|
SUTURE TIGERSTICK #2 AR-7209T
|
Facility
|
IP
|
$1,306.00
|
|
| Hospital Charge Code |
5307085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$665.54 |
| Max. Negotiated Rate |
$1,249.58 |
| Rate for Payer: Aetna Commercial |
$1,222.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,168.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.87
|
| Rate for Payer: Cash Price |
$391.80
|
| Rate for Payer: Cigna Commercial |
$1,249.58
|
| Rate for Payer: Health EOS Commercial |
$1,208.83
|
| Rate for Payer: HFN Commercial |
$1,249.58
|
| Rate for Payer: Multiplan Commercial |
$1,086.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,249.58
|
| Rate for Payer: Quartz Beloit One Network |
$665.54
|
| Rate for Payer: Quartz Commercial |
$814.94
|
| Rate for Payer: WEA Trust Commercial |
$747.03
|
| Rate for Payer: WPS Commercial |
$1,006.01
|
|
|
SUTURE TIGERSTICK #2 AR-7209T
|
Facility
|
OP
|
$1,306.00
|
|
| Hospital Charge Code |
5307085
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.31 |
| Max. Negotiated Rate |
$1,249.58 |
| Rate for Payer: Aetna Commercial |
$1,222.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,168.09
|
| Rate for Payer: Aetna Managed Medicare |
$380.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$882.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$679.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$651.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.87
|
| Rate for Payer: Cash Price |
$391.80
|
| Rate for Payer: Cigna Commercial |
$1,249.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$760.09
|
| Rate for Payer: Health EOS Commercial |
$1,208.83
|
| Rate for Payer: HFN Commercial |
$1,249.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,018.68
|
| Rate for Payer: Multiplan Commercial |
$1,086.59
|
| Rate for Payer: NAPHCARE Commercial |
$814.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,249.58
|
| Rate for Payer: Quartz Beloit One Network |
$665.54
|
| Rate for Payer: Quartz Commercial |
$882.86
|
| Rate for Payer: Quartz Medicare Advantage |
$814.94
|
| Rate for Payer: The Alliance Commercial |
$679.12
|
| Rate for Payer: WEA Trust Commercial |
$747.03
|
| Rate for Payer: WPS Commercial |
$1,006.01
|
|
|
SUTURE TIGHTROPE TWIN TAIL
|
Facility
|
IP
|
$5,263.00
|
|
| Hospital Charge Code |
2964704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,682.02 |
| Max. Negotiated Rate |
$5,035.64 |
| Rate for Payer: Aetna Commercial |
$4,926.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,900.97
|
| Rate for Payer: Cash Price |
$1,578.90
|
| Rate for Payer: Cigna Commercial |
$5,035.64
|
| Rate for Payer: Health EOS Commercial |
$4,871.43
|
| Rate for Payer: HFN Commercial |
$5,035.64
|
| Rate for Payer: Multiplan Commercial |
$4,378.82
|
| Rate for Payer: Preferred Network Access Commercial |
$5,035.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.02
|
| Rate for Payer: Quartz Commercial |
$3,284.11
|
| Rate for Payer: WEA Trust Commercial |
$3,010.44
|
| Rate for Payer: WPS Commercial |
$4,054.09
|
|
|
SUTURE TIGHTROPE TWIN TAIL
|
Facility
|
OP
|
$5,263.00
|
|
| Hospital Charge Code |
2964704
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,532.59 |
| Max. Negotiated Rate |
$5,035.64 |
| Rate for Payer: Aetna Commercial |
$4,926.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,707.23
|
| Rate for Payer: Aetna Managed Medicare |
$1,532.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,557.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,736.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,627.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,900.97
|
| Rate for Payer: Cash Price |
$1,578.90
|
| Rate for Payer: Cigna Commercial |
$5,035.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,063.07
|
| Rate for Payer: Health EOS Commercial |
$4,871.43
|
| Rate for Payer: HFN Commercial |
$5,035.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,105.14
|
| Rate for Payer: Multiplan Commercial |
$4,378.82
|
| Rate for Payer: NAPHCARE Commercial |
$3,284.11
|
| Rate for Payer: Preferred Network Access Commercial |
$5,035.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,682.02
|
| Rate for Payer: Quartz Commercial |
$3,557.79
|
| Rate for Payer: Quartz Medicare Advantage |
$3,284.11
|
| Rate for Payer: The Alliance Commercial |
$2,736.76
|
| Rate for Payer: WEA Trust Commercial |
$3,010.44
|
| Rate for Payer: WPS Commercial |
$4,054.09
|
|
|
SUTURE UMBILICAL TAPE U11T
|
Facility
|
OP
|
$75.00
|
|
| Hospital Charge Code |
