|
NEEDLE FISTULA MEDISYSTEM 17GA X 1 D9-2007MGLB"
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
2973052
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.91
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$20.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.20
|
| Rate for Payer: The Alliance Commercial |
$128.00
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
NEEDLE FORAMEN 5.0 X 18.5G INTERSTIM 041839
|
Facility
|
IP
|
$1,597.00
|
|
| Hospital Charge Code |
5603702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$782.53 |
| Max. Negotiated Rate |
$1,469.24 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$958.20
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
NEEDLE FORAMEN 5.0 X 18.5G INTERSTIM 041839
|
Facility
|
OP
|
$1,597.00
|
|
| Hospital Charge Code |
5603702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$447.16 |
| Max. Negotiated Rate |
$6,388.00 |
| Rate for Payer: Aetna Commercial |
$1,437.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,373.42
|
| Rate for Payer: Aetna Managed Medicare |
$447.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,038.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$798.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$766.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$846.41
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,469.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$893.68
|
| Rate for Payer: Health EOS Commercial |
$1,421.33
|
| Rate for Payer: HFN Commercial |
$1,469.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,197.75
|
| Rate for Payer: Multiplan Commercial |
$1,277.60
|
| Rate for Payer: NAPHCARE Commercial |
$958.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,469.24
|
| Rate for Payer: Quartz Beloit One Network |
$782.53
|
| Rate for Payer: Quartz Commercial |
$1,038.05
|
| Rate for Payer: Quartz Medicare Advantage |
$958.20
|
| Rate for Payer: The Alliance Commercial |
$6,388.00
|
| Rate for Payer: WEA Trust Commercial |
$878.35
|
| Rate for Payer: WPS Commercial |
$1,182.90
|
|
|
NEEDLE FRENCH SPRING 1/2 CIR SIZE 3 1862
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
4400974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.50
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$138.00
|
| Rate for Payer: Health EOS Commercial |
$133.50
|
| Rate for Payer: HFN Commercial |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.00
|
| Rate for Payer: Preferred Network Access Commercial |
$138.00
|
| Rate for Payer: Quartz Beloit One Network |
$73.50
|
| Rate for Payer: Quartz Commercial |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
NEEDLE FRENCH SPRING 1/2 CIR SIZE 3 1862
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
4400974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Aetna Managed Medicare |
$42.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.50
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$138.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.94
|
| Rate for Payer: Health EOS Commercial |
$133.50
|
| Rate for Payer: HFN Commercial |
$138.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.00
|
| Rate for Payer: Preferred Network Access Commercial |
$138.00
|
| Rate for Payer: Quartz Beloit One Network |
$73.50
|
| Rate for Payer: Quartz Commercial |
$97.50
|
| Rate for Payer: Quartz Medicare Advantage |
$90.00
|
| Rate for Payer: The Alliance Commercial |
$600.00
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
NEEDLE GUIDE SONOSITE L25 21G 58 PROBE COVER & GEL STERILE P09073-01
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6201017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$1,788.00 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$125.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.14
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.25
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$290.55
|
| Rate for Payer: Quartz Medicare Advantage |
$268.20
|
| Rate for Payer: The Alliance Commercial |
$1,788.00
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
NEEDLE GUIDE SONOSITE L25 21G 58 PROBE COVER & GEL STERILE P09073-01
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6201017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.03 |
| Max. Negotiated Rate |
$411.24 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$268.20
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
NEEDLE HD SCORPION WITH MEGALOADER AR-13999HDN
|
Facility
|
OP
|
$1,936.00
|
|
| Hospital Charge Code |
6226159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$542.08 |
| Max. Negotiated Rate |
$7,744.00 |
| Rate for Payer: Aetna Commercial |
$1,742.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,664.96
|
| Rate for Payer: Aetna Managed Medicare |
$542.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,258.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$968.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$929.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.08
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna Commercial |
$1,781.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,083.39
|
| Rate for Payer: Health EOS Commercial |
$1,723.04
|
| Rate for Payer: HFN Commercial |
$1,781.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,452.00
|
| Rate for Payer: Multiplan Commercial |
$1,548.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,161.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.12
|
| Rate for Payer: Quartz Beloit One Network |
$948.64
|
| Rate for Payer: Quartz Commercial |
$1,258.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,161.60
|
| Rate for Payer: The Alliance Commercial |
$7,744.00
|
| Rate for Payer: WEA Trust Commercial |
$1,064.80
|
| Rate for Payer: WPS Commercial |
$1,434.00
|
|
|
NEEDLE HD SCORPION WITH MEGALOADER AR-13999HDN
|
Facility
|
IP
|
$1,936.00
|
|
| Hospital Charge Code |
6226159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$948.64 |
| Max. Negotiated Rate |
$1,781.12 |
| Rate for Payer: Aetna Commercial |
$1,742.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,664.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,026.08
