|
N BLOCK INJ, PARACERVICAL 64435
|
Professional
|
Both
|
$528.00
|
|
|
Service Code
|
CPT 64435
|
| Hospital Charge Code |
3015189
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.28 |
| Max. Negotiated Rate |
$501.60 |
| Rate for Payer: Aetna Commercial |
$501.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$454.08
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cash Price |
$158.40
|
| Rate for Payer: Cigna Commercial |
$501.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.80
|
| Rate for Payer: Health EOS Commercial |
$480.48
|
| Rate for Payer: HFN Commercial |
$501.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.53
|
| Rate for Payer: Multiplan Commercial |
$422.40
|
| Rate for Payer: Preferred Network Access Commercial |
$501.60
|
| Rate for Payer: Quartz Beloit One Network |
$232.32
|
| Rate for Payer: Quartz Commercial |
$300.96
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: United Healthcare Medicaid |
$62.28
|
| Rate for Payer: WEA Trust Commercial |
$290.40
|
| Rate for Payer: WPS Commercial |
$391.09
|
|
|
N BLOCK INJ, PUDENDAL 64430
|
Professional
|
Both
|
$1,006.00
|
|
|
Service Code
|
CPT 64430
|
| Hospital Charge Code |
3015188
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.63 |
| Max. Negotiated Rate |
$955.70 |
| Rate for Payer: Aetna Commercial |
$955.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$955.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$603.60
|
| Rate for Payer: Health EOS Commercial |
$915.46
|
| Rate for Payer: HFN Commercial |
$955.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: Preferred Network Access Commercial |
$955.70
|
| Rate for Payer: Quartz Beloit One Network |
$442.64
|
| Rate for Payer: Quartz Commercial |
$573.42
|
| Rate for Payer: The Alliance Commercial |
$503.00
|
| Rate for Payer: United Healthcare Medicaid |
$60.63
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
N BLOCK INJ, PUDENDAL 6443050
|
Professional
|
Both
|
$2,013.00
|
|
|
Service Code
|
CPT 64430 50
|
| Hospital Charge Code |
5412941
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.63 |
| Max. Negotiated Rate |
$1,912.35 |
| Rate for Payer: Aetna Commercial |
$1,912.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,731.18
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Cigna Commercial |
$1,912.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,207.80
|
| Rate for Payer: Health EOS Commercial |
$1,831.83
|
| Rate for Payer: HFN Commercial |
$1,912.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$183.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$183.60
|
| Rate for Payer: Multiplan Commercial |
$1,610.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,912.35
|
| Rate for Payer: Quartz Beloit One Network |
$885.72
|
| Rate for Payer: Quartz Commercial |
$1,147.41
|
| Rate for Payer: The Alliance Commercial |
$1,006.50
|
| Rate for Payer: United Healthcare Medicaid |
$60.63
|
| Rate for Payer: WEA Trust Commercial |
$1,107.15
|
| Rate for Payer: WPS Commercial |
$1,491.03
|
|
|
N Block Inj Suprascapular Nerve 64418
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
5232627
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.74 |
| Max. Negotiated Rate |
$537.70 |
| Rate for Payer: Aetna Commercial |
$537.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.76
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$537.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$339.60
|
| Rate for Payer: Health EOS Commercial |
$515.06
|
| Rate for Payer: HFN Commercial |
$537.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$191.64
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: Preferred Network Access Commercial |
$537.70
|
| Rate for Payer: Quartz Beloit One Network |
$249.04
|
| Rate for Payer: Quartz Commercial |
$322.62
|
| Rate for Payer: The Alliance Commercial |
$283.00
|
| Rate for Payer: United Healthcare Medicaid |
$115.74
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
N BLOCK, OTHER PERIPHERAL 64450
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
3015190
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$74.37 |
| Max. Negotiated Rate |
$767.60 |
| Rate for Payer: Aetna Commercial |
$767.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$694.88
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$767.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$484.80
|
| Rate for Payer: Health EOS Commercial |
$735.28
|
| Rate for Payer: HFN Commercial |
$767.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$142.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$142.08
|
| Rate for Payer: Multiplan Commercial |
$646.40
|
| Rate for Payer: Preferred Network Access Commercial |
$767.60
|
| Rate for Payer: Quartz Beloit One Network |
$355.52
|
| Rate for Payer: Quartz Commercial |
$460.56
|
| Rate for Payer: The Alliance Commercial |
$404.00
|
| Rate for Payer: United Healthcare Medicaid |
$74.37
|
| Rate for Payer: WEA Trust Commercial |
$444.40
|
| Rate for Payer: WPS Commercial |
$598.49
|
|
|
N Block Trigeminal Nerve 64400
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
5232614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.40 |
| Max. Negotiated Rate |
$562.40 |
| Rate for Payer: Aetna Commercial |
$562.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$509.12
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$562.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.20
|
