|
NEEDLE INSUFFLATION 14GA 150MM
|
Facility
|
OP
|
$505.00
|
|
| Hospital Charge Code |
2962995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$141.40 |
| Max. Negotiated Rate |
$2,020.00 |
| Rate for Payer: Aetna Commercial |
$454.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.30
|
| Rate for Payer: Aetna Managed Medicare |
$141.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$328.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$252.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$242.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.65
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$464.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$282.60
|
| Rate for Payer: Health EOS Commercial |
$449.45
|
| Rate for Payer: HFN Commercial |
$464.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$378.75
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: NAPHCARE Commercial |
$303.00
|
| Rate for Payer: Preferred Network Access Commercial |
$464.60
|
| Rate for Payer: Quartz Beloit One Network |
$247.45
|
| Rate for Payer: Quartz Commercial |
$328.25
|
| Rate for Payer: Quartz Medicare Advantage |
$303.00
|
| Rate for Payer: The Alliance Commercial |
$2,020.00
|
| Rate for Payer: WEA Trust Commercial |
$277.75
|
| Rate for Payer: WPS Commercial |
$374.05
|
|
|
NEEDLE INSUFFLATION 14GA 150MM
|
Facility
|
IP
|
$505.00
|
|
| Hospital Charge Code |
2962995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$247.45 |
| Max. Negotiated Rate |
$464.60 |
| Rate for Payer: Aetna Commercial |
$454.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$434.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$267.65
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$464.60
|
| Rate for Payer: Health EOS Commercial |
$449.45
|
| Rate for Payer: HFN Commercial |
$464.60
|
| Rate for Payer: Multiplan Commercial |
$404.00
|
| Rate for Payer: NAPHCARE Commercial |
$303.00
|
| Rate for Payer: Preferred Network Access Commercial |
$464.60
|
| Rate for Payer: Quartz Beloit One Network |
$247.45
|
| Rate for Payer: Quartz Commercial |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$277.75
|
| Rate for Payer: WPS Commercial |
$374.05
|
|
|
NEEDLE INTRAOSSEOUS DISPOSBLE C-DIN-16-4.0-T45
|
Facility
|
OP
|
$575.00
|
|
| Hospital Charge Code |
2963601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.00 |
| Max. Negotiated Rate |
$2,300.00 |
| Rate for Payer: Aetna Commercial |
$517.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.50
|
| Rate for Payer: Aetna Managed Medicare |
$161.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.75
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$529.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.77
|
| Rate for Payer: Health EOS Commercial |
$511.75
|
| Rate for Payer: HFN Commercial |
$529.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$431.25
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: NAPHCARE Commercial |
$345.00
|
| Rate for Payer: Preferred Network Access Commercial |
$529.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.75
|
| Rate for Payer: Quartz Commercial |
$373.75
|
| Rate for Payer: Quartz Medicare Advantage |
$345.00
|
| Rate for Payer: The Alliance Commercial |
$2,300.00
|
| Rate for Payer: WEA Trust Commercial |
$316.25
|
| Rate for Payer: WPS Commercial |
$425.90
|
|
|
NEEDLE INTRAOSSEOUS DISPOSBLE C-DIN-16-4.0-T45
|
Facility
|
IP
|
$575.00
|
|
| Hospital Charge Code |
2963601
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.75 |
| Max. Negotiated Rate |
$529.00 |
| Rate for Payer: Aetna Commercial |
$517.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.75
|
| Rate for Payer: Cash Price |
$172.50
|
| Rate for Payer: Cigna Commercial |
$529.00
|
| Rate for Payer: Health EOS Commercial |
$511.75
|
| Rate for Payer: HFN Commercial |
$529.00
|
| Rate for Payer: Multiplan Commercial |
$460.00
|
| Rate for Payer: NAPHCARE Commercial |
$345.00
|
| Rate for Payer: Preferred Network Access Commercial |
$529.00
|
| Rate for Payer: Quartz Beloit One Network |
$281.75
|
| Rate for Payer: Quartz Commercial |
$345.00
|
| Rate for Payer: WEA Trust Commercial |
$316.25
|
| Rate for Payer: WPS Commercial |
