|
NERVE BLOCK NEEDLE 21GX3.5 AB-21090-SSE"
|
Facility
|
IP
|
$320.00
|
|
| Hospital Charge Code |
3065504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$156.80 |
| Max. Negotiated Rate |
$294.40 |
| Rate for Payer: Aetna Commercial |
$288.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.20
|
| 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: Health EOS Commercial |
$284.80
|
| Rate for Payer: HFN Commercial |
$294.40
|
| 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 |
$192.00
|
| Rate for Payer: WEA Trust Commercial |
$176.00
|
| Rate for Payer: WPS Commercial |
$237.02
|
|
|
NERVE BLOCK OTHER PERIPHERAL
|
Facility
|
IP
|
$335.00
|
|
| Hospital Charge Code |
5262653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$164.15 |
| Max. Negotiated Rate |
$308.20 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.00
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
NERVE BLOCK OTHER PERIPHERAL
|
Facility
|
OP
|
$335.00
|
|
| Hospital Charge Code |
5262653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$1,340.00 |
| Rate for Payer: Aetna Commercial |
$301.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$288.10
|
| Rate for Payer: Aetna Managed Medicare |
$93.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$217.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$167.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$160.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.55
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$308.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.47
|
| Rate for Payer: Health EOS Commercial |
$298.15
|
| Rate for Payer: HFN Commercial |
$308.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$251.25
|
| Rate for Payer: Multiplan Commercial |
$268.00
|
| Rate for Payer: NAPHCARE Commercial |
$201.00
|
| Rate for Payer: Preferred Network Access Commercial |
$308.20
|
| Rate for Payer: Quartz Beloit One Network |
$164.15
|
| Rate for Payer: Quartz Commercial |
$217.75
|
| Rate for Payer: Quartz Medicare Advantage |
$201.00
|
| Rate for Payer: The Alliance Commercial |
$1,340.00
|
| Rate for Payer: WEA Trust Commercial |
$184.25
|
| Rate for Payer: WPS Commercial |
$248.13
|
|
|
NERVE BLOCK PUDENDAL
|
Facility
|
IP
|
$916.00
|
|
| Hospital Charge Code |
5262642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$448.84 |
| Max. Negotiated Rate |
$842.72 |
| Rate for Payer: Aetna Commercial |
$824.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.48
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$842.72
|
| Rate for Payer: Health EOS Commercial |
$815.24
|
| Rate for Payer: HFN Commercial |
$842.72
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: NAPHCARE Commercial |
$549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$842.72
|
| Rate for Payer: Quartz Beloit One Network |
$448.84
|
| Rate for Payer: Quartz Commercial |
$549.60
|
| Rate for Payer: WEA Trust Commercial |
$503.80
|
| Rate for Payer: WPS Commercial |
$678.48
|
|
|
NERVE BLOCK PUDENDAL
|
Facility
|
OP
|
$916.00
|
|
| Hospital Charge Code |
5262642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$256.48 |
| Max. Negotiated Rate |
$3,664.00 |
| Rate for Payer: Aetna Commercial |
$824.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$787.76
|
| Rate for Payer: Aetna Managed Medicare |
$256.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$595.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$458.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$485.48
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$842.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.59
|
| Rate for Payer: Health EOS Commercial |
$815.24
|
| Rate for Payer: HFN Commercial |
$842.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.00
|
| Rate for Payer: Multiplan Commercial |
$732.80
|
| Rate for Payer: NAPHCARE Commercial |
$549.60
|
| Rate for Payer: Preferred Network Access Commercial |
$842.72
|
| Rate for Payer: Quartz Beloit One Network |
$448.84
|
| Rate for Payer: Quartz Commercial |
$595.40
|
| Rate for Payer: Quartz Medicare Advantage |
$549.60
|
| Rate for Payer: The Alliance Commercial |
$3,664.00
|
| Rate for Payer: WEA Trust Commercial |
$503.80
|
| Rate for Payer: WPS Commercial |
$678.48
|
|
|
NERVE BLOCK SCIATIC
|
Facility
|
OP
|
$691.00
|
|
| Hospital Charge Code |
5262647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$193.48 |
| Max. Negotiated Rate |
$2,764.00 |
| Rate for Payer: Aetna Commercial |
$621.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.26
|
| Rate for Payer: Aetna Managed Medicare |
$193.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$449.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$345.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$331.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.23
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$635.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$386.68
|
| Rate for Payer: Health EOS Commercial |
$614.99
|
| Rate for Payer: HFN Commercial |
$635.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$518.25
|
| Rate for Payer: Multiplan Commercial |
$552.80
|
| Rate for Payer: NAPHCARE Commercial |
$414.60
|
| Rate for Payer: Preferred Network Access Commercial |
$635.72
|