| Rate for Payer: Health EOS Commercial |
$538.72
|
| Rate for Payer: HFN Commercial |
$562.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$160.79
|
| Rate for Payer: Multiplan Commercial |
$473.60
|
| Rate for Payer: Preferred Network Access Commercial |
$562.40
|
| Rate for Payer: Quartz Beloit One Network |
$260.48
|
| Rate for Payer: Quartz Commercial |
$337.44
|
| Rate for Payer: The Alliance Commercial |
$296.00
|
| Rate for Payer: United Healthcare Medicaid |
$93.40
|
| Rate for Payer: WEA Trust Commercial |
$325.60
|
| Rate for Payer: WPS Commercial |
$438.49
|
|
|
Nebulizer Kit PARI LCD
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3153476
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Nebulizer Kit PARI LCD
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3153476
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
NEBULIZER MINI HEART HI-FLO
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2969759
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$73.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.06
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$156.60
|
| Rate for Payer: The Alliance Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
NEBULIZER MINI HEART HI-FLO
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2969759
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
NECK DISSECTION, RADICAL
|
Facility
|
IP
|
$4,048.00
|
|
| Hospital Charge Code |
2960334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,983.52 |
| Max. Negotiated Rate |
$3,724.16 |
| Rate for Payer: Aetna Commercial |
$3,643.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,481.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,145.44
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$3,724.16
|
| Rate for Payer: Health EOS Commercial |
$3,602.72
|
| Rate for Payer: HFN Commercial |
$3,724.16
|
| Rate for Payer: Multiplan Commercial |
$3,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,428.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,724.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,983.52
|
| Rate for Payer: Quartz Commercial |
$2,428.80
|
| Rate for Payer: WEA Trust Commercial |
$2,226.40
|
| Rate for Payer: WPS Commercial |
$2,998.35
|
|
|
NECK DISSECTION, RADICAL
|
Facility
|
OP
|
$4,048.00
|
|
| Hospital Charge Code |
2960334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,133.44 |
| Max. Negotiated Rate |
$16,192.00 |
| Rate for Payer: Aetna Commercial |
$3,643.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,481.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,133.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,631.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,024.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,943.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,145.44
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$3,724.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,265.26
|
| Rate for Payer: Health EOS Commercial |
$3,602.72
|
| Rate for Payer: HFN Commercial |
$3,724.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,036.00
|
| Rate for Payer: Multiplan Commercial |
$3,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,428.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,724.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,983.52
|
| Rate for Payer: Quartz Commercial |
$2,631.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,428.80
|
| Rate for Payer: The Alliance Commercial |
$16,192.00
|
| Rate for Payer: WEA Trust Commercial |
$2,226.40
|
| Rate for Payer: WPS Commercial |
$2,998.35
|
|
|
NECK EXPLORATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
NECK EXPLORATION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
NEEDLE 15ga FISTULA (DO NOT ORDER) 666-1731
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
2973050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.44 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.87
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$13.80
|
| Rate for Payer: The Alliance Commercial |
$92.00
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
NEEDLE 15ga FISTULA (DO NOT ORDER) 666-1731
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
2973050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
|
NEEDLE 18g ANGIOGRAPHIC -MERIT #AD18T71W
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
2969633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.64 |
| Max. Negotiated Rate |
$252.00 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Aetna Managed Medicare |
$17.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.25
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$40.95
|
| Rate for Payer: Quartz Medicare Advantage |
$37.80
|
| Rate for Payer: The Alliance Commercial |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
NEEDLE 18g ANGIOGRAPHIC -MERIT #AD18T71W
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
2969633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$30.87 |
| Max. Negotiated Rate |
$57.96 |
| Rate for Payer: Aetna Commercial |
$56.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.39
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$57.96
|
| Rate for Payer: Health EOS Commercial |
$56.07
|
| Rate for Payer: HFN Commercial |
$57.96
|
| Rate for Payer: Multiplan Commercial |
$50.40
|
| Rate for Payer: NAPHCARE Commercial |
$37.80
|
| Rate for Payer: Preferred Network Access Commercial |
$57.96
|
| Rate for Payer: Quartz Beloit One Network |