$425.90
|
|
|
NEEDLE KEITH ABDOMINAL STRAIGHT TRI POINT SZ 4 1827-4DG
|
Facility
|
OP
|
$427.00
|
|
| Hospital Charge Code |
5107338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$119.56 |
| Max. Negotiated Rate |
$1,708.00 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Aetna Managed Medicare |
$119.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$277.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$213.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$204.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$238.95
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$320.25
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$277.55
|
| Rate for Payer: Quartz Medicare Advantage |
$256.20
|
| Rate for Payer: The Alliance Commercial |
$1,708.00
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
NEEDLE KEITH ABDOMINAL STRAIGHT TRI POINT SZ 4 1827-4DG
|
Facility
|
IP
|
$427.00
|
|
| Hospital Charge Code |
5107338
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$209.23 |
| Max. Negotiated Rate |
$392.84 |
| Rate for Payer: Aetna Commercial |
$384.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$367.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$226.31
|
| Rate for Payer: Cash Price |
$128.10
|
| Rate for Payer: Cigna Commercial |
$392.84
|
| Rate for Payer: Health EOS Commercial |
$380.03
|
| Rate for Payer: HFN Commercial |
$392.84
|
| Rate for Payer: Multiplan Commercial |
$341.60
|
| Rate for Payer: NAPHCARE Commercial |
$256.20
|
| Rate for Payer: Preferred Network Access Commercial |
$392.84
|
| Rate for Payer: Quartz Beloit One Network |
$209.23
|
| Rate for Payer: Quartz Commercial |
$256.20
|
| Rate for Payer: WEA Trust Commercial |
$234.85
|
| Rate for Payer: WPS Commercial |
$316.28
|
|
|
NEEDLE KEITH ABDOMINAL STRAIGHT TRI POINT SZ 6 REUSE 1827-6
|
Facility
|
IP
|
$60.00
|
|
| Hospital Charge Code |
5107337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.40 |
| Max. Negotiated Rate |
$55.20 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
NEEDLE KEITH ABDOMINAL STRAIGHT TRI POINT SZ 6 REUSE 1827-6
|
Facility
|
OP
|
$60.00
|
|
| Hospital Charge Code |
5107337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.80 |
| Max. Negotiated Rate |
$240.00 |
| Rate for Payer: Aetna Commercial |
$54.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.60
|
| Rate for Payer: Aetna Managed Medicare |
$16.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.80
|
| Rate for Payer: Cash Price |
$18.00
|
| Rate for Payer: Cigna Commercial |
$55.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.58
|
| Rate for Payer: Health EOS Commercial |
$53.40
|
| Rate for Payer: HFN Commercial |
$55.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.00
|
| Rate for Payer: Multiplan Commercial |
$48.00
|
| Rate for Payer: NAPHCARE Commercial |
$36.00
|
| Rate for Payer: Preferred Network Access Commercial |
$55.20
|
| Rate for Payer: Quartz Beloit One Network |
$29.40
|
| Rate for Payer: Quartz Commercial |
$39.00
|
| Rate for Payer: Quartz Medicare Advantage |
$36.00
|
| Rate for Payer: The Alliance Commercial |
$240.00
|
| Rate for Payer: WEA Trust Commercial |
$33.00
|
| Rate for Payer: WPS Commercial |
$44.44
|
|
|
Needle Localization by Xray 77002
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
5008611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$149.60 |
| Max. Negotiated Rate |
$395.54 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.40
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.00
|
| Rate for Payer: Health EOS Commercial |
$309.40
|
| Rate for Payer: HFN Commercial |
$323.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$395.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$395.54
|
| Rate for Payer: Multiplan Commercial |
$272.00
|
| Rate for Payer: Preferred Network Access Commercial |
$323.00
|
| Rate for Payer: Quartz Beloit One Network |
$149.60
|
| Rate for Payer: Quartz Commercial |
$193.80
|
| Rate for Payer: The Alliance Commercial |
$170.00
|
| Rate for Payer: WEA Trust Commercial |
$187.00
|
| Rate for Payer: WPS Commercial |
$251.84
|
|
|
Needle Localization by Xray 7700226
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 77002 26
