|
Nepro Rth 1000 mL
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031445
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$197.96 |
| Max. Negotiated Rate |
$371.68 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$242.40
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
Nepro Rth 1000 mL
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS B4154
|
| Hospital Charge Code |
3031445
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$113.12 |
| Max. Negotiated Rate |
$1,616.00 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$113.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.08
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$303.00
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$262.60
|
| Rate for Payer: Quartz Medicare Advantage |
$242.40
|
| Rate for Payer: The Alliance Commercial |
$1,616.00
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
NEPSY-II KIT & SCORING ASST. &
|
Facility
|
OP
|
$9,144.00
|
|
| Hospital Charge Code |
2973755
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,560.32 |
| Max. Negotiated Rate |
$36,576.00 |
| Rate for Payer: Aetna Commercial |
$8,229.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,863.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,560.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,943.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,572.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,389.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,846.32
|
| Rate for Payer: Cash Price |
$2,743.20
|
| Rate for Payer: Cigna Commercial |
$8,412.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,116.98
|
| Rate for Payer: Health EOS Commercial |
$8,138.16
|
| Rate for Payer: HFN Commercial |
$8,412.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,858.00
|
| Rate for Payer: Multiplan Commercial |
$7,315.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,486.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,412.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,480.56
|
| Rate for Payer: Quartz Commercial |
$5,943.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,486.40
|
| Rate for Payer: The Alliance Commercial |
$36,576.00
|
| Rate for Payer: WEA Trust Commercial |
$5,029.20
|
| Rate for Payer: WPS Commercial |
$6,772.96
|
|
|
NEPSY-II KIT & SCORING ASST. &
|
Facility
|
IP
|
$9,144.00
|
|
| Hospital Charge Code |
2973755
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4,480.56 |
| Max. Negotiated Rate |
$8,412.48 |
| Rate for Payer: Aetna Commercial |
$8,229.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,863.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,846.32
|
| Rate for Payer: Cash Price |
$2,743.20
|
| Rate for Payer: Cigna Commercial |
$8,412.48
|
| Rate for Payer: Health EOS Commercial |
$8,138.16
|
| Rate for Payer: HFN Commercial |
$8,412.48
|
| Rate for Payer: Multiplan Commercial |
$7,315.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,486.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,412.48
|
| Rate for Payer: Quartz Beloit One Network |
$4,480.56
|
| Rate for Payer: Quartz Commercial |
$5,486.40
|
| Rate for Payer: WEA Trust Commercial |
$5,029.20
|
| Rate for Payer: WPS Commercial |
$6,772.96
|
|
|
NERVE BLOCK CERVICAL PLEXUS
|
Facility
|
OP
|
$714.00
|
|
| Hospital Charge Code |
5262634
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$199.92 |
| Max. Negotiated Rate |
$2,856.00 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Aetna Managed Medicare |
$199.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$464.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$357.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$342.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$399.55
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$535.50
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$464.10
|
| Rate for Payer: Quartz Medicare Advantage |
$428.40
|
| Rate for Payer: The Alliance Commercial |
$2,856.00
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
NERVE BLOCK CERVICAL PLEXUS
|
Facility
|
IP
|
$714.00
|
|
| Hospital Charge Code |
5262634
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$349.86 |
| Max. Negotiated Rate |
$656.88 |
| Rate for Payer: Aetna Commercial |
$642.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$614.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$378.42
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$656.88
|
| Rate for Payer: Health EOS Commercial |
$635.46
|
| Rate for Payer: HFN Commercial |
$656.88
|
| Rate for Payer: Multiplan Commercial |
$571.20
|
| Rate for Payer: NAPHCARE Commercial |
$428.40
|
| Rate for Payer: Preferred Network Access Commercial |
$656.88
|
| Rate for Payer: Quartz Beloit One Network |
$349.86
|
| Rate for Payer: Quartz Commercial |
$428.40
