|
STENT WALLFLEX COLONIC 22 X 27MM 9CM 6511
|
Facility
|
OP
|
$14,613.00
|
|
| Hospital Charge Code |
3072502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,255.31 |
| Max. Negotiated Rate |
$13,981.72 |
| Rate for Payer: Aetna Commercial |
$13,677.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,069.87
|
| Rate for Payer: Aetna Managed Medicare |
$4,255.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,878.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,598.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,294.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,054.69
|
| Rate for Payer: Cash Price |
$4,383.90
|
| Rate for Payer: Cigna Commercial |
$13,981.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,504.77
|
| Rate for Payer: Health EOS Commercial |
$13,525.79
|
| Rate for Payer: HFN Commercial |
$13,981.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,398.14
|
| Rate for Payer: Multiplan Commercial |
$12,158.02
|
| Rate for Payer: NAPHCARE Commercial |
$9,118.51
|
| Rate for Payer: Preferred Network Access Commercial |
$13,981.72
|
| Rate for Payer: Quartz Beloit One Network |
$7,446.78
|
| Rate for Payer: Quartz Commercial |
$9,878.39
|
| Rate for Payer: Quartz Medicare Advantage |
$9,118.51
|
| Rate for Payer: The Alliance Commercial |
$7,598.76
|
| Rate for Payer: WEA Trust Commercial |
$8,358.64
|
| Rate for Payer: WPS Commercial |
$11,256.39
|
|
|
STENT WALLFLEX COLONIC 22 X 27MM 9CM 6511
|
Facility
|
IP
|
$14,613.00
|
|
| Hospital Charge Code |
3072502
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,446.78 |
| Max. Negotiated Rate |
$13,981.72 |
| Rate for Payer: Aetna Commercial |
$13,677.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,069.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,054.69
|
| Rate for Payer: Cash Price |
$4,383.90
|
| Rate for Payer: Cigna Commercial |
$13,981.72
|
| Rate for Payer: Health EOS Commercial |
$13,525.79
|
| Rate for Payer: HFN Commercial |
$13,981.72
|
| Rate for Payer: Multiplan Commercial |
$12,158.02
|
| Rate for Payer: Preferred Network Access Commercial |
$13,981.72
|
| Rate for Payer: Quartz Beloit One Network |
$7,446.78
|
| Rate for Payer: Quartz Commercial |
$9,118.51
|
| Rate for Payer: WEA Trust Commercial |
$8,358.64
|
| Rate for Payer: WPS Commercial |
$11,256.39
|
|
|
STER-DRAPE SMALL 24 X 14 DYNJSD1040
|
Facility
|
OP
|
$102.00
|
|
| Hospital Charge Code |
2963304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.70 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Aetna Managed Medicare |
$29.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.36
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$79.56
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: NAPHCARE Commercial |
$63.65
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$68.95
|
| Rate for Payer: Quartz Medicare Advantage |
$63.65
|
| Rate for Payer: The Alliance Commercial |
$53.04
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
STER-DRAPE SMALL 24 X 14 DYNJSD1040
|
Facility
|
IP
|
$102.00
|
|
| Hospital Charge Code |
2963304
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$51.98 |
| Max. Negotiated Rate |
$97.59 |
| Rate for Payer: Aetna Commercial |
$95.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$91.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.22
|
| Rate for Payer: Cash Price |
$30.60
|
| Rate for Payer: Cigna Commercial |
$97.59
|
| Rate for Payer: Health EOS Commercial |
$94.41
|
| Rate for Payer: HFN Commercial |
$97.59
|
| Rate for Payer: Multiplan Commercial |
$84.86
|
| Rate for Payer: Preferred Network Access Commercial |
$97.59
|
| Rate for Payer: Quartz Beloit One Network |
$51.98
|
| Rate for Payer: Quartz Commercial |
$63.65
|
| Rate for Payer: WEA Trust Commercial |
$58.34
|
| Rate for Payer: WPS Commercial |
$78.57
|
|
|
Stereotactic Body Radiation Delivery 77373
|
Professional
|
Both
|
$6,691.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
5430723
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$969.40 |
| Max. Negotiated Rate |
$6,610.71 |
| Rate for Payer: Aetna Commercial |
$6,610.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,984.43
|
| Rate for Payer: Aetna Managed Medicare |
$969.40
|
| Rate for Payer: Anthem Medicare Advantage |