|
| Hospital Charge Code |
4374594
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.51 |
| Max. Negotiated Rate |
$323.00 |
| Rate for Payer: Aetna Commercial |
$323.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$292.40
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cash Price |
$102.00
|
| Rate for Payer: Cigna Commercial |
$323.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$170.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$204.00
|
| Rate for Payer: Health EOS Commercial |
$309.40
|
| Rate for Payer: HFN Commercial |
$323.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.51
|
| Rate for Payer: Multiplan Commercial |
$272.00
|
| Rate for Payer: Preferred Network Access Commercial |
$323.00
|
| Rate for Payer: Quartz Beloit One Network |
$149.60
|
| Rate for Payer: Quartz Commercial |
$193.80
|
| Rate for Payer: The Alliance Commercial |
$170.00
|
| Rate for Payer: WEA Trust Commercial |
$187.00
|
| Rate for Payer: WPS Commercial |
$251.84
|
|
|
NEEDLE MICRO ACCESS 21GA X 7CM B-BEVEL ECHOGENIC 06506802
|
Facility
|
OP
|
$384.00
|
|
| Hospital Charge Code |
2963804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.52 |
| Max. Negotiated Rate |
$1,536.00 |
| Rate for Payer: Aetna Commercial |
$345.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.24
|
| Rate for Payer: Aetna Managed Medicare |
$107.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$249.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$192.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.52
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$353.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.89
|
| Rate for Payer: Health EOS Commercial |
$341.76
|
| Rate for Payer: HFN Commercial |
$353.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$288.00
|
| Rate for Payer: Multiplan Commercial |
$307.20
|
| Rate for Payer: NAPHCARE Commercial |
$230.40
|
| Rate for Payer: Preferred Network Access Commercial |
$353.28
|
| Rate for Payer: Quartz Beloit One Network |
$188.16
|
| Rate for Payer: Quartz Commercial |
$249.60
|
| Rate for Payer: Quartz Medicare Advantage |
$230.40
|
| Rate for Payer: The Alliance Commercial |
$1,536.00
|
| Rate for Payer: WEA Trust Commercial |
$211.20
|
| Rate for Payer: WPS Commercial |
$284.43
|
|
|
NEEDLE MICRO ACCESS 21GA X 7CM B-BEVEL ECHOGENIC 06506802
|
Facility
|
IP
|
$384.00
|
|
| Hospital Charge Code |
2963804
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.16 |
| Max. Negotiated Rate |
$353.28 |
| Rate for Payer: Aetna Commercial |
$345.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.52
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$353.28
|
| Rate for Payer: Health EOS Commercial |
$341.76
|
| Rate for Payer: HFN Commercial |
$353.28
|
| Rate for Payer: Multiplan Commercial |
$307.20
|
| Rate for Payer: NAPHCARE Commercial |
$230.40
|
| Rate for Payer: Preferred Network Access Commercial |
$353.28
|
| Rate for Payer: Quartz Beloit One Network |
$188.16
|
| Rate for Payer: Quartz Commercial |
$230.40
|
| Rate for Payer: WEA Trust Commercial |
$211.20
|
| Rate for Payer: WPS Commercial |
$284.43
|
|
|
NEEDLE MP w/WINGS
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
2971870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.08 |
| Max. Negotiated Rate |
$244.00 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Aetna Managed Medicare |
$17.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.14
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.75
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$39.65
|
| Rate for Payer: Quartz Medicare Advantage |
$36.60
|
| Rate for Payer: The Alliance Commercial |
$244.00
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
NEEDLE MP w/WINGS
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
2971870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$29.89 |
| Max. Negotiated Rate |
$56.12 |
| Rate for Payer: Aetna Commercial |
$54.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.33
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$56.12
|
| Rate for Payer: Health EOS Commercial |
$54.29
|
| Rate for Payer: HFN Commercial |
$56.12
|
| Rate for Payer: Multiplan Commercial |