2965759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$21.84 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Aetna Managed Medicare |
$21.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.65
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.50
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: NAPHCARE Commercial |
$46.80
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$50.70
|
| Rate for Payer: Quartz Medicare Advantage |
$46.80
|
| Rate for Payer: The Alliance Commercial |
$39.00
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE UMBILICAL TAPE U11T
|
Facility
|
IP
|
$75.00
|
|
| Hospital Charge Code |
2965759
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.22 |
| Max. Negotiated Rate |
$71.76 |
| Rate for Payer: Aetna Commercial |
$70.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$67.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$41.34
|
| Rate for Payer: Cash Price |
$22.50
|
| Rate for Payer: Cigna Commercial |
$71.76
|
| Rate for Payer: Health EOS Commercial |
$69.42
|
| Rate for Payer: HFN Commercial |
$71.76
|
| Rate for Payer: Multiplan Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$71.76
|
| Rate for Payer: Quartz Beloit One Network |
$38.22
|
| Rate for Payer: Quartz Commercial |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$42.90
|
| Rate for Payer: WPS Commercial |
$57.77
|
|
|
SUTURE VICRYL 4-0 J422H
|
Facility
|
IP
|
$88.00
|
|
| Hospital Charge Code |
2974771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$44.84 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$54.91
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE VICRYL 4-0 J422H
|
Facility
|
OP
|
$88.00
|
|
| Hospital Charge Code |
2974771
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.63 |
| Max. Negotiated Rate |
$84.20 |
| Rate for Payer: Aetna Commercial |
$82.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$25.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$59.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$48.51
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$84.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.22
|
| Rate for Payer: Health EOS Commercial |
$81.45
|
| Rate for Payer: HFN Commercial |
$84.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.64
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$84.20
|
| Rate for Payer: Quartz Beloit One Network |
$44.84
|
| Rate for Payer: Quartz Commercial |
$59.49
|
| Rate for Payer: Quartz Medicare Advantage |
$54.91
|
| Rate for Payer: The Alliance Commercial |
$45.76
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$67.79
|
|
|
SUTURE VICRYL 6-0 J492G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE VICRYL 6-0 J492G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE VICRYL 6-0 J499G
|
Facility
|
IP
|
$111.00
|
|
| Hospital Charge Code |
2974690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
SUTURE VICRYL 6-0 J499G
|
Facility
|
OP
|
$111.00
|
|
| Hospital Charge Code |
2974690
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.32 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.60
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$57.72
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
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 |
$667.14 |
| Max. Negotiated Rate |
$2,192.03 |
| Rate for Payer: Aetna Commercial |
$2,144.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,049.07
|
| Rate for Payer: Aetna Managed Medicare |
$667.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,548.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,191.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,143.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,262.80
|
| Rate for Payer: Cash Price |
$687.30
|
| Rate for Payer: Cigna Commercial |
$2,192.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,333.36
|
| Rate for Payer: Health EOS Commercial |
$2,120.55
|
| Rate for Payer: HFN Commercial |
$2,192.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,786.98
|
| Rate for Payer: Multiplan Commercial |
$1,906.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,429.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,192.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,167.49
|
| Rate for Payer: Quartz Commercial |
$1,548.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,429.58
|
| Rate for Payer: The Alliance Commercial |
$1,191.32
|
| Rate for Payer: WEA Trust Commercial |
$1,310.45
|
| Rate for Payer: WPS Commercial |
$1,764.76
|
|
|
SUTURE WASHER TITANIUM AR-7000-18T