$969.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$969.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$969.40
|
| Rate for Payer: Cash Price |
$2,007.30
|
| Rate for Payer: Cash Price |
$2,007.30
|
| Rate for Payer: Cash Price |
$2,007.30
|
| Rate for Payer: Cigna Commercial |
$6,610.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,479.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$969.40
|
| Rate for Payer: Health EOS Commercial |
$6,332.36
|
| Rate for Payer: HFN Commercial |
$6,610.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,035.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,035.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$969.40
|
| Rate for Payer: Multiplan Commercial |
$5,566.91
|
| Rate for Payer: NAPHCARE Commercial |
$1,454.11
|
| Rate for Payer: Preferred Network Access Commercial |
$6,610.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,061.80
|
| Rate for Payer: Quartz Commercial |
$3,966.42
|
| Rate for Payer: Quartz Medicare Advantage |
$969.40
|
| Rate for Payer: The Alliance Commercial |
$3,683.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$969.40
|
| Rate for Payer: WEA Trust Commercial |
$3,827.25
|
| Rate for Payer: WPS Commercial |
$4,847.02
|
|
|
Stereotactic Body Radiation Management 77435
|
Professional
|
Both
|
$8,637.00
|
|
|
Service Code
|
CPT 77435
|
| Hospital Charge Code |
5432657
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$635.04 |
| Max. Negotiated Rate |
$8,533.36 |
| Rate for Payer: Aetna Commercial |
$8,533.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,724.93
|
| Rate for Payer: Aetna Managed Medicare |
$635.04
|
| Rate for Payer: Anthem Medicare Advantage |
$635.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$635.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$635.04
|
| Rate for Payer: Cash Price |
$2,591.10
|
| Rate for Payer: Cash Price |
$2,591.10
|
| Rate for Payer: Cash Price |
$2,591.10
|
| Rate for Payer: Cigna Commercial |
$8,533.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,491.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.04
|
| Rate for Payer: Health EOS Commercial |
$8,174.06
|
| Rate for Payer: HFN Commercial |
$8,533.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,254.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,254.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$635.04
|
| Rate for Payer: Multiplan Commercial |
$7,185.98
|
| Rate for Payer: NAPHCARE Commercial |
$952.57
|
| Rate for Payer: Preferred Network Access Commercial |
$8,533.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,952.29
|
| Rate for Payer: Quartz Commercial |
$5,120.01
|
| Rate for Payer: Quartz Medicare Advantage |
$635.04
|
| Rate for Payer: The Alliance Commercial |
$2,413.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$635.04
|
| Rate for Payer: WEA Trust Commercial |
$4,940.36
|
| Rate for Payer: WPS Commercial |
$3,175.22
|
|
|
Stereotactic Body Radiation Therapy
|
Facility
|
IP
|
$12,381.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
3970755
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$6,309.36 |
| Max. Negotiated Rate |
$11,846.14 |
| Rate for Payer: Aetna Commercial |
$11,588.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,073.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,824.41
|
| Rate for Payer: Cash Price |
$3,714.30
|
| Rate for Payer: Cigna Commercial |
$11,846.14
|
| Rate for Payer: Health EOS Commercial |
$11,459.85
|
| Rate for Payer: HFN Commercial |
$11,846.14
|
| Rate for Payer: Multiplan Commercial |
$10,300.99
|
| Rate for Payer: Preferred Network Access Commercial |
$11,846.14
|
| Rate for Payer: Quartz Beloit One Network |
$6,309.36
|
| Rate for Payer: Quartz Commercial |
$7,725.74
|
| Rate for Payer: WEA Trust Commercial |
$7,081.93
|
| Rate for Payer: WPS Commercial |
$9,537.08
|
|
|
Stereotactic Body Radiation Therapy
|
Facility
|
OP
|
$12,381.00
|
|
|
Service Code
|
CPT 77373
|
| Hospital Charge Code |
3970755
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$1,881.72 |
| Max. Negotiated Rate |
$11,846.14 |
| Rate for Payer: Aetna Commercial |
$11,588.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,073.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,881.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,878.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,502.65
