|
NEBULIZER MINI HEART HI-FLO
|
Facility
|
IP
|
$261.00
|
|
| Hospital Charge Code |
2969759
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$133.01 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.86
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$249.72
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$162.86
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
NECK DISSECTION, RADICAL
|
Facility
|
IP
|
$4,048.00
|
|
| Hospital Charge Code |
2960334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,062.86 |
| Max. Negotiated Rate |
$3,873.13 |
| Rate for Payer: Aetna Commercial |
$3,788.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,620.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,231.26
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$3,873.13
|
| Rate for Payer: Health EOS Commercial |
$3,746.83
|
| Rate for Payer: HFN Commercial |
$3,873.13
|
| Rate for Payer: Multiplan Commercial |
$3,367.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,873.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,062.86
|
| Rate for Payer: Quartz Commercial |
$2,525.95
|
| Rate for Payer: WEA Trust Commercial |
$2,315.46
|
| Rate for Payer: WPS Commercial |
$3,118.17
|
|
|
NECK DISSECTION, RADICAL
|
Facility
|
OP
|
$4,048.00
|
|
| Hospital Charge Code |
2960334
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,178.78 |
| Max. Negotiated Rate |
$3,873.13 |
| Rate for Payer: Aetna Commercial |
$3,788.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,620.53
|
| Rate for Payer: Aetna Managed Medicare |
$1,178.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,736.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,104.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,020.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,231.26
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$3,873.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,355.94
|
| Rate for Payer: Health EOS Commercial |
$3,746.83
|
| Rate for Payer: HFN Commercial |
$3,873.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,157.44
|
| Rate for Payer: Multiplan Commercial |
$3,367.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,525.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,873.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,062.86
|
| Rate for Payer: Quartz Commercial |
$2,736.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,525.95
|
| Rate for Payer: The Alliance Commercial |
$2,104.96
|
| Rate for Payer: WEA Trust Commercial |
$2,315.46
|
| Rate for Payer: WPS Commercial |
$3,118.17
|
|
|
NECK EXPLORATION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
NECK EXPLORATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960239
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
NEEDLE 15ga FISTULA (DO NOT ORDER) 666-1731
|
Facility
|
IP
|
$23.00
|
|
| Hospital Charge Code |
2973050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.72 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$14.35
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
NEEDLE 15ga FISTULA (DO NOT ORDER) 666-1731
|
Facility
|
OP
|
$23.00
|
|
| Hospital Charge Code |
2973050
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.70 |
| Max. Negotiated Rate |
$22.01 |
| Rate for Payer: Aetna Commercial |
$21.53
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$6.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.68
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.39
|
| Rate for Payer: Health EOS Commercial |
$21.29
|
| Rate for Payer: HFN Commercial |
$22.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.94
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$14.35
|
| Rate for Payer: Preferred Network Access Commercial |
$22.01
|
| Rate for Payer: Quartz Beloit One Network |
$11.72
|
| Rate for Payer: Quartz Commercial |
$15.55
|
| Rate for Payer: Quartz Medicare Advantage |
$14.35
|
| Rate for Payer: The Alliance Commercial |
$11.96
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$17.72
|
|
|
NEEDLE 18g ANGIOGRAPHIC -MERIT #AD18T71W
|
Facility
|
OP
|
$63.00
|
|
| Hospital Charge Code |
2969633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.35 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$18.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.67
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.14
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$39.31
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$42.59
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$32.76
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
NEEDLE 18g ANGIOGRAPHIC -MERIT #AD18T71W
|
Facility
|
IP
|
$63.00
|
|
| Hospital Charge Code |
2969633
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.10 |
| Max. Negotiated Rate |
$60.28 |
| Rate for Payer: Aetna Commercial |
$58.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.73
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$60.28
|
| Rate for Payer: Health EOS Commercial |
$58.31
|
| Rate for Payer: HFN Commercial |
$60.28
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: Preferred Network Access Commercial |
$60.28
|
| Rate for Payer: Quartz Beloit One Network |
$32.10
|
| Rate for Payer: Quartz Commercial |
$39.31
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$48.53
|
|
|
NEEDLE 18G X 7CM 195318
|
Facility
|
OP
|
$227.00
|
|
| Hospital Charge Code |
6207019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$66.10 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Aetna Managed Medicare |
$66.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$153.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$118.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$113.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.11
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.06
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: NAPHCARE Commercial |
$141.65
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$153.45
|
| Rate for Payer: Quartz Medicare Advantage |
$141.65
|
| Rate for Payer: The Alliance Commercial |
$118.04
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
NEEDLE 18G X 7CM 195318
|
Facility
|
IP
|
$227.00
|
|
| Hospital Charge Code |
6207019
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$115.68 |
| Max. Negotiated Rate |
$217.19 |
| Rate for Payer: Aetna Commercial |