| Rate for Payer: Quartz Beloit One Network |
$338.59
|
| Rate for Payer: Quartz Commercial |
$449.15
|
| Rate for Payer: Quartz Medicare Advantage |
$414.60
|
| Rate for Payer: The Alliance Commercial |
$2,764.00
|
| Rate for Payer: WEA Trust Commercial |
$380.05
|
| Rate for Payer: WPS Commercial |
$511.82
|
|
|
NERVE BLOCK SCIATIC
|
Facility
|
IP
|
$691.00
|
|
| Hospital Charge Code |
5262647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$338.59 |
| Max. Negotiated Rate |
$635.72 |
| Rate for Payer: Aetna Commercial |
$621.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$594.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.23
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$635.72
|
| Rate for Payer: Health EOS Commercial |
$614.99
|
| Rate for Payer: HFN Commercial |
$635.72
|
| Rate for Payer: Multiplan Commercial |
$552.80
|
| Rate for Payer: NAPHCARE Commercial |
$414.60
|
| Rate for Payer: Preferred Network Access Commercial |
$635.72
|
| Rate for Payer: Quartz Beloit One Network |
$338.59
|
| Rate for Payer: Quartz Commercial |
$414.60
|
| Rate for Payer: WEA Trust Commercial |
$380.05
|
| Rate for Payer: WPS Commercial |
$511.82
|
|
|
NERVE BLOCK SUPRASCAPULAR
|
Facility
|
IP
|
$714.00
|
|
| Hospital Charge Code |
5262635
|
|
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 SUPRASCAPULAR
|
Facility
|
OP
|
$714.00
|
|
| Hospital Charge Code |
5262635
|
|
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 TRIGEMINAL
|
Facility
|
IP
|
$869.00
|
|
| Hospital Charge Code |
5262632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$425.81 |
| Max. Negotiated Rate |
$799.48 |
| Rate for Payer: Aetna Commercial |
$782.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$747.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.57
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna Commercial |
$799.48
|
| Rate for Payer: Health EOS Commercial |
$773.41
|
| Rate for Payer: HFN Commercial |
$799.48
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: NAPHCARE Commercial |
$521.40
|
| Rate for Payer: Preferred Network Access Commercial |
$799.48
|
| Rate for Payer: Quartz Beloit One Network |
$425.81
|
| Rate for Payer: Quartz Commercial |
$521.40
|
| Rate for Payer: WEA Trust Commercial |
$477.95
|
| Rate for Payer: WPS Commercial |
$643.67
|
|
|
NERVE BLOCK TRIGEMINAL
|
Facility
|
OP
|
$869.00
|
|
| Hospital Charge Code |
5262632
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$243.32 |
| Max. Negotiated Rate |
$3,476.00 |
| Rate for Payer: Aetna Commercial |
$782.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$747.34
|
| Rate for Payer: Aetna Managed Medicare |
$243.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$564.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$434.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$417.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.57
|
| Rate for Payer: Cash Price |
$260.70
|
| Rate for Payer: Cigna Commercial |
$799.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$486.29
|
| Rate for Payer: Health EOS Commercial |
$773.41
|
| Rate for Payer: HFN Commercial |
$799.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$651.75
|
| Rate for Payer: Multiplan Commercial |
$695.20
|
| Rate for Payer: NAPHCARE Commercial |
$521.40
|
| Rate for Payer: Preferred Network Access Commercial |
$799.48
|
| Rate for Payer: Quartz Beloit One Network |
$425.81
|
| Rate for Payer: Quartz Commercial |
$564.85
|
| Rate for Payer: Quartz Medicare Advantage |
$521.40
|
| Rate for Payer: The Alliance Commercial |
$3,476.00
|
| Rate for Payer: WEA Trust Commercial |
$477.95
|
| Rate for Payer: WPS Commercial |
$643.67
|
|
|
Nerve Conduction Studies 13/> Studies 95913
|
Professional
|
Both
|
$3,008.00
|
|
|
Service Code
|
CPT 95913
|
| Hospital Charge Code |
4596649
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$232.39 |
| Max. Negotiated Rate |
$2,857.60 |
| Rate for Payer: Aetna Commercial |
$2,857.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,586.88
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cash Price |
$902.40
|
| Rate for Payer: Cigna Commercial |
$2,857.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$232.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,804.80
|
| Rate for Payer: Health EOS Commercial |
$2,737.28
|
| Rate for Payer: HFN Commercial |
$2,857.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,042.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,042.23
|
| Rate for Payer: Multiplan Commercial |
$2,406.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,857.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,323.52
|
| Rate for Payer: Quartz Commercial |
$1,714.56
|
| Rate for Payer: The Alliance Commercial |
$1,504.00
|
| Rate for Payer: United Healthcare Medicaid |
$232.39
|
| Rate for Payer: WEA Trust Commercial |
$1,654.40
|
| Rate for Payer: WPS Commercial |
$2,228.03
|
|
|
NERVE GRAFT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
NERVE GRAFT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960090
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
NERVE GUIDE NEURAGEN 5MM ID X 3CM (C9352 PER CM LENGTH) LENGTH PNG530
|
Facility
|
OP
|
$13,647.00
|
|
|
Service Code
|
HCPCS C9352
|
| Hospital Charge Code |