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,227.52
|
| Rate for Payer: Anthem Medicare Advantage |
$1,881.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,824.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,881.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,881.72
|
| Rate for Payer: Cash Price |
$3,714.30
|
| Rate for Payer: Cash Price |
$3,714.30
|
| Rate for Payer: Cigna Commercial |
$11,846.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,881.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,205.74
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,881.72
|
| Rate for Payer: Health EOS Commercial |
$11,459.85
|
| Rate for Payer: HFN Commercial |
$11,846.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,000.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,881.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,881.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,881.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,881.72
|
| Rate for Payer: Multiplan Commercial |
$10,300.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,822.59
|
| Rate for Payer: Preferred Network Access Commercial |
$11,846.14
|
| Rate for Payer: Quartz Beloit One Network |
$6,309.36
|
| Rate for Payer: Quartz Commercial |
$8,369.56
|
| Rate for Payer: Quartz Medicare Advantage |
$1,881.72
|
| Rate for Payer: The Alliance Commercial |
$7,526.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,881.72
|
| Rate for Payer: United Healthcare PPO |
$7,725.74
|
| Rate for Payer: WEA Trust Commercial |
$7,081.93
|
| Rate for Payer: Wellcare Medicare |
$1,881.72
|
| Rate for Payer: WPS Commercial |
$9,537.08
|
|
|
Stereotactic Cranial Linear Radiation Therapy
|
Facility
|
OP
|
$18,484.00
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
5586206
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$7,751.15 |
| Max. Negotiated Rate |
$31,004.60 |
| Rate for Payer: Aetna Commercial |
$17,301.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,532.09
|
| Rate for Payer: Aetna Managed Medicare |
$7,751.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,018.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,014.61
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,813.88
|
| Rate for Payer: Anthem Medicare Advantage |
$7,751.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,188.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,751.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,751.15
|
| Rate for Payer: Cash Price |
$5,545.20
|
| Rate for Payer: Cash Price |
$5,545.20
|
| Rate for Payer: Cigna Commercial |
$17,685.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,751.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,757.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,751.15
|
| Rate for Payer: Health EOS Commercial |
$17,108.79
|
| Rate for Payer: HFN Commercial |
$17,685.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,834.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,751.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,751.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,751.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,751.15
|
| Rate for Payer: Multiplan Commercial |
$15,378.69
|
| Rate for Payer: NAPHCARE Commercial |
$11,626.73
|
| Rate for Payer: Preferred Network Access Commercial |
$17,685.49
|
| Rate for Payer: Quartz Beloit One Network |
$9,419.45
|
| Rate for Payer: Quartz Commercial |
$12,495.18
|
| Rate for Payer: Quartz Medicare Advantage |
$7,751.15
|
| Rate for Payer: The Alliance Commercial |
$31,004.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,751.15
|
| Rate for Payer: United Healthcare PPO |
$11,534.02
|
| Rate for Payer: WEA Trust Commercial |
$10,572.85
|
| Rate for Payer: Wellcare Medicare |
$7,751.15
|
| Rate for Payer: WPS Commercial |
$14,238.23
|
|
|
Stereotactic Cranial Linear Radiation Therapy
|
Facility
|
IP
|
$18,484.00
|
|
|
Service Code
|
CPT 77372
|
| Hospital Charge Code |
5586206
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$9,419.45 |
| Max. Negotiated Rate |
$17,685.49 |
| Rate for Payer: Aetna Commercial |
$17,301.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,532.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,188.38
