEVE 125MM FOR 4 IN ELECTRODE 0703-005-125
|
Facility
|
IP
|
$158.00
|
|
| Hospital Charge Code |
4520035
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$80.52 |
| Max. Negotiated Rate |
$151.17 |
| Rate for Payer: Aetna Commercial |
$147.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$141.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$87.09
|
| Rate for Payer: Cash Price |
$47.40
|
| Rate for Payer: Cigna Commercial |
$151.17
|
| Rate for Payer: Health EOS Commercial |
$146.24
|
| Rate for Payer: HFN Commercial |
$151.17
|
| Rate for Payer: Multiplan Commercial |
$131.46
|
| Rate for Payer: Preferred Network Access Commercial |
$151.17
|
| Rate for Payer: Quartz Beloit One Network |
$80.52
|
| Rate for Payer: Quartz Commercial |
$98.59
|
| Rate for Payer: WEA Trust Commercial |
$90.38
|
| Rate for Payer: WPS Commercial |
$121.71
|
|
|
SMOKE EVAC SLEEVE 165MM FOR 6 IN ELECTRODE 0703-005-165
|
Facility
|
OP
|
$106.00
|
|
| Hospital Charge Code |
5685687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Aetna Managed Medicare |
$30.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.69
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.68
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: NAPHCARE Commercial |
$66.14
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$71.66
|
| Rate for Payer: Quartz Medicare Advantage |
$66.14
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
SMOKE EVAC SLEEVE 165MM FOR 6 IN ELECTRODE 0703-005-165
|
Facility
|
IP
|
$106.00
|
|
| Hospital Charge Code |
5685687
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$101.42 |
| Rate for Payer: Aetna Commercial |
$99.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$94.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.43
|
| Rate for Payer: Cash Price |
$31.80
|
| Rate for Payer: Cigna Commercial |
$101.42
|
| Rate for Payer: Health EOS Commercial |
$98.11
|
| Rate for Payer: HFN Commercial |
$101.42
|
| Rate for Payer: Multiplan Commercial |
$88.19
|
| Rate for Payer: Preferred Network Access Commercial |
$101.42
|
| Rate for Payer: Quartz Beloit One Network |
$54.02
|
| Rate for Payer: Quartz Commercial |
$66.14
|
| Rate for Payer: WEA Trust Commercial |
$60.63
|
| Rate for Payer: WPS Commercial |
$81.65
|
|
|
SMOKE EVACUATION SYSTEM LAPAROSCOPIC SC082500
|
Facility
|
IP
|
$85.00
|
|
| Hospital Charge Code |
5415099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.32 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
SMOKE EVACUATION SYSTEM LAPAROSCOPIC SC082500
|
Facility
|
OP
|
$85.00
|
|
| Hospital Charge Code |
5415099
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.75 |
| Max. Negotiated Rate |
$81.33 |
| Rate for Payer: Aetna Commercial |
$79.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.02
|
| Rate for Payer: Aetna Managed Medicare |
$24.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.85
|
| Rate for Payer: Cash Price |
$25.50
|
| Rate for Payer: Cigna Commercial |
$81.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.47
|
| Rate for Payer: Health EOS Commercial |
$78.68
|
| Rate for Payer: HFN Commercial |
$81.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.30
|
| Rate for Payer: Multiplan Commercial |
$70.72
|
| Rate for Payer: NAPHCARE Commercial |
$53.04
|
| Rate for Payer: Preferred Network Access Commercial |
$81.33
|
| Rate for Payer: Quartz Beloit One Network |
$43.32
|
| Rate for Payer: Quartz Commercial |
$57.46
|
| Rate for Payer: Quartz Medicare Advantage |
$53.04
|
| Rate for Payer: The Alliance Commercial |
$44.20
|
| Rate for Payer: WEA Trust Commercial |
$48.62
|
| Rate for Payer: WPS Commercial |
$65.48
|
|
|
SMOKE EVACUATOR VALLEYLAB LAPAROSCOPIC SEL7010
|
Facility
|
OP
|
$658.00
|
|
| Hospital Charge Code |
5641690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$191.61 |
| Max. Negotiated Rate |
$629.57 |
| Rate for Payer: Aetna Commercial |
$615.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.52
|
| Rate for Payer: Aetna Managed Medicare |
$191.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$444.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$342.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$328.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.69