|
| Rate for Payer: WEA Trust Commercial |
$392.70
|
| Rate for Payer: WPS Commercial |
$528.86
|
|
|
NERVE BLOCK FEM CONTINUOUS
|
Facility
|
IP
|
$958.00
|
|
| Hospital Charge Code |
5262652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$469.42 |
| Max. Negotiated Rate |
$881.36 |
| Rate for Payer: Aetna Commercial |
$862.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.74
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$881.36
|
| Rate for Payer: Health EOS Commercial |
$852.62
|
| Rate for Payer: HFN Commercial |
$881.36
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: NAPHCARE Commercial |
$574.80
|
| Rate for Payer: Preferred Network Access Commercial |
$881.36
|
| Rate for Payer: Quartz Beloit One Network |
$469.42
|
| Rate for Payer: Quartz Commercial |
$574.80
|
| Rate for Payer: WEA Trust Commercial |
$526.90
|
| Rate for Payer: WPS Commercial |
$709.59
|
|
|
NERVE BLOCK FEM CONTINUOUS
|
Facility
|
OP
|
$958.00
|
|
| Hospital Charge Code |
5262652
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$268.24 |
| Max. Negotiated Rate |
$3,832.00 |
| Rate for Payer: Aetna Commercial |
$862.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$823.88
|
| Rate for Payer: Aetna Managed Medicare |
$268.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$622.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$459.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$507.74
|
| Rate for Payer: Cash Price |
$287.40
|
| Rate for Payer: Cigna Commercial |
$881.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$536.10
|
| Rate for Payer: Health EOS Commercial |
$852.62
|
| Rate for Payer: HFN Commercial |
$881.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$718.50
|
| Rate for Payer: Multiplan Commercial |
$766.40
|
| Rate for Payer: NAPHCARE Commercial |
$574.80
|
| Rate for Payer: Preferred Network Access Commercial |
$881.36
|
| Rate for Payer: Quartz Beloit One Network |
$469.42
|
| Rate for Payer: Quartz Commercial |
$622.70
|
| Rate for Payer: Quartz Medicare Advantage |
$574.80
|
| Rate for Payer: The Alliance Commercial |
$3,832.00
|
| Rate for Payer: WEA Trust Commercial |
$526.90
|
| Rate for Payer: WPS Commercial |
$709.59
|
|
|
NERVE BLOCK GENICULAR
|
Facility
|
OP
|
$1,289.00
|
|
| Hospital Charge Code |
5262657
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$360.92 |
| Max. Negotiated Rate |
$5,156.00 |
| Rate for Payer: Aetna Commercial |
$1,160.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,108.54
|
| Rate for Payer: Aetna Managed Medicare |
$360.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$837.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$644.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$618.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.17
|
| Rate for Payer: Cash Price |
$386.70
|
| Rate for Payer: Cigna Commercial |
$1,185.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$721.32
|
| Rate for Payer: Health EOS Commercial |
$1,147.21
|
| Rate for Payer: HFN Commercial |
$1,185.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$966.75
|
| Rate for Payer: Multiplan Commercial |
$1,031.20
|
| Rate for Payer: NAPHCARE Commercial |
$773.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,185.88
|
| Rate for Payer: Quartz Beloit One Network |
$631.61
|
| Rate for Payer: Quartz Commercial |
$837.85
|
| Rate for Payer: Quartz Medicare Advantage |
$773.40
|
| Rate for Payer: The Alliance Commercial |
$5,156.00
|
| Rate for Payer: WEA Trust Commercial |
$708.95
|
| Rate for Payer: WPS Commercial |
$954.76
|
|
|
NERVE BLOCK GENICULAR
|
Facility
|
IP
|
$1,289.00
|
|
| Hospital Charge Code |
5262657
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$631.61 |
| Max. Negotiated Rate |
$1,185.88 |
| Rate for Payer: Aetna Commercial |
$1,160.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,108.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$683.17
|
| Rate for Payer: Cash Price |
$386.70
|
| Rate for Payer: Cigna Commercial |
$1,185.88
|
| Rate for Payer: Health EOS Commercial |
$1,147.21
|
| Rate for Payer: HFN Commercial |
$1,185.88
|
| Rate for Payer: Multiplan Commercial |
$1,031.20
|
| Rate for Payer: NAPHCARE Commercial |
$773.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,185.88
|
| Rate for Payer: Quartz Beloit One Network |
$631.61
|
| Rate for Payer: Quartz Commercial |
$773.40
|
| Rate for Payer: WEA Trust Commercial |
$708.95
|
| Rate for Payer: WPS Commercial |
$954.76
|
|
|
NERVE BLOCK GREATER OCCIPITAL
|
Facility
|
OP
|
$312.00
|
|
| Hospital Charge Code |
5262633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$1,248.00 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Aetna Managed Medicare |