6199065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,821.16 |
| Max. Negotiated Rate |
$54,588.00 |
| Rate for Payer: Aetna Commercial |
$12,282.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,736.42
|
| Rate for Payer: Aetna Managed Medicare |
$3,821.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,870.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,823.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,550.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,232.91
|
| Rate for Payer: Cash Price |
$4,094.10
|
| Rate for Payer: Cigna Commercial |
$12,555.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,636.86
|
| Rate for Payer: Health EOS Commercial |
$12,145.83
|
| Rate for Payer: HFN Commercial |
$12,555.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,235.25
|
| Rate for Payer: Multiplan Commercial |
$10,917.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,188.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,555.24
|
| Rate for Payer: Quartz Beloit One Network |
$6,687.03
|
| Rate for Payer: Quartz Commercial |
$8,870.55
|
| Rate for Payer: Quartz Medicare Advantage |
$8,188.20
|
| Rate for Payer: The Alliance Commercial |
$54,588.00
|
| Rate for Payer: WEA Trust Commercial |
$7,505.85
|
| Rate for Payer: WPS Commercial |
$10,108.33
|
|
|
NERVE GUIDE NEURAGEN 5MM ID X 3CM (C9352 PER CM LENGTH) LENGTH PNG530
|
Facility
|
IP
|
$13,647.00
|
|
|
Service Code
|
HCPCS C9352
|
| Hospital Charge Code |
6199065
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,687.03 |
| Max. Negotiated Rate |
$12,555.24 |
| Rate for Payer: Aetna Commercial |
$12,282.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,736.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,232.91
|
| Rate for Payer: Cash Price |
$4,094.10
|
| Rate for Payer: Cigna Commercial |
$12,555.24
|
| Rate for Payer: Health EOS Commercial |
$12,145.83
|
| Rate for Payer: HFN Commercial |
$12,555.24
|
| Rate for Payer: Multiplan Commercial |
$10,917.60
|
| Rate for Payer: NAPHCARE Commercial |
$8,188.20
|
| Rate for Payer: Preferred Network Access Commercial |
$12,555.24
|
| Rate for Payer: Quartz Beloit One Network |
$6,687.03
|
| Rate for Payer: Quartz Commercial |
$8,188.20
|
| Rate for Payer: WEA Trust Commercial |
$7,505.85
|
| Rate for Payer: WPS Commercial |
$10,108.33
|
|
|
NERVE LOCATOR VARI-STIM III 8562010
|
Facility
|
OP
|
$864.00
|
|
| Hospital Charge Code |
2965317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$241.92 |
| Max. Negotiated Rate |
$3,456.00 |
| Rate for Payer: Aetna Commercial |
$777.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$743.04
|
| Rate for Payer: Aetna Managed Medicare |
$241.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$561.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$432.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$414.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$457.92
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$794.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$483.49
|
| Rate for Payer: Health EOS Commercial |
$768.96
|
| Rate for Payer: HFN Commercial |
$794.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$648.00
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: NAPHCARE Commercial |
$518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$794.88
|
| Rate for Payer: Quartz Beloit One Network |
$423.36
|
| Rate for Payer: Quartz Commercial |
$561.60
|
| Rate for Payer: Quartz Medicare Advantage |
$518.40
|
| Rate for Payer: The Alliance Commercial |
$3,456.00
|
| Rate for Payer: WEA Trust Commercial |
$475.20
|
| Rate for Payer: WPS Commercial |
$639.96
|
|
|
NERVE LOCATOR VARI-STIM III 8562010
|
Facility
|
IP
|
$864.00
|
|
| Hospital Charge Code |
2965317
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$423.36 |
| Max. Negotiated Rate |
$794.88 |
| Rate for Payer: Aetna Commercial |
$777.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$743.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$457.92
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$794.88
|
| Rate for Payer: Health EOS Commercial |
$768.96
|
| Rate for Payer: HFN Commercial |
$794.88
|
| Rate for Payer: Multiplan Commercial |
$691.20
|
| Rate for Payer: NAPHCARE Commercial |
$518.40
|
| Rate for Payer: Preferred Network Access Commercial |
$794.88
|
| Rate for Payer: Quartz Beloit One Network |
$423.36
|
| Rate for Payer: Quartz Commercial |
$518.40
|
| Rate for Payer: WEA Trust Commercial |
$475.20
|
| Rate for Payer: WPS Commercial |
$639.96
|
|
|
NERVE SURGERY, PERIPHERAL
|
Facility
|
IP
|
$7,388.00
|
|
| Hospital Charge Code |
2960247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,620.12 |
| Max. Negotiated Rate |
$6,796.96 |
| Rate for Payer: Aetna Commercial |
$6,649.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,353.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.64
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$6,796.96
|
| Rate for Payer: Health EOS Commercial |
$6,575.32
|
| Rate for Payer: HFN Commercial |
$6,796.96
|
| Rate for Payer: Multiplan Commercial |
$5,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.12
|
| Rate for Payer: Quartz Commercial |
$4,432.80
|
| Rate for Payer: WEA Trust Commercial |
$4,063.40
|