$48.80
|
| Rate for Payer: NAPHCARE Commercial |
$36.60
|
| Rate for Payer: Preferred Network Access Commercial |
$56.12
|
| Rate for Payer: Quartz Beloit One Network |
$29.89
|
| Rate for Payer: Quartz Commercial |
$36.60
|
| Rate for Payer: WEA Trust Commercial |
$33.55
|
| Rate for Payer: WPS Commercial |
$45.18
|
|
|
NEEDLE MYOJET 15m x 25g
|
Facility
|
IP
|
$568.00
|
|
| Hospital Charge Code |
2973337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$278.32 |
| Max. Negotiated Rate |
$522.56 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$340.80
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
NEEDLE MYOJET 15m x 25g
|
Facility
|
OP
|
$568.00
|
|
| Hospital Charge Code |
2973337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$159.04 |
| Max. Negotiated Rate |
$2,272.00 |
| Rate for Payer: Aetna Commercial |
$511.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$488.48
|
| Rate for Payer: Aetna Managed Medicare |
$159.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$369.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$284.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$272.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$301.04
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$522.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$317.85
|
| Rate for Payer: Health EOS Commercial |
$505.52
|
| Rate for Payer: HFN Commercial |
$522.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$426.00
|
| Rate for Payer: Multiplan Commercial |
$454.40
|
| Rate for Payer: NAPHCARE Commercial |
$340.80
|
| Rate for Payer: Preferred Network Access Commercial |
$522.56
|
| Rate for Payer: Quartz Beloit One Network |
$278.32
|
| Rate for Payer: Quartz Commercial |
$369.20
|
| Rate for Payer: Quartz Medicare Advantage |
$340.80
|
| Rate for Payer: The Alliance Commercial |
$2,272.00
|
| Rate for Payer: WEA Trust Commercial |
$312.40
|
| Rate for Payer: WPS Commercial |
$420.72
|
|
|
NEEDLE NERVE BLOCK 21G X 150MM AB-21150-SSE
|
Facility
|
OP
|
$267.00
|
|
| Hospital Charge Code |
5349365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.76 |
| Max. Negotiated Rate |
$1,068.00 |
| Rate for Payer: Aetna Commercial |
$240.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$229.62
|
| Rate for Payer: Aetna Managed Medicare |
$74.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$173.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$133.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$128.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.51
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna Commercial |
$245.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$149.41
|
| Rate for Payer: Health EOS Commercial |
$237.63
|
| Rate for Payer: HFN Commercial |
$245.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.25
|
| Rate for Payer: Multiplan Commercial |
$213.60
|
| Rate for Payer: NAPHCARE Commercial |
$160.20
|
| Rate for Payer: Preferred Network Access Commercial |
$245.64
|
| Rate for Payer: Quartz Beloit One Network |
$130.83
|
| Rate for Payer: Quartz Commercial |
$173.55
|
| Rate for Payer: Quartz Medicare Advantage |
$160.20
|
| Rate for Payer: The Alliance Commercial |
$1,068.00
|
| Rate for Payer: WEA Trust Commercial |
$146.85
|
| Rate for Payer: WPS Commercial |
$197.77
|
|
|
NEEDLE NERVE BLOCK 21G X 150MM AB-21150-SSE
|
Facility
|
IP
|
$267.00
|
|
| Hospital Charge Code |
5349365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.83 |
| Max. Negotiated Rate |
$245.64 |
| Rate for Payer: Aetna Commercial |
$240.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$229.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$141.51
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna Commercial |
$245.64
|
| Rate for Payer: Health EOS Commercial |
$237.63
|
| Rate for Payer: HFN Commercial |
$245.64
|
| Rate for Payer: Multiplan Commercial |
$213.60
|
| Rate for Payer: NAPHCARE Commercial |
$160.20
|
| Rate for Payer: Preferred Network Access Commercial |
$245.64
|
| Rate for Payer: Quartz Beloit One Network |
$130.83
|
| Rate for Payer: Quartz Commercial |
$160.20
|
| Rate for Payer: WEA Trust Commercial |
$146.85
|
| Rate for Payer: WPS Commercial |