|
Facility
|
IP
|
$2,291.00
|
|
|
Service Code
|
HCPCS C1713
|
| Hospital Charge Code |
5617711
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,167.49 |
| Max. Negotiated Rate |
$2,192.03 |
| Rate for Payer: Aetna Commercial |
$2,144.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,049.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,262.80
|
| Rate for Payer: Cash Price |
$687.30
|
| Rate for Payer: Cigna Commercial |
$2,192.03
|
| Rate for Payer: Health EOS Commercial |
$2,120.55
|
| Rate for Payer: HFN Commercial |
$2,192.03
|
| Rate for Payer: Multiplan Commercial |
$1,906.11
|
| Rate for Payer: Preferred Network Access Commercial |
$2,192.03
|
| Rate for Payer: Quartz Beloit One Network |
$1,167.49
|
| Rate for Payer: Quartz Commercial |
$1,429.58
|
| Rate for Payer: WEA Trust Commercial |
$1,310.45
|
| Rate for Payer: WPS Commercial |
$1,764.76
|
|
|
SUTURING DEVICE CAPIO RP
|
Facility
|
IP
|
$2,747.00
|
|
| Hospital Charge Code |
2964823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.87 |
| Max. Negotiated Rate |
$2,628.33 |
| Rate for Payer: Aetna Commercial |
$2,571.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,456.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,514.15
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,628.33
|
| Rate for Payer: Health EOS Commercial |
$2,542.62
|
| Rate for Payer: HFN Commercial |
$2,628.33
|
| Rate for Payer: Multiplan Commercial |
$2,285.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,628.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,399.87
|
| Rate for Payer: Quartz Commercial |
$1,714.13
|
| Rate for Payer: WEA Trust Commercial |
$1,571.28
|
| Rate for Payer: WPS Commercial |
$2,116.01
|
|
|
SUTURING DEVICE CAPIO RP
|
Facility
|
OP
|
$2,747.00
|
|
| Hospital Charge Code |
2964823
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$799.93 |
| Max. Negotiated Rate |
$2,628.33 |
| Rate for Payer: Aetna Commercial |
$2,571.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,456.92
|
| Rate for Payer: Aetna Managed Medicare |
$799.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,856.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,428.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,371.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,514.15
|
| Rate for Payer: Cash Price |
$824.10
|
| Rate for Payer: Cigna Commercial |
$2,628.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,598.75
|
| Rate for Payer: Health EOS Commercial |
$2,542.62
|
| Rate for Payer: HFN Commercial |
$2,628.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,142.66
|
| Rate for Payer: Multiplan Commercial |
$2,285.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,714.13
|
| Rate for Payer: Preferred Network Access Commercial |
$2,628.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,399.87
|
| Rate for Payer: Quartz Commercial |
$1,856.97
|
| Rate for Payer: Quartz Medicare Advantage |
$1,714.13
|
| Rate for Payer: The Alliance Commercial |
$1,428.44
|
| Rate for Payer: WEA Trust Commercial |
$1,571.28
|
| Rate for Payer: WPS Commercial |
$2,116.01
|
|
|
S viridis
|
Facility
|
OP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.24
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$61.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.40
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$70.98
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$53.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: United Healthcare PPO |
$81.90
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: Wellcare Medicare |
$13.40
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
S viridis
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.40 |
| Max. Negotiated Rate |
$103.74 |
| Rate for Payer: Aetna Commercial |
$103.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Aetna Managed Medicare |
$13.40
|
| Rate for Payer: Anthem Medicare Advantage |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.40
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$103.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.40
|
| Rate for Payer: Health EOS Commercial |
$99.37
|
| Rate for Payer: HFN Commercial |
$103.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.40
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: NAPHCARE Commercial |
$20.09
|
| Rate for Payer: Preferred Network Access Commercial |
$103.74
|
| Rate for Payer: Quartz Beloit One Network |
$48.05
|
| Rate for Payer: Quartz Commercial |
$62.24
|
| Rate for Payer: Quartz Medicare Advantage |