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna Commercial |
$1,781.12
|
| Rate for Payer: Health EOS Commercial |
$1,723.04
|
| Rate for Payer: HFN Commercial |
$1,781.12
|
| Rate for Payer: Multiplan Commercial |
$1,548.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,161.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,781.12
|
| Rate for Payer: Quartz Beloit One Network |
$948.64
|
| Rate for Payer: Quartz Commercial |
$1,161.60
|
| Rate for Payer: WEA Trust Commercial |
$1,064.80
|
| Rate for Payer: WPS Commercial |
$1,434.00
|
|
|
NEEDLE HUBER 20G X 1.5SAFETY 0652015
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
2963149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$79.20
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
NEEDLE HUBER 20G X 1.5SAFETY 0652015
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
2963149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Aetna Managed Medicare |
$36.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.87
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$85.80
|
| Rate for Payer: Quartz Medicare Advantage |
$79.20
|
| Rate for Payer: The Alliance Commercial |
$528.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
NEEDLE HUBER 20Gx1 SAFETY 0652010
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
2963150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$79.20
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
NEEDLE HUBER 20Gx1 SAFETY 0652010
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
2963150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Aetna Managed Medicare |
$36.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.87
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$85.80
|
| Rate for Payer: Quartz Medicare Advantage |
$79.20
|
| Rate for Payer: The Alliance Commercial |
$528.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
NEEDLE HUBER 20G X .75 SAFETY 0652034
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
2963148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$121.44 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$79.20
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
NEEDLE HUBER 20G X .75 SAFETY 0652034
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
2963148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$528.00 |
| Rate for Payer: Aetna Commercial |
$118.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$113.52
|
| Rate for Payer: Aetna Managed Medicare |
$36.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$85.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$69.96
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$121.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$73.87
|
| Rate for Payer: Health EOS Commercial |
$117.48
|
| Rate for Payer: HFN Commercial |
$121.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99.00
|
| Rate for Payer: Multiplan Commercial |
$105.60
|
| Rate for Payer: NAPHCARE Commercial |
$79.20
|
| Rate for Payer: Preferred Network Access Commercial |
$121.44
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$85.80
|
| Rate for Payer: Quartz Medicare Advantage |
$79.20
|
| Rate for Payer: The Alliance Commercial |
$528.00
|
| Rate for Payer: WEA Trust Commercial |
$72.60
|
| Rate for Payer: WPS Commercial |
$97.77
|
|
|
NEEDLE HUBER 22G X .75 SAFETY 0652234
|
Facility
|
OP
|
$215.00
|
|
| Hospital Charge Code |
2963147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$60.20 |
| Max. Negotiated Rate |
$860.00 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Aetna Managed Medicare |
$60.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$139.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$107.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$103.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.95
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.31
|
| Rate for Payer: Health EOS Commercial |
$191.35
|
| Rate for Payer: HFN Commercial |
$197.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.25
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: NAPHCARE Commercial |
$129.00
|
| Rate for Payer: Preferred Network Access Commercial |
$197.80
|
| Rate for Payer: Quartz Beloit One Network |
$105.35
|
| Rate for Payer: Quartz Commercial |
$139.75
|
| Rate for Payer: Quartz Medicare Advantage |
$129.00
|
| Rate for Payer: The Alliance Commercial |
$860.00
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
NEEDLE HUBER 22G X .75 SAFETY 0652234
|
Facility
|
IP
|
$215.00
|
|
| Hospital Charge Code |
2963147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$105.35 |
| Max. Negotiated Rate |
$197.80 |
| Rate for Payer: Aetna Commercial |
$193.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$184.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$113.95
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$197.80
|
| Rate for Payer: Health EOS Commercial |
$191.35
|
| Rate for Payer: HFN Commercial |
$197.80
|
| Rate for Payer: Multiplan Commercial |
$172.00
|
| Rate for Payer: NAPHCARE Commercial |
$129.00
|
| Rate for Payer: Preferred Network Access Commercial |
$197.80
|
| Rate for Payer: Quartz Beloit One Network |
$105.35
|
| Rate for Payer: Quartz Commercial |
$129.00
|
| Rate for Payer: WEA Trust Commercial |
$118.25
|
| Rate for Payer: WPS Commercial |
$159.25
|
|
|
Needle Ill.Aspiration 15Ga
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
3040330
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.96 |
| Max. Negotiated Rate |
$128.00 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Aetna Managed Medicare |
$8.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.91
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.00
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$20.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.20
|
| Rate for Payer: The Alliance Commercial |
$128.00
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
Needle Ill.Aspiration 15Ga
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
3040330
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$15.68 |
