|
SUTURE WASHER TITANIUM AR-7000-18T
|
Facility
|
OP
|
$2,291.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$641.48 |
| Max. Negotiated Rate |
$9,164.00 |
| Rate for Payer: Aetna Commercial |
$2,061.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,970.26
|
| Rate for Payer: Aetna Managed Medicare |
$641.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,489.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,145.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,099.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,214.23
|
| Rate for Payer: Cash Price |
$687.30
|
| Rate for Payer: Cigna Commercial |
$2,107.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,282.04
|
| Rate for Payer: Health EOS Commercial |
$2,038.99
|
| Rate for Payer: HFN Commercial |
$2,107.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,718.25
|
| Rate for Payer: Multiplan Commercial |
$1,832.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,374.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,107.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,122.59
|
| Rate for Payer: Quartz Commercial |
$1,489.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,374.60
|
| Rate for Payer: The Alliance Commercial |
$9,164.00
|
| Rate for Payer: WEA Trust Commercial |
$1,260.05
|
| Rate for Payer: WPS Commercial |
$1,696.94
|
|
|
SUTURING DEVICE CAPIO RP
|
Facility
|
OP
|
$2,747.00
|
|
| Hospital Charge Code |
2964823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$769.16 |
| Max. Negotiated Rate |
$10,988.00 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.42
|
| Rate for Payer: Aetna Managed Medicare |
$769.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,785.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,373.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,318.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,537.22
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,060.25
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,785.55
|
| Rate for Payer: Quartz Medicare Advantage |
$1,648.20
|
| Rate for Payer: The Alliance Commercial |
$10,988.00
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
SUTURING DEVICE CAPIO RP
|
Facility
|
IP
|
$2,747.00
|
|
| Hospital Charge Code |
2964823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,346.03 |
| Max. Negotiated Rate |
$2,527.24 |
| Rate for Payer: Aetna Commercial |
$2,472.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,362.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,455.91
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,527.24
|
| Rate for Payer: Health EOS Commercial |
$2,444.83
|
| Rate for Payer: HFN Commercial |
$2,527.24
|
| Rate for Payer: Multiplan Commercial |
$2,197.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,648.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,527.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,346.03
|
| Rate for Payer: Quartz Commercial |
$1,648.20
|
| Rate for Payer: WEA Trust Commercial |
$1,510.85
|
| Rate for Payer: WPS Commercial |
$2,034.70
|
|
|
S viridis
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.76
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$51.52
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$78.75
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
S viridis
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$99.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63.00
|
| Rate for Payer: Health EOS Commercial |
$95.55
|
| Rate for Payer: HFN Commercial |
$99.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$99.75
|
| Rate for Payer: Quartz Beloit One Network |
$46.20
|
| Rate for Payer: Quartz Commercial |
$59.85
|
| Rate for Payer: The Alliance Commercial |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
S viridis
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
SWAB BETADINE SWABSTICKS #3 S41125
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
2963995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
SWAB BETADINE SWABSTICKS #3 S41125
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
2963995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$1.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
SWAB CHLORAPREP 3 ML CLEAR
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2974452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
SWAB CHLORAPREP 3 ML CLEAR
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2974452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
SWAB SKIN PREP NON STING
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS A5120
|
| Hospital Charge Code |
2962916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.64 |
| Max. Negotiated Rate |
$152.00 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Aetna Managed Medicare |
$10.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.26
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28.50
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$24.70
|
| Rate for Payer: Quartz Medicare Advantage |
$22.80
|
| Rate for Payer: The Alliance Commercial |
$152.00
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
SWAB SKIN PREP NON STING
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS A5120
|
| Hospital Charge Code |
2962916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.62 |
| Max. Negotiated Rate |
$34.96 |
| Rate for Payer: Aetna Commercial |
$34.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.14
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$34.96
|
| Rate for Payer: Health EOS Commercial |
$33.82
|
| Rate for Payer: HFN Commercial |
$34.96
|
| Rate for Payer: Multiplan Commercial |
$30.40
|
| Rate for Payer: NAPHCARE Commercial |
$22.80
|
| Rate for Payer: Preferred Network Access Commercial |
$34.96
|
| Rate for Payer: Quartz Beloit One Network |
$18.62
|
| Rate for Payer: Quartz Commercial |
$22.80
|
| Rate for Payer: WEA Trust Commercial |
$20.90
|
| Rate for Payer: WPS Commercial |
$28.15
|
|
|
SWABS SUCTION SYSTEM 6552
|
Facility
|
IP
|
$276.00
|
|
| Hospital Charge Code |
2963001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
SWABS SUCTION SYSTEM 6552