$13.40
|
| Rate for Payer: The Alliance Commercial |
$52.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.40
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$58.94
|
|
|
S viridis
|
Facility
|
IP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942922
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$53.51 |
| Max. Negotiated Rate |
$100.46 |
| Rate for Payer: Aetna Commercial |
$98.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$100.46
|
| Rate for Payer: Health EOS Commercial |
$97.19
|
| Rate for Payer: HFN Commercial |
$100.46
|
| Rate for Payer: Multiplan Commercial |
$87.36
|
| Rate for Payer: Preferred Network Access Commercial |
$100.46
|
| Rate for Payer: Quartz Beloit One Network |
$53.51
|
| Rate for Payer: Quartz Commercial |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$60.06
|
| Rate for Payer: WPS Commercial |
$80.88
|
|
|
SWAB BETADINE SWABSTICKS #3 S41125
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
2963995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.46 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Aetna Managed Medicare |
$1.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.91
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.90
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: NAPHCARE Commercial |
$3.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.38
|
| Rate for Payer: Quartz Medicare Advantage |
$3.12
|
| Rate for Payer: The Alliance Commercial |
$2.60
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
SWAB BETADINE SWABSTICKS #3 S41125
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
2963995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
|
SWAB CHLORAPREP 3 ML CLEAR
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2974452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.33 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Aetna Managed Medicare |
$2.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.41
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.66
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.24
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: NAPHCARE Commercial |
$4.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$5.41
|
| Rate for Payer: Quartz Medicare Advantage |
$4.99
|
| Rate for Payer: The Alliance Commercial |
$4.16
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
SWAB CHLORAPREP 3 ML CLEAR
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2974452
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$4.08 |
| Max. Negotiated Rate |
$7.65 |
| Rate for Payer: Aetna Commercial |
$7.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.41
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.65
|
| Rate for Payer: Health EOS Commercial |
$7.40
|
| Rate for Payer: HFN Commercial |
$7.65
|
| Rate for Payer: Multiplan Commercial |
$6.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7.65
|
| Rate for Payer: Quartz Beloit One Network |
$4.08
|
| Rate for Payer: Quartz Commercial |
$4.99
|
| Rate for Payer: WEA Trust Commercial |
$4.58
|
| Rate for Payer: WPS Commercial |
$6.16
|
|
|
SWAB SKIN PREP NON STING
|
Facility
|
IP
|
$38.00
|
|
|
Service Code
|
HCPCS A5120
|
| Hospital Charge Code |
2962916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.36 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
|
SWAB SKIN PREP NON STING
|
Facility
|
OP
|
$38.00
|
|
|
Service Code
|
HCPCS A5120
|
| Hospital Charge Code |
2962916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.07 |
| Max. Negotiated Rate |
$36.36 |
| Rate for Payer: Aetna Commercial |
$35.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33.99
|
| Rate for Payer: Aetna Managed Medicare |
$11.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20.95
|
| Rate for Payer: Cash Price |
$11.40
|
| Rate for Payer: Cigna Commercial |
$36.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22.12
|
| Rate for Payer: Health EOS Commercial |
$35.17
|
| Rate for Payer: HFN Commercial |
$36.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.64
|
| Rate for Payer: Multiplan Commercial |
$31.62
|
| Rate for Payer: NAPHCARE Commercial |
$23.71
|
| Rate for Payer: Preferred Network Access Commercial |
$36.36
|
| Rate for Payer: Quartz Beloit One Network |
$19.36
|
| Rate for Payer: Quartz Commercial |
$25.69
|
| Rate for Payer: Quartz Medicare Advantage |
$23.71
|
| Rate for Payer: The Alliance Commercial |
$19.76
|
| Rate for Payer: WEA Trust Commercial |
$21.74
|
| Rate for Payer: WPS Commercial |
$29.27
|
|