|
| Rate for Payer: Cash Price |
$5,545.20
|
| Rate for Payer: Cigna Commercial |
$17,685.49
|
| Rate for Payer: Health EOS Commercial |
$17,108.79
|
| Rate for Payer: HFN Commercial |
$17,685.49
|
| Rate for Payer: Multiplan Commercial |
$15,378.69
|
| Rate for Payer: Preferred Network Access Commercial |
$17,685.49
|
| Rate for Payer: Quartz Beloit One Network |
$9,419.45
|
| Rate for Payer: Quartz Commercial |
$11,534.02
|
| Rate for Payer: WEA Trust Commercial |
$10,572.85
|
| Rate for Payer: WPS Commercial |
$14,238.23
|
|
|
STEREOTACTIC RADIATION CRANIAL LESION TX MANAGEMENT 77432
|
Professional
|
Both
|
$5,762.00
|
|
|
Service Code
|
CPT 77432
|
| Hospital Charge Code |
5586200
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$420.12 |
| Max. Negotiated Rate |
$5,692.86 |
| Rate for Payer: Aetna Commercial |
$5,692.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,153.53
|
| Rate for Payer: Aetna Managed Medicare |
$420.12
|
| Rate for Payer: Anthem Medicare Advantage |
$420.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$420.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$420.12
|
| Rate for Payer: Cash Price |
$1,728.60
|
| Rate for Payer: Cash Price |
$1,728.60
|
| Rate for Payer: Cash Price |
$1,728.60
|
| Rate for Payer: Cigna Commercial |
$5,692.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,996.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$420.12
|
| Rate for Payer: Health EOS Commercial |
$5,453.16
|
| Rate for Payer: HFN Commercial |
$5,692.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,493.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,493.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$420.12
|
| Rate for Payer: Multiplan Commercial |
$4,793.98
|
| Rate for Payer: NAPHCARE Commercial |
$630.18
|
| Rate for Payer: Preferred Network Access Commercial |
$5,692.86
|
| Rate for Payer: Quartz Beloit One Network |
$2,636.69
|
| Rate for Payer: Quartz Commercial |
$3,415.71
|
| Rate for Payer: Quartz Medicare Advantage |
$420.12
|
| Rate for Payer: The Alliance Commercial |
$1,596.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$420.12
|
| Rate for Payer: WEA Trust Commercial |
$3,295.86
|
| Rate for Payer: WPS Commercial |
$2,100.59
|
|
|
STERI-DRAPE INCISE IOBAN 2 LG ISOLATION 27 X 12IN WITH POUCH 6619
|
Facility
|
OP
|
$991.00
|
|
| Hospital Charge Code |
2963200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$288.58 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Aetna Managed Medicare |
$288.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$669.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$515.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$494.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$576.76
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$772.98
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: NAPHCARE Commercial |
$618.38
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$669.92
|
| Rate for Payer: Quartz Medicare Advantage |
$618.38
|
| Rate for Payer: The Alliance Commercial |
$515.32
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
STERI-DRAPE INCISE IOBAN 2 LG ISOLATION 27 X 12IN WITH POUCH 6619
|
Facility
|
IP
|
$991.00
|
|
| Hospital Charge Code |
2963200
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$505.01 |
| Max. Negotiated Rate |
$948.19 |
| Rate for Payer: Aetna Commercial |
$927.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$886.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$546.24
|
| Rate for Payer: Cash Price |
$297.30
|
| Rate for Payer: Cigna Commercial |
$948.19
|
| Rate for Payer: Health EOS Commercial |
$917.27
|
| Rate for Payer: HFN Commercial |
$948.19
|
| Rate for Payer: Multiplan Commercial |
$824.51
|
| Rate for Payer: Preferred Network Access Commercial |
$948.19
|
| Rate for Payer: Quartz Beloit One Network |
$505.01
|
| Rate for Payer: Quartz Commercial |
$618.38
|
| Rate for Payer: WEA Trust Commercial |
$566.85
|
| Rate for Payer: WPS Commercial |
$763.37
|
|
|
STERI-DRAPE LARGE 23 X 33 1051
|
Facility
|
IP
|
$234.00
|
|
| Hospital Charge Code |
2963417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
STERI-DRAPE LARGE 23 X 33 1051
|
Facility
|
OP
|
$234.00
|
|