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$629.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$382.96
|
| Rate for Payer: Health EOS Commercial |
$609.04
|
| Rate for Payer: HFN Commercial |
$629.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$513.24
|
| Rate for Payer: Multiplan Commercial |
$547.46
|
| Rate for Payer: NAPHCARE Commercial |
$410.59
|
| Rate for Payer: Preferred Network Access Commercial |
$629.57
|
| Rate for Payer: Quartz Beloit One Network |
$335.32
|
| Rate for Payer: Quartz Commercial |
$444.81
|
| Rate for Payer: Quartz Medicare Advantage |
$410.59
|
| Rate for Payer: The Alliance Commercial |
$342.16
|
| Rate for Payer: WEA Trust Commercial |
$376.38
|
| Rate for Payer: WPS Commercial |
$506.86
|
|
|
SMOKE EVACUATOR VALLEYLAB LAPAROSCOPIC SEL7010
|
Facility
|
IP
|
$658.00
|
|
| Hospital Charge Code |
5641690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$335.32 |
| Max. Negotiated Rate |
$629.57 |
| Rate for Payer: Aetna Commercial |
$615.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$588.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$362.69
|
| Rate for Payer: Cash Price |
$197.40
|
| Rate for Payer: Cigna Commercial |
$629.57
|
| Rate for Payer: Health EOS Commercial |
$609.04
|
| Rate for Payer: HFN Commercial |
$629.57
|
| Rate for Payer: Multiplan Commercial |
$547.46
|
| Rate for Payer: Preferred Network Access Commercial |
$629.57
|
| Rate for Payer: Quartz Beloit One Network |
$335.32
|
| Rate for Payer: Quartz Commercial |
$410.59
|
| Rate for Payer: WEA Trust Commercial |
$376.38
|
| Rate for Payer: WPS Commercial |
$506.86
|
|
|
Smoking Cessation 3-10 Min-Office
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
CPT 99406
|
| Hospital Charge Code |
1122844
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$10.55 |
| Max. Negotiated Rate |
$43.58 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$10.55
|
| Rate for Payer: Anthem Medicare Advantage |
$10.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.55
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$24.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.55
|
| Rate for Payer: Health EOS Commercial |
$23.66
|
| Rate for Payer: HFN Commercial |
$24.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.55
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$15.82
|
| Rate for Payer: Preferred Network Access Commercial |
$24.70
|
| Rate for Payer: Quartz Beloit One Network |
$11.44
|
| Rate for Payer: Quartz Commercial |
$14.82
|
| Rate for Payer: Quartz Medicare Advantage |
$10.55
|
| Rate for Payer: The Alliance Commercial |
$25.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.55
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$29.00
|
|
|
Smoking Cessation More Than10 Min-Office
|
Professional
|
Both
|
$80.00
|
|
|
Service Code
|
CPT 99407
|
| Hospital Charge Code |
1122845
|
|
Hospital Revenue Code
|
942
|
| Min. Negotiated Rate |
$21.79 |
| Max. Negotiated Rate |
$89.69 |
| Rate for Payer: Aetna Commercial |
$79.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.55
|
| Rate for Payer: Aetna Managed Medicare |
$21.79
|
| Rate for Payer: Anthem Medicare Advantage |
$21.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.79
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cash Price |
$24.00
|
| Rate for Payer: Cigna Commercial |
$79.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.79
|
| Rate for Payer: Health EOS Commercial |
$75.71
|
| Rate for Payer: HFN Commercial |
$79.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.79
|
| Rate for Payer: Multiplan Commercial |
$66.56
|
| Rate for Payer: NAPHCARE Commercial |
$32.68
|
| Rate for Payer: Preferred Network Access Commercial |
$79.04
|
| Rate for Payer: Quartz Beloit One Network |
$36.61
|
| Rate for Payer: Quartz Commercial |
$47.42
|
| Rate for Payer: Quartz Medicare Advantage |
$21.79
|
| Rate for Payer: The Alliance Commercial |
$52.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.79
|
| Rate for Payer: WEA Trust Commercial |
$45.76
|