|
Facility
|
OP
|
$276.00
|
|
| Hospital Charge Code |
2963001
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.28 |
| Max. Negotiated Rate |
$1,104.00 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$77.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$179.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.45
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.00
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: Quartz Medicare Advantage |
$165.60
|
| Rate for Payer: The Alliance Commercial |
$1,104.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
SWABS SUCTION SYSTEM W/ CHG 6914
|
Facility
|
OP
|
$485.00
|
|
| Hospital Charge Code |
2962919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$135.80 |
| Max. Negotiated Rate |
$1,940.00 |
| Rate for Payer: Aetna Commercial |
$436.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.10
|
| Rate for Payer: Aetna Managed Medicare |
$135.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$315.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$242.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$232.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.05
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$446.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.41
|
| Rate for Payer: Health EOS Commercial |
$431.65
|
| Rate for Payer: HFN Commercial |
$446.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$363.75
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: NAPHCARE Commercial |
$291.00
|
| Rate for Payer: Preferred Network Access Commercial |
$446.20
|
| Rate for Payer: Quartz Beloit One Network |
$237.65
|
| Rate for Payer: Quartz Commercial |
$315.25
|
| Rate for Payer: Quartz Medicare Advantage |
$291.00
|
| Rate for Payer: The Alliance Commercial |
$1,940.00
|
| Rate for Payer: WEA Trust Commercial |
$266.75
|
| Rate for Payer: WPS Commercial |
$359.24
|
|
|
SWABS SUCTION SYSTEM W/ CHG 6914
|
Facility
|
IP
|
$485.00
|
|
| Hospital Charge Code |
2962919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$237.65 |
| Max. Negotiated Rate |
$446.20 |
| Rate for Payer: Aetna Commercial |
$436.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$417.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$257.05
|
| Rate for Payer: Cash Price |
$145.50
|
| Rate for Payer: Cigna Commercial |
$446.20
|
| Rate for Payer: Health EOS Commercial |
$431.65
|
| Rate for Payer: HFN Commercial |
$446.20
|
| Rate for Payer: Multiplan Commercial |
$388.00
|
| Rate for Payer: NAPHCARE Commercial |
$291.00
|
| Rate for Payer: Preferred Network Access Commercial |
$446.20
|
| Rate for Payer: Quartz Beloit One Network |
$237.65
|
| Rate for Payer: Quartz Commercial |
$291.00
|
| Rate for Payer: WEA Trust Commercial |
$266.75
|
| Rate for Payer: WPS Commercial |
$359.24
|
|
|
Swallow Therapy Treatment
|
Facility
|
IP
|
$616.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
5184733
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$301.84 |
| Max. Negotiated Rate |
$566.72 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Health EOS Commercial |
$548.24
|
| Rate for Payer: HFN Commercial |
$566.72
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: NAPHCARE Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.72
|
| Rate for Payer: Quartz Beloit One Network |
$301.84
|
| Rate for Payer: Quartz Commercial |
$369.60
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
Swallow Therapy Treatment
|
Facility
|
OP
|
$616.00
|
|
|
Service Code
|
CPT 92526 GN
|
| Hospital Charge Code |
5184733
|
|
Hospital Revenue Code
|
440
|
| Min. Negotiated Rate |
$172.48 |
| Max. Negotiated Rate |
$2,464.00 |
| Rate for Payer: Aetna Commercial |
$554.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.76
|
| Rate for Payer: Aetna Managed Medicare |
$172.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$326.48
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cash Price |
$184.80
|
| Rate for Payer: Cigna Commercial |
$566.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$344.71
|
| Rate for Payer: Health EOS Commercial |
$548.24
|
| Rate for Payer: HFN Commercial |
$566.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.00
|
| Rate for Payer: Multiplan Commercial |
$492.80
|
| Rate for Payer: NAPHCARE Commercial |
$369.60
|
| Rate for Payer: Preferred Network Access Commercial |
$566.72
|
| Rate for Payer: Quartz Beloit One Network |
$301.84
|
| Rate for Payer: Quartz Commercial |
$400.40
|
| Rate for Payer: Quartz Medicare Advantage |
$369.60
|
| Rate for Payer: The Alliance Commercial |
$2,464.00
|
| Rate for Payer: United Healthcare PPO |
$462.00
|
| Rate for Payer: WEA Trust Commercial |
$338.80
|
| Rate for Payer: WPS Commercial |
$456.27
|
|
|
SWEA 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutan
|
Facility
|
IP
|
$543.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
3147641
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$266.07 |
| Max. Negotiated Rate |
$499.56 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$325.80
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$325.80
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
SWEA 10060 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis, cutan
|
Facility
|
OP
|
$543.00
|
|
|
Service Code
|
CPT 10060
|
| Hospital Charge Code |
3147641
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$488.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$466.98
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$271.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.64
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cash Price |
$162.90
|
| Rate for Payer: Cigna Commercial |
$499.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$483.27
|
| Rate for Payer: HFN Commercial |
$499.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$434.40
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$499.56
|
| Rate for Payer: Quartz Beloit One Network |
$266.07
|
| Rate for Payer: Quartz Commercial |
$352.95
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: WEA Trust Commercial |
$298.65