| Hospital Charge Code |
2963417
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.14 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$68.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$158.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$121.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$116.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.19
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$182.52
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$146.02
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$146.02
|
| Rate for Payer: The Alliance Commercial |
$121.68
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
STERILE BLANK LATEX FREE #AM897AM
|
Facility
|
OP
|
$83.00
|
|
| Hospital Charge Code |
2971737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.17 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Aetna Managed Medicare |
$24.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.31
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.74
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: NAPHCARE Commercial |
$51.79
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$56.11
|
| Rate for Payer: Quartz Medicare Advantage |
$51.79
|
| Rate for Payer: The Alliance Commercial |
$43.16
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
STERILE BLANK LATEX FREE #AM897AM
|
Facility
|
IP
|
$83.00
|
|
| Hospital Charge Code |
2971737
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.30 |
| Max. Negotiated Rate |
$79.41 |
| Rate for Payer: Aetna Commercial |
$77.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$74.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.75
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$79.41
|
| Rate for Payer: Health EOS Commercial |
$76.82
|
| Rate for Payer: HFN Commercial |
$79.41
|
| Rate for Payer: Multiplan Commercial |
$69.06
|
| Rate for Payer: Preferred Network Access Commercial |
$79.41
|
| Rate for Payer: Quartz Beloit One Network |
$42.30
|
| Rate for Payer: Quartz Commercial |
$51.79
|
| Rate for Payer: WEA Trust Commercial |
$47.48
|
| Rate for Payer: WPS Commercial |
$63.93
|
|
|
STERILE CONTAINER 0.9 SODIUM
|
Facility
|
OP
|
$864.00
|
|
| Hospital Charge Code |
2974006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.60 |
| Max. Negotiated Rate |
$826.68 |
| Rate for Payer: Aetna Commercial |
$808.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Aetna Managed Medicare |
$251.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$584.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$449.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$431.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$476.24
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$826.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$502.85
|
| Rate for Payer: Health EOS Commercial |
$799.72
|
| Rate for Payer: HFN Commercial |
$826.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$673.92
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: NAPHCARE Commercial |
$539.14
|
| Rate for Payer: Preferred Network Access Commercial |
$826.68
|
| Rate for Payer: Quartz Beloit One Network |
$440.29
|
| Rate for Payer: Quartz Commercial |
$584.06
|
| Rate for Payer: Quartz Medicare Advantage |
$539.14
|
| Rate for Payer: The Alliance Commercial |
$449.28
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$665.54
|
|
|
STERILE CONTAINER 0.9 SODIUM
|
Facility
|
IP
|
$864.00
|
|
| Hospital Charge Code |
2974006
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$440.29 |
| Max. Negotiated Rate |
$826.68 |
| Rate for Payer: Aetna Commercial |
$808.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$476.24
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$826.68
|
| Rate for Payer: Health EOS Commercial |
$799.72
|
| Rate for Payer: HFN Commercial |
$826.68
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: Preferred Network Access Commercial |
$826.68
|
| Rate for Payer: Quartz Beloit One Network |
$440.29
|
| Rate for Payer: Quartz Commercial |
$539.14
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$665.54
|
|
|
STERILE CUSTOM MED LATEX FREE #132174
|
Facility
|
IP
|
$70.00
|
|
| Hospital Charge Code |
2971974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.67 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