$30.87
|
| Rate for Payer: Quartz Commercial |
$37.80
|
| Rate for Payer: WEA Trust Commercial |
$34.65
|
| Rate for Payer: WPS Commercial |
$46.66
|
|
|
NEEDLE 18G X 7CM 195318
|
Facility
|
IP
|
$227.00
|
|
| Hospital Charge Code |
6207019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$111.23 |
| Max. Negotiated Rate |
$208.84 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$136.20
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
NEEDLE 18G X 7CM 195318
|
Facility
|
OP
|
$227.00
|
|
| Hospital Charge Code |
6207019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$63.56 |
| Max. Negotiated Rate |
$908.00 |
| Rate for Payer: Aetna Commercial |
$204.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$195.22
|
| Rate for Payer: Aetna Managed Medicare |
$63.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$108.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$120.31
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$208.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.03
|
| Rate for Payer: Health EOS Commercial |
$202.03
|
| Rate for Payer: HFN Commercial |
$208.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$170.25
|
| Rate for Payer: Multiplan Commercial |
$181.60
|
| Rate for Payer: NAPHCARE Commercial |
$136.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.84
|
| Rate for Payer: Quartz Beloit One Network |
$111.23
|
| Rate for Payer: Quartz Commercial |
$147.55
|
| Rate for Payer: Quartz Medicare Advantage |
$136.20
|
| Rate for Payer: The Alliance Commercial |
$908.00
|
| Rate for Payer: WEA Trust Commercial |
$124.85
|
| Rate for Payer: WPS Commercial |
$168.14
|
|
|
NEEDLE 20G X 4 (10MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-95
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
6170126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Aetna Managed Medicare |
$88.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.27
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.25
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$204.75
|
| Rate for Payer: Quartz Medicare Advantage |
$189.00
|
| Rate for Payer: The Alliance Commercial |
$1,260.00
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
NEEDLE 20G X 4 (10MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-95
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
6170126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$189.00
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
NEEDLE 20G X 4 3/4IN (120MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-72
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
6170125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.35 |
| Max. Negotiated Rate |
$289.80 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$189.00
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
NEEDLE 20G X 4 3/4IN (120MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-72
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
6170125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$1,260.00 |
| Rate for Payer: Aetna Commercial |
$283.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.90
|
| Rate for Payer: Aetna Managed Medicare |
$88.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$151.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.95
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$289.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$176.27
|
| Rate for Payer: Health EOS Commercial |
$280.35
|
| Rate for Payer: HFN Commercial |
$289.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.25
|
| Rate for Payer: Multiplan Commercial |
$252.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.00
|
| Rate for Payer: Preferred Network Access Commercial |
$289.80
|
| Rate for Payer: Quartz Beloit One Network |
$154.35
|
| Rate for Payer: Quartz Commercial |
$204.75
|
| Rate for Payer: Quartz Medicare Advantage |
$189.00
|
| Rate for Payer: The Alliance Commercial |
$1,260.00
|
| Rate for Payer: WEA Trust Commercial |
$173.25
|
| Rate for Payer: WPS Commercial |
$233.32
|
|
|
NEEDLE 20G X 4IN (100MM) PAJUNK SONOPLEX II STIMULATING REGIONAL BLOCK 001287-95
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
5957631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$84.00 |
| Max. Negotiated Rate |
$1,200.00 |
| Rate for Payer: Aetna Commercial |
$270.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$258.00
|
| Rate for Payer: Aetna Managed Medicare |
$84.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$195.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$150.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$144.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$159.00
|
| Rate for Payer: Cash Price |
$90.00
|
| Rate for Payer: Cigna Commercial |
$276.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.88
|
| Rate for Payer: Health EOS Commercial |
$267.00
|
| Rate for Payer: HFN Commercial |
$276.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$225.00
|
| Rate for Payer: Multiplan Commercial |
$240.00
|
| Rate for Payer: NAPHCARE Commercial |
$180.00
|
| Rate for Payer: Preferred Network Access Commercial |
$276.00
|
| Rate for Payer: Quartz Beloit One Network |
$147.00
|
| Rate for Payer: Quartz Commercial |
$195.00
|
| Rate for Payer: Quartz Medicare Advantage |
$180.00
|
| Rate for Payer: The Alliance Commercial |
$1,200.00
|
| Rate for Payer: WEA Trust Commercial |
$165.00
|
| Rate for Payer: WPS Commercial |
$222.21
|
|