$197.77
|
|
|
NEEDLE ORO-TRACHEAL LARYNGEAL INJECTOR 1650050
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
5831659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$262.15 |
| Max. Negotiated Rate |
$492.20 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$321.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
NEEDLE ORO-TRACHEAL LARYNGEAL INJECTOR 1650050
|
Facility
|
OP
|
$535.00
|
|
| Hospital Charge Code |
5831659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.80 |
| Max. Negotiated Rate |
$2,140.00 |
| Rate for Payer: Aetna Commercial |
$481.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Aetna Managed Medicare |
$149.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$347.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$267.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$283.55
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$492.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$299.39
|
| Rate for Payer: Health EOS Commercial |
$476.15
|
| Rate for Payer: HFN Commercial |
$492.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$401.25
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: NAPHCARE Commercial |
$321.00
|
| Rate for Payer: Preferred Network Access Commercial |
$492.20
|
| Rate for Payer: Quartz Beloit One Network |
$262.15
|
| Rate for Payer: Quartz Commercial |
$347.75
|
| Rate for Payer: Quartz Medicare Advantage |
$321.00
|
| Rate for Payer: The Alliance Commercial |
$2,140.00
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
NEEDLE PAJUNK SONOBLOCK 22G X 2IN 50MM 001280-74
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
5957630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
NEEDLE PAJUNK SONOBLOCK 22G X 2IN 50MM 001280-74
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
5957630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$1,140.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
NEEDLE PARACENTESIS 18ga
|
Facility
|
IP
|
$421.00
|
|
| Hospital Charge Code |
2963225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$206.29 |
| Max. Negotiated Rate |
$387.32 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$252.60
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
NEEDLE PARACENTESIS 18ga
|
Facility
|
OP
|
$421.00
|
|
| Hospital Charge Code |
2963225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$117.88 |
| Max. Negotiated Rate |
$1,684.00 |
| Rate for Payer: Aetna Commercial |
$378.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$362.06
|
| Rate for Payer: Aetna Managed Medicare |
$117.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$202.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$223.13
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$387.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.59
|
| Rate for Payer: Health EOS Commercial |
$374.69
|
| Rate for Payer: HFN Commercial |
$387.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$315.75
|
| Rate for Payer: Multiplan Commercial |
$336.80
|
| Rate for Payer: NAPHCARE Commercial |
$252.60
|
| Rate for Payer: Preferred Network Access Commercial |
$387.32
|
| Rate for Payer: Quartz Beloit One Network |
$206.29
|
| Rate for Payer: Quartz Commercial |
$273.65
|
| Rate for Payer: Quartz Medicare Advantage |
$252.60
|
| Rate for Payer: The Alliance Commercial |
$1,684.00
|
| Rate for Payer: WEA Trust Commercial |
$231.55
|
| Rate for Payer: WPS Commercial |
$311.83
|
|
|
NEEDLE POLYESTER DOUBLE ARMED
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
2964930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$334.18 |
| Max. Negotiated Rate |
$627.44 |
| Rate for Payer: Aetna Commercial |
$613.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$627.44
|
| Rate for Payer: Health EOS Commercial |
$606.98
|
| Rate for Payer: HFN Commercial |
$627.44
|
| Rate for Payer: Multiplan Commercial |
$545.60
|
| Rate for Payer: NAPHCARE Commercial |
$409.20
|
| Rate for Payer: Preferred Network Access Commercial |
$627.44
|
| Rate for Payer: Quartz Beloit One Network |
$334.18
|
| Rate for Payer: Quartz Commercial |
$409.20
|
| Rate for Payer: WEA Trust Commercial |
$375.10
|
| Rate for Payer: WPS Commercial |
$505.16
|
|