STERILE CUSTOM MED LATEX FREE #132174
|
Facility
|
OP
|
$70.00
|
|
| Hospital Charge Code |
2971974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$66.98 |
| Rate for Payer: Aetna Commercial |
$65.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$62.61
|
| Rate for Payer: Aetna Managed Medicare |
$20.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$36.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$34.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$38.58
|
| Rate for Payer: Cash Price |
$21.00
|
| Rate for Payer: Cigna Commercial |
$66.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.74
|
| Rate for Payer: Health EOS Commercial |
$64.79
|
| Rate for Payer: HFN Commercial |
$66.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.60
|
| Rate for Payer: Multiplan Commercial |
$58.24
|
| Rate for Payer: NAPHCARE Commercial |
$43.68
|
| Rate for Payer: Preferred Network Access Commercial |
$66.98
|
| Rate for Payer: Quartz Beloit One Network |
$35.67
|
| Rate for Payer: Quartz Commercial |
$47.32
|
| Rate for Payer: Quartz Medicare Advantage |
$43.68
|
| Rate for Payer: The Alliance Commercial |
$36.40
|
| Rate for Payer: WEA Trust Commercial |
$40.04
|
| Rate for Payer: WPS Commercial |
$53.92
|
|
|
STERIPACK SIDEKICK CORETRAK ARTICULATING XPCK1200
|
Facility
|
OP
|
$16,243.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,729.96 |
| Max. Negotiated Rate |
$15,541.30 |
| Rate for Payer: Aetna Commercial |
$15,203.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,527.74
|
| Rate for Payer: Aetna Managed Medicare |
$4,729.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,980.27
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,446.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,108.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,953.14
|
| Rate for Payer: Cash Price |
$4,872.90
|
| Rate for Payer: Cigna Commercial |
$15,541.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,453.43
|
| Rate for Payer: Health EOS Commercial |
$15,034.52
|
| Rate for Payer: HFN Commercial |
$15,541.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,669.54
|
| Rate for Payer: Multiplan Commercial |
$13,514.18
|
| Rate for Payer: NAPHCARE Commercial |
$10,135.63
|
| Rate for Payer: Preferred Network Access Commercial |
$15,541.30
|
| Rate for Payer: Quartz Beloit One Network |
$8,277.43
|
| Rate for Payer: Quartz Commercial |
$10,980.27
|
| Rate for Payer: Quartz Medicare Advantage |
$10,135.63
|
| Rate for Payer: The Alliance Commercial |
$8,446.36
|
| Rate for Payer: WEA Trust Commercial |
$9,291.00
|
| Rate for Payer: WPS Commercial |
$12,511.98
|
|
|
STERIPACK SIDEKICK CORETRAK ARTICULATING XPCK1200
|
Facility
|
IP
|
$16,243.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
6178282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,277.43 |
| Max. Negotiated Rate |
$15,541.30 |
| Rate for Payer: Aetna Commercial |
$15,203.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,527.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,953.14
|
| Rate for Payer: Cash Price |
$4,872.90
|
| Rate for Payer: Cigna Commercial |
$15,541.30
|
| Rate for Payer: Health EOS Commercial |
$15,034.52
|
| Rate for Payer: HFN Commercial |
$15,541.30
|
| Rate for Payer: Multiplan Commercial |
$13,514.18
|
| Rate for Payer: Preferred Network Access Commercial |
$15,541.30
|
| Rate for Payer: Quartz Beloit One Network |
$8,277.43
|
| Rate for Payer: Quartz Commercial |
$10,135.63
|
| Rate for Payer: WEA Trust Commercial |
$9,291.00
|
| Rate for Payer: WPS Commercial |
$12,511.98
|
|
|
STERI STRIP 1/2 X 4 R1547
|
Facility
|
OP
|
$54.00
|
|
| Hospital Charge Code |
2963545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$15.72 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$15.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.43
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.12
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$33.70
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$33.70
|
| Rate for Payer: The Alliance Commercial |
$28.08
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
STERI STRIP 1/2 X 4 R1547
|
Facility
|
IP
|
$54.00
|
|
| Hospital Charge Code |
2963545
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