| Rate for Payer: WPS Commercial |
$5,472.29
|
|
|
NERVE SURGERY, PERIPHERAL
|
Facility
|
OP
|
$7,388.00
|
|
| Hospital Charge Code |
2960247
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,068.64 |
| Max. Negotiated Rate |
$29,552.00 |
| Rate for Payer: Aetna Commercial |
$6,649.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,353.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,068.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,802.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,694.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,546.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,915.64
|
| Rate for Payer: Cash Price |
$2,216.40
|
| Rate for Payer: Cigna Commercial |
$6,796.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,134.32
|
| Rate for Payer: Health EOS Commercial |
$6,575.32
|
| Rate for Payer: HFN Commercial |
$6,796.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,541.00
|
| Rate for Payer: Multiplan Commercial |
$5,910.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,432.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,796.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,620.12
|
| Rate for Payer: Quartz Commercial |
$4,802.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,432.80
|
| Rate for Payer: The Alliance Commercial |
$29,552.00
|
| Rate for Payer: WEA Trust Commercial |
$4,063.40
|
| Rate for Payer: WPS Commercial |
$5,472.29
|
|
|
NERVOUS SYSTEM NEOPLASMS WITH MCC
|
Facility
|
IP
|
$39,495.00
|
|
|
Service Code
|
MSDRG 054
|
| Min. Negotiated Rate |
$14,206.78 |
| Max. Negotiated Rate |
$39,495.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,206.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,840.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,639.07
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,458.66
|
| Rate for Payer: Anthem Medicare Advantage |
$14,206.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,206.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,206.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,206.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,931.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,206.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,733.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,206.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,206.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,206.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,206.78
|
| Rate for Payer: NAPHCARE Commercial |
$21,310.17
|
| Rate for Payer: Quartz Medicare Advantage |
$14,206.78
|
| Rate for Payer: The Alliance Commercial |
$39,495.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,206.78
|
| Rate for Payer: United Healthcare PPO |
$22,369.20
|
| Rate for Payer: Wellcare Medicare |
$14,206.78
|
|
|
NERVOUS SYSTEM NEOPLASMS WITHOUT MCC
|
Facility
|
IP
|
$28,852.00
|
|
|
Service Code
|
MSDRG 055
|
| Min. Negotiated Rate |
$10,378.59 |
| Max. Negotiated Rate |
$28,852.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,378.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,448.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,206.67
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,347.46
|
| Rate for Payer: Anthem Medicare Advantage |
$10,378.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,378.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,378.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,378.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,147.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,378.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,927.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,378.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,378.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,378.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,378.59
|
| Rate for Payer: NAPHCARE Commercial |
$15,567.88
|
| Rate for Payer: Quartz Medicare Advantage |
$10,378.59
|
| Rate for Payer: The Alliance Commercial |
$28,852.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,378.59
|
| Rate for Payer: United Healthcare PPO |
$16,292.25
|
| Rate for Payer: Wellcare Medicare |
$10,378.59
|
|
|
NESBIT PROCEDURE
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
NESBIT PROCEDURE
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
NET RESCUE DGN-538-5
|
Facility
|
IP
|
$1,494.00
|
|
| Hospital Charge Code |
5414814
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$732.06 |
| Max. Negotiated Rate |
$1,374.48 |
| Rate for Payer: Aetna Commercial |
$1,344.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,284.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$791.82
|
| Rate for Payer: Cash Price |
$448.20
|
| Rate for Payer: Cigna Commercial |
$1,374.48
|
| Rate for Payer: Health EOS Commercial |
$1,329.66
|
| Rate for Payer: HFN Commercial |
$1,374.48
|
| Rate for Payer: Multiplan Commercial |
$1,195.20
|
| Rate for Payer: NAPHCARE Commercial |
$896.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,374.48
|
| Rate for Payer: Quartz Beloit One Network |
$732.06
|
| Rate for Payer: Quartz Commercial |
$896.40
|
| Rate for Payer: WEA Trust Commercial |
$821.70
|
| Rate for Payer: WPS Commercial |
$1,106.61
|
|