| Rate for Payer: WPS Commercial |
$59.92
|
|
|
.Smooth Muscle Antibody Titer
|
Facility
|
OP
|
$214.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
978069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$144.66
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$166.92
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
.Smooth Muscle Antibody Titer
|
Professional
|
Both
|
$214.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
978069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$211.43 |
| Rate for Payer: Aetna Commercial |
$211.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$211.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$202.53
|
| Rate for Payer: HFN Commercial |
$211.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$211.43
|
| Rate for Payer: Quartz Beloit One Network |
$97.93
|
| Rate for Payer: Quartz Commercial |
$126.86
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
.Smooth Muscle Antibody Titer
|
Facility
|
IP
|
$214.00
|
|
|
Service Code
|
CPT 86256
|
| Hospital Charge Code |
978069
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$109.05 |
| Max. Negotiated Rate |
$204.76 |
| Rate for Payer: Aetna Commercial |
$200.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$191.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.96
|
| Rate for Payer: Cash Price |
$64.20
|
| Rate for Payer: Cigna Commercial |
$204.76
|
| Rate for Payer: Health EOS Commercial |
$198.08
|
| Rate for Payer: HFN Commercial |
$204.76
|
| Rate for Payer: Multiplan Commercial |
$178.05
|
| Rate for Payer: Preferred Network Access Commercial |
$204.76
|
| Rate for Payer: Quartz Beloit One Network |
$109.05
|
| Rate for Payer: Quartz Commercial |
$133.54
|
| Rate for Payer: WEA Trust Commercial |
$122.41
|
| Rate for Payer: WPS Commercial |
$164.84
|
|
|
Smooth Muscle Antibody w/ Rfx Titer
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
983406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
Smooth Muscle Antibody w/ Rfx Titer
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
983406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$203.58
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
Smooth Muscle Antibody w/ Rfx Titer
|
Professional
|
Both
|
$261.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
983406
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$257.87 |
| Rate for Payer: Aetna Commercial |
$257.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$257.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$247.01
|
| Rate for Payer: HFN Commercial |
$257.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$257.87
|
| Rate for Payer: Quartz Beloit One Network |
$119.43
|
| Rate for Payer: Quartz Commercial |
$154.72
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
Sm/RNP Antibody
|
Professional
|
Both
|
$47.00
|
|
|
Service Code
|
CPT 86235
|
| Hospital Charge Code |
5547022
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.65 |
| Max. Negotiated Rate |
$82.05 |
| Rate for Payer: Aetna Commercial |
$46.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.04
|
| Rate for Payer: Aetna Managed Medicare |
$18.65
|
| Rate for Payer: Anthem Medicare Advantage |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.65
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cash Price |
$14.10
|
| Rate for Payer: Cigna Commercial |
$46.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.65
|
| Rate for Payer: Health EOS Commercial |
$44.48
|
| Rate for Payer: HFN Commercial |
$46.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$65.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.65
|
| Rate for Payer: Multiplan Commercial |
$39.10
|
| Rate for Payer: NAPHCARE Commercial |
$27.97
|
| Rate for Payer: Preferred Network Access Commercial |
$46.44
|
| Rate for Payer: Quartz Beloit One Network |
$21.51
|
| Rate for Payer: Quartz Commercial |
$27.86
|
| Rate for Payer: Quartz Medicare Advantage |
$18.65
|
| Rate for Payer: The Alliance Commercial |
$73.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.65
|
| Rate for Payer: WEA Trust Commercial |
$26.88
|
| Rate for Payer: WPS Commercial |
$82.05
|
|