$87.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$202.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$156.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$149.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$174.60
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$234.00
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$202.80
|
| Rate for Payer: Quartz Medicare Advantage |
$187.20
|
| Rate for Payer: The Alliance Commercial |
$1,248.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
NERVE BLOCK GREATER OCCIPITAL
|
Facility
|
IP
|
$312.00
|
|
| Hospital Charge Code |
5262633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$152.88 |
| Max. Negotiated Rate |
$287.04 |
| Rate for Payer: Aetna Commercial |
$280.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$268.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$165.36
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$287.04
|
| Rate for Payer: Health EOS Commercial |
$277.68
|
| Rate for Payer: HFN Commercial |
$287.04
|
| Rate for Payer: Multiplan Commercial |
$249.60
|
| Rate for Payer: NAPHCARE Commercial |
$187.20
|
| Rate for Payer: Preferred Network Access Commercial |
$287.04
|
| Rate for Payer: Quartz Beloit One Network |
$152.88
|
| Rate for Payer: Quartz Commercial |
$187.20
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.10
|
|
|
NERVE BLOCK ILIOINGUINAL/ILIOHYP
|
Facility
|
OP
|
$719.00
|
|
| Hospital Charge Code |
5262638
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.32 |
| Max. Negotiated Rate |
$2,876.00 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Aetna Managed Medicare |
$201.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$467.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$359.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$345.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.07
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$661.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.35
|
| Rate for Payer: Health EOS Commercial |
$639.91
|
| Rate for Payer: HFN Commercial |
$661.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$539.25
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: NAPHCARE Commercial |
$431.40
|
| Rate for Payer: Preferred Network Access Commercial |
$661.48
|
| Rate for Payer: Quartz Beloit One Network |
$352.31
|
| Rate for Payer: Quartz Commercial |
$467.35
|
| Rate for Payer: Quartz Medicare Advantage |
$431.40
|
| Rate for Payer: The Alliance Commercial |
$2,876.00
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
NERVE BLOCK ILIOINGUINAL/ILIOHYP
|
Facility
|
IP
|
$719.00
|
|
| Hospital Charge Code |
5262638
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$352.31 |
| Max. Negotiated Rate |
$661.48 |
| Rate for Payer: Aetna Commercial |
$647.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.07
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$661.48
|
| Rate for Payer: Health EOS Commercial |
$639.91
|
| Rate for Payer: HFN Commercial |
$661.48
|
| Rate for Payer: Multiplan Commercial |
$575.20
|
| Rate for Payer: NAPHCARE Commercial |
$431.40
|
| Rate for Payer: Preferred Network Access Commercial |
$661.48
|
| Rate for Payer: Quartz Beloit One Network |
$352.31
|
| Rate for Payer: Quartz Commercial |
$431.40
|
| Rate for Payer: WEA Trust Commercial |
$395.45
|
| Rate for Payer: WPS Commercial |
$532.56
|
|
|
Nerve Block Injection Femerol Nerve, Single 64447
|
Professional
|
Both
|
$764.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
4924608
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.08 |
| Max. Negotiated Rate |
$725.80 |
| Rate for Payer: Aetna Commercial |
$725.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$657.04
|
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cigna Commercial |
$725.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$458.40
|
| Rate for Payer: Health EOS Commercial |
$695.24
|
| Rate for Payer: HFN Commercial |
$725.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.39
|
| Rate for Payer: Multiplan Commercial |
$611.20
|
| Rate for Payer: Preferred Network Access Commercial |
$725.80
|
| Rate for Payer: Quartz Beloit One Network |
$336.16
|
| Rate for Payer: Quartz Commercial |
$435.48
|
| Rate for Payer: The Alliance Commercial |
$382.00
|
| Rate for Payer: United Healthcare Medicaid |
$68.08
|
| Rate for Payer: WEA Trust Commercial |
$420.20
|
| Rate for Payer: WPS Commercial |
$565.89
|
|
|
Nerve Block Injection Occipital Nerve 64405
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
4924609
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$619.40 |
| Rate for Payer: Aetna Commercial |
$619.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$560.72
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$619.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$391.20
|
| Rate for Payer: Health EOS Commercial |
$593.32
|
| Rate for Payer: HFN Commercial |