| Max. Negotiated Rate |
$29.44 |
| Rate for Payer: Aetna Commercial |
$28.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$27.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.96
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$29.44
|
| Rate for Payer: Health EOS Commercial |
$28.48
|
| Rate for Payer: HFN Commercial |
$29.44
|
| Rate for Payer: Multiplan Commercial |
$25.60
|
| Rate for Payer: NAPHCARE Commercial |
$19.20
|
| Rate for Payer: Preferred Network Access Commercial |
$29.44
|
| Rate for Payer: Quartz Beloit One Network |
$15.68
|
| Rate for Payer: Quartz Commercial |
$19.20
|
| Rate for Payer: WEA Trust Commercial |
$17.60
|
| Rate for Payer: WPS Commercial |
$23.70
|
|
|
NEEDLE INJECTION 25GA
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
2973102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$392.00 |
| Max. Negotiated Rate |
$736.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$480.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
NEEDLE INJECTION 25GA
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
2973102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$224.00 |
| Max. Negotiated Rate |
$3,200.00 |
| Rate for Payer: Aetna Commercial |
$720.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$688.00
|
| Rate for Payer: Aetna Managed Medicare |
$224.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$520.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$400.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$384.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$424.00
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$736.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$447.68
|
| Rate for Payer: Health EOS Commercial |
$712.00
|
| Rate for Payer: HFN Commercial |
$736.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$600.00
|
| Rate for Payer: Multiplan Commercial |
$640.00
|
| Rate for Payer: NAPHCARE Commercial |
$480.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.00
|
| Rate for Payer: Quartz Beloit One Network |
$392.00
|
| Rate for Payer: Quartz Commercial |
$520.00
|
| Rate for Payer: Quartz Medicare Advantage |
$480.00
|
| Rate for Payer: The Alliance Commercial |
$3,200.00
|
| Rate for Payer: WEA Trust Commercial |
$440.00
|
| Rate for Payer: WPS Commercial |
$592.56
|
|
|
NEEDLE INJECTION 25GA PEDS BX00711822
|
Facility
|
IP
|
$1,118.00
|
|
| Hospital Charge Code |
5458774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$547.82 |
| Max. Negotiated Rate |
$1,028.56 |
| Rate for Payer: Aetna Commercial |
$1,006.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$961.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.54
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$1,028.56
|
| Rate for Payer: Health EOS Commercial |
$995.02
|
| Rate for Payer: HFN Commercial |
$1,028.56
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: NAPHCARE Commercial |
$670.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,028.56
|
| Rate for Payer: Quartz Beloit One Network |
$547.82
|
| Rate for Payer: Quartz Commercial |
$670.80
|
| Rate for Payer: WEA Trust Commercial |
$614.90
|
| Rate for Payer: WPS Commercial |
$828.10
|
|
|
NEEDLE INJECTION 25GA PEDS BX00711822
|
Facility
|
OP
|
$1,118.00
|
|
| Hospital Charge Code |
5458774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,472.00 |
| Rate for Payer: Aetna Commercial |
$1,006.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$961.48
|
| Rate for Payer: Aetna Managed Medicare |
$313.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$726.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$559.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$536.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$592.54
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$1,028.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$625.63
|
| Rate for Payer: Health EOS Commercial |
$995.02
|
| Rate for Payer: HFN Commercial |
$1,028.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$838.50
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: NAPHCARE Commercial |
$670.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,028.56
|
| Rate for Payer: Quartz Beloit One Network |
$547.82
|
| Rate for Payer: Quartz Commercial |
$726.70
|
| Rate for Payer: Quartz Medicare Advantage |
$670.80
|
| Rate for Payer: The Alliance Commercial |
$4,472.00
|
| Rate for Payer: WEA Trust Commercial |
$614.90
|
| Rate for Payer: WPS Commercial |
$828.10
|
|
|
NEEDLE INSUFFLATION 14GA 120MM C2201
|
Facility
|
IP
|
$562.00
|
|
| Hospital Charge Code |
2963861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$275.38 |
| Max. Negotiated Rate |
$517.04 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$337.20
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
|
NEEDLE INSUFFLATION 14GA 120MM C2201
|
Facility
|
OP
|
$562.00
|
|
| Hospital Charge Code |
2963861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$157.36 |
| Max. Negotiated Rate |
$2,248.00 |
| Rate for Payer: Aetna Commercial |
$505.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$483.32
|
| Rate for Payer: Aetna Managed Medicare |
$157.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$365.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$281.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$269.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$297.86
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$517.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$314.50
|
| Rate for Payer: Health EOS Commercial |
$500.18
|
| Rate for Payer: HFN Commercial |
$517.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$421.50
|
| Rate for Payer: Multiplan Commercial |
$449.60
|
| Rate for Payer: NAPHCARE Commercial |
$337.20
|
| Rate for Payer: Preferred Network Access Commercial |
$517.04
|
| Rate for Payer: Quartz Beloit One Network |
$275.38
|
| Rate for Payer: Quartz Commercial |
$365.30
|
| Rate for Payer: Quartz Medicare Advantage |
$337.20
|
| Rate for Payer: The Alliance Commercial |
$2,248.00
|
| Rate for Payer: WEA Trust Commercial |
$309.10
|
| Rate for Payer: WPS Commercial |
$416.27
|
|