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$402.20
|
|
|
SWEA 10061 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis
|
Facility
|
IP
|
$887.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
3147642
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$434.63 |
| Max. Negotiated Rate |
$816.04 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.11
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cigna Commercial |
$816.04
|
| Rate for Payer: Health EOS Commercial |
$789.43
|
| Rate for Payer: HFN Commercial |
$816.04
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: NAPHCARE Commercial |
$532.20
|
| Rate for Payer: Preferred Network Access Commercial |
$816.04
|
| Rate for Payer: Quartz Beloit One Network |
$434.63
|
| Rate for Payer: Quartz Commercial |
$532.20
|
| Rate for Payer: WEA Trust Commercial |
$487.85
|
| Rate for Payer: WPS Commercial |
$657.00
|
|
|
SWEA 10061 Incision and drainage of abscess (eg, carbuncle, suppurative hidradenitis
|
Facility
|
OP
|
$887.00
|
|
|
Service Code
|
CPT 10061
|
| Hospital Charge Code |
3147642
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$394.12 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$762.82
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$576.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$443.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$425.76
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$470.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cash Price |
$266.10
|
| Rate for Payer: Cigna Commercial |
$816.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$789.43
|
| Rate for Payer: HFN Commercial |
$816.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$709.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$816.04
|
| Rate for Payer: Quartz Beloit One Network |
$434.63
|
| Rate for Payer: Quartz Commercial |
$576.55
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$1,576.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: WEA Trust Commercial |
$487.85
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$657.00
|
|
|
SWEA 10160 Puncture aspiration of abscess, hematoma, bulla, or cyst
|
Facility
|
IP
|
$522.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
3147648
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$255.78 |
| Max. Negotiated Rate |
$480.24 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.66
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$480.24
|
| Rate for Payer: Health EOS Commercial |
$464.58
|
| Rate for Payer: HFN Commercial |
$480.24
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: NAPHCARE Commercial |
$313.20
|
| Rate for Payer: Preferred Network Access Commercial |
$480.24
|
| Rate for Payer: Quartz Beloit One Network |
$255.78
|
| Rate for Payer: Quartz Commercial |
$313.20
|
| Rate for Payer: WEA Trust Commercial |
$287.10
|
| Rate for Payer: WPS Commercial |
$386.65
|
|
|
SWEA 10160 Puncture aspiration of abscess, hematoma, bulla, or cyst
|
Facility
|
OP
|
$522.00
|
|
|
Service Code
|
CPT 10160
|
| Hospital Charge Code |
3147648
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$250.56 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$469.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.92
|
| Rate for Payer: Aetna Managed Medicare |
$394.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.56
|
| Rate for Payer: Anthem Medicare Advantage |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$394.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$394.12
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cash Price |
$156.60
|
| Rate for Payer: Cigna Commercial |
$480.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$394.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$394.12
|
| Rate for Payer: Health EOS Commercial |
$464.58
|
| Rate for Payer: HFN Commercial |
$480.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,466.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$394.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$394.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$394.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$394.12
|
| Rate for Payer: Multiplan Commercial |
$417.60
|
| Rate for Payer: NAPHCARE Commercial |
$591.18
|
| Rate for Payer: Preferred Network Access Commercial |
$480.24
|
| Rate for Payer: Quartz Beloit One Network |
$255.78
|
| Rate for Payer: Quartz Commercial |
$339.30
|
| Rate for Payer: Quartz Medicare Advantage |
$394.12
|
| Rate for Payer: The Alliance Commercial |
$1,576.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$394.12
|
| Rate for Payer: WEA Trust Commercial |
$287.10
|
| Rate for Payer: Wellcare Medicare |
$394.12
|
| Rate for Payer: WPS Commercial |
$386.65
|
|
|
SWEA 12001 Simple repair of superficial wounds of scalp, neck, axillae, external genitalia,
|
Facility
|
OP
|
$502.00
|
|
|
Service Code
|
CPT 12001
|
| Hospital Charge Code |
3147668
|
|
Hospital Revenue Code
|
516
|
| Min. Negotiated Rate |
$197.88 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Aetna Managed Medicare |
$197.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.96
|
| Rate for Payer: Anthem Medicare Advantage |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$197.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$197.88
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$197.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$197.88
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$736.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$197.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$197.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$197.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$197.88
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$296.82
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$326.30
|
| Rate for Payer: Quartz Medicare Advantage |
$197.88
|
| Rate for Payer: The Alliance Commercial |
$791.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$197.88
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: Wellcare Medicare |
$197.88
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