$619.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.16
|
| Rate for Payer: Multiplan Commercial |
$521.60
|
| Rate for Payer: Preferred Network Access Commercial |
$619.40
|
| Rate for Payer: Quartz Beloit One Network |
$286.88
|
| Rate for Payer: Quartz Commercial |
$371.64
|
| Rate for Payer: The Alliance Commercial |
$326.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$358.60
|
| Rate for Payer: WPS Commercial |
$482.94
|
|
|
Nerve Block Injection Occipital Nerve 6440550
|
Professional
|
Both
|
$1,305.00
|
|
|
Service Code
|
CPT 64405 50
|
| Hospital Charge Code |
4848606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.00 |
| Max. Negotiated Rate |
$1,239.75 |
| Rate for Payer: Aetna Commercial |
$1,239.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,122.30
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,239.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$783.00
|
| Rate for Payer: Health EOS Commercial |
$1,187.55
|
| Rate for Payer: HFN Commercial |
$1,239.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.16
|
| Rate for Payer: Multiplan Commercial |
$1,044.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,239.75
|
| Rate for Payer: Quartz Beloit One Network |
$574.20
|
| Rate for Payer: Quartz Commercial |
$743.85
|
| Rate for Payer: The Alliance Commercial |
$652.50
|
| Rate for Payer: United Healthcare Medicaid |
$45.00
|
| Rate for Payer: WEA Trust Commercial |
$717.75
|
| Rate for Payer: WPS Commercial |
$966.61
|
|
|
Nerve Block Injection Sciatic Single 64445
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
5232785
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$552.90 |
| Rate for Payer: Aetna Commercial |
$552.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.52
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$552.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$349.20
|
| Rate for Payer: Health EOS Commercial |
$529.62
|
| Rate for Payer: HFN Commercial |
$552.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$181.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.34
|
| Rate for Payer: Multiplan Commercial |
$465.60
|
| Rate for Payer: Preferred Network Access Commercial |
$552.90
|
| Rate for Payer: Quartz Beloit One Network |
$256.08
|
| Rate for Payer: Quartz Commercial |
$331.74
|
| Rate for Payer: The Alliance Commercial |
$291.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$320.10
|
| Rate for Payer: WPS Commercial |
$431.09
|
|
|
NERVE BLOCK INTERCOSTAL, MULT/REG
|
Facility
|
OP
|
$2,511.00
|
|
| Hospital Charge Code |
5262637
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$703.08 |
| Max. Negotiated Rate |
$10,044.00 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Aetna Managed Medicare |
$703.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,632.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,405.16
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,883.25
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,632.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,506.60
|
| Rate for Payer: The Alliance Commercial |
$10,044.00
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
NERVE BLOCK INTERCOSTAL, MULT/REG
|
Facility
|
IP
|
$2,511.00
|
|
| Hospital Charge Code |
5262637
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,230.39 |
| Max. Negotiated Rate |
$2,310.12 |
| Rate for Payer: Aetna Commercial |
$2,259.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,159.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,330.83
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,310.12
|
| Rate for Payer: Health EOS Commercial |
$2,234.79
|
| Rate for Payer: HFN Commercial |
$2,310.12
|
| Rate for Payer: Multiplan Commercial |
$2,008.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,506.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,310.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.39
|
| Rate for Payer: Quartz Commercial |
$1,506.60
|
| Rate for Payer: WEA Trust Commercial |
$1,381.05
|
| Rate for Payer: WPS Commercial |
$1,859.90
|
|
|
NERVE BLOCK INTERCOSTAL, SINGLE
|
Facility
|
IP
|
$1,640.00
|
|
| Hospital Charge Code |
5262636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$803.60 |
| Max. Negotiated Rate |
$1,508.80 |
| Rate for Payer: Aetna Commercial |
$1,476.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,410.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$869.20
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$1,508.80
|
| Rate for Payer: Health EOS Commercial |
$1,459.60
|
| Rate for Payer: HFN Commercial |
$1,508.80
|
| Rate for Payer: Multiplan Commercial |
$1,312.00
|
| Rate for Payer: NAPHCARE Commercial |
$984.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,508.80
|
| Rate for Payer: Quartz Beloit One Network |
$803.60
|
| Rate for Payer: Quartz Commercial |
$984.00
|
| Rate for Payer: WEA Trust Commercial |
$902.00
|
| Rate for Payer: WPS Commercial |
$1,214.75
|
|
|
NERVE BLOCK INTERCOSTAL, SINGLE
|
Facility
|
OP
|
$1,640.00
|
|
| Hospital Charge Code |
5262636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$459.20 |
| Max. Negotiated Rate |
$6,560.00 |
| Rate for Payer: Aetna Commercial |
$1,476.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,410.40
|
| Rate for Payer: Aetna Managed Medicare |
$459.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,066.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$820.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$787.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$869.20
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$1,508.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$917.74
|
| Rate for Payer: Health EOS Commercial |
$1,459.60
|
| Rate for Payer: HFN Commercial |
$1,508.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,230.00
|
| Rate for Payer: Multiplan Commercial |
$1,312.00
|
| Rate for Payer: NAPHCARE Commercial |
$984.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,508.80
|
| Rate for Payer: Quartz Beloit One Network |
$803.60
|
| Rate for Payer: Quartz Commercial |
$1,066.00
|
| Rate for Payer: Quartz Medicare Advantage |
$984.00
|
| Rate for Payer: The Alliance Commercial |
$6,560.00
|
| Rate for Payer: WEA Trust Commercial |
$902.00
|
| Rate for Payer: WPS Commercial |
$1,214.75
|
|
|
Nerve Block Lumbar/Thoracic 64520
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
5232689
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$158.49 |
| Max. Negotiated Rate |
$1,075.40 |
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$973.52
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$1,075.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$679.20
|
| Rate for Payer: Health EOS Commercial |
$1,030.12
|
| Rate for Payer: HFN Commercial |
$1,075.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$283.92
|
| Rate for Payer: Multiplan Commercial |
$905.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,075.40
|
| Rate for Payer: Quartz Beloit One Network |
$498.08
|
| Rate for Payer: Quartz Commercial |
$645.24
|
| Rate for Payer: The Alliance Commercial |
$566.00
|
| Rate for Payer: United Healthcare Medicaid |
$158.49
|
| Rate for Payer: WEA Trust Commercial |
$622.60
|
| Rate for Payer: WPS Commercial |
$838.47
|
|
|
Nerve Block Lumbar/Thoracic 6452050
|
Professional
|
Both
|
$2,263.00
|
|
|
Service Code
|
CPT 64520 50
|
| Hospital Charge Code |
5232690
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$158.49 |
| Max. Negotiated Rate |
$2,149.85 |
| Rate for Payer: Aetna Commercial |
$2,149.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,946.18
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,149.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,357.80
|
| Rate for Payer: Health EOS Commercial |
$2,059.33
|
| Rate for Payer: HFN Commercial |
$2,149.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$283.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$283.92
|
| Rate for Payer: Multiplan Commercial |
$1,810.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,149.85
|
| Rate for Payer: Quartz Beloit One Network |
$995.72
|
| Rate for Payer: Quartz Commercial |
$1,289.91
|
| Rate for Payer: The Alliance Commercial |
$1,131.50
|
| Rate for Payer: United Healthcare Medicaid |
$158.49
|
| Rate for Payer: WEA Trust Commercial |
$1,244.65
|
| Rate for Payer: WPS Commercial |
$1,676.20
|
|
|
NERVE BLOCK NEEDLE 21GX3.5 AB-21090-SSE"
|
Facility
|
OP
|
$320.00
|
|
| Hospital Charge Code |
3065504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$89.60 |
| Max. Negotiated Rate |
$1,280.00 |
| Rate for Payer: Aetna Commercial |
$288.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| Rate for Payer: Aetna Managed Medicare |
$89.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$208.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$160.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.60
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$294.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$179.07
|
| Rate for Payer: Health EOS Commercial |
$284.80
|
| Rate for Payer: HFN Commercial |
$294.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.00
|
| Rate for Payer: Multiplan Commercial |
$256.00
|
| Rate for Payer: NAPHCARE Commercial |
$192.00
|
| Rate for Payer: Preferred Network Access Commercial |
$294.40
|
| Rate for Payer: Quartz Beloit One Network |
$156.80
|
| Rate for Payer: Quartz Commercial |
$208.00
|
| Rate for Payer: Quartz Medicare Advantage |
$192.00
|
| Rate for Payer: The Alliance Commercial |
$1,280.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