$212.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$203.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$125.12
|
| Rate for Payer: Cash Price |
$68.10
|
| Rate for Payer: Cigna Commercial |
$217.19
|
| Rate for Payer: Health EOS Commercial |
$210.11
|
| Rate for Payer: HFN Commercial |
$217.19
|
| Rate for Payer: Multiplan Commercial |
$188.86
|
| Rate for Payer: Preferred Network Access Commercial |
$217.19
|
| Rate for Payer: Quartz Beloit One Network |
$115.68
|
| Rate for Payer: Quartz Commercial |
$141.65
|
| Rate for Payer: WEA Trust Commercial |
$129.84
|
| Rate for Payer: WPS Commercial |
$174.86
|
|
|
NEEDLE 20G X 4 (10MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-95
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
6170126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.52 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
NEEDLE 20G X 4 (10MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-95
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
6170126
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Aetna Managed Medicare |
$91.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.33
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$245.70
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: NAPHCARE Commercial |
$196.56
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$212.94
|
| Rate for Payer: Quartz Medicare Advantage |
$196.56
|
| Rate for Payer: The Alliance Commercial |
$163.80
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
NEEDLE 20G X 4 3/4IN (120MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-72
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
6170125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.52 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
NEEDLE 20G X 4 3/4IN (120MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-72
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
6170125
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Aetna Managed Medicare |
$91.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.33
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$245.70
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: NAPHCARE Commercial |
$196.56
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$212.94
|
| Rate for Payer: Quartz Medicare Advantage |
$196.56
|
| Rate for Payer: The Alliance Commercial |
$163.80
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
NEEDLE 20G X 4IN (100MM) PAJUNK SONOPLEX II STIMULATING REGIONAL BLOCK 001287-95
|
Facility
|
IP
|
$300.00
|
|
| Hospital Charge Code |
5957631
|
|
Hospital Revenue Code
|
272
|
| 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 |
$90.00
|
| 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: 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 |
$231.09
|
|
|
NEEDLE 20G X 4IN (100MM) PAJUNK SONOPLEX II STIMULATING REGIONAL BLOCK 001287-95
|
Facility
|
OP
|
$300.00
|
|
| Hospital Charge Code |
5957631
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$87.36 |
| Max. Negotiated Rate |
$287.04 |
| 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 |
$90.00
|
| 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 |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$171.60
|
| Rate for Payer: WPS Commercial |
$231.09
|
|
|
NEEDLE 20G X 6IN (150MM) PAJUNK SONOPLEX II STIMULATING REGIONAL BLOCK 001287-76
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
6170122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.66 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$205.30
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
NEEDLE 20G X 6IN (150MM) PAJUNK SONOPLEX II STIMULATING REGIONAL BLOCK 001287-76
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
6170122
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Aetna Managed Medicare |
$95.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$222.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.48
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.62
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: NAPHCARE Commercial |
$205.30
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$222.40
|
| Rate for Payer: Quartz Medicare Advantage |
$205.30
|
| Rate for Payer: The Alliance Commercial |
$171.08
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
NEEDLE 21G X 4IN (100MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-77
|
Facility
|
IP
|
$315.00
|
|
| Hospital Charge Code |
6170124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$160.52 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$196.56
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
NEEDLE 21G X 4IN (100MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-77
|
Facility
|
OP
|
$315.00
|
|
| Hospital Charge Code |
6170124
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.73 |
| Max. Negotiated Rate |
$301.39 |
| Rate for Payer: Aetna Commercial |
$294.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$281.74
|
| Rate for Payer: Aetna Managed Medicare |
$91.73
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$157.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.63
|
| Rate for Payer: Cash Price |
$94.50
|
| Rate for Payer: Cigna Commercial |
$301.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$183.33
|
| Rate for Payer: Health EOS Commercial |
$291.56
|
| Rate for Payer: HFN Commercial |
$301.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$245.70
|
| Rate for Payer: Multiplan Commercial |
$262.08
|
| Rate for Payer: NAPHCARE Commercial |
$196.56
|
| Rate for Payer: Preferred Network Access Commercial |
$301.39
|
| Rate for Payer: Quartz Beloit One Network |
$160.52
|
| Rate for Payer: Quartz Commercial |
$212.94
|
| Rate for Payer: Quartz Medicare Advantage |
$196.56
|
| Rate for Payer: The Alliance Commercial |
$163.80
|
| Rate for Payer: WEA Trust Commercial |
$180.18
|
| Rate for Payer: WPS Commercial |
$242.64
|
|
|
NEEDLE 22G X 2IN (50MM) PAJUNK SONOPLEX II STIMULATING REGIONAL BLOCK 001287-74
|
Facility
|
IP
|
$329.00
|
|
| Hospital Charge Code |
5957632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$167.66 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$205.30
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
NEEDLE 22G X 2IN (50MM) PAJUNK SONOPLEX II STIMULATING REGIONAL BLOCK 001287-74
|
Facility
|
OP
|
$329.00
|
|
| Hospital Charge Code |
5957632
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$95.80 |
| Max. Negotiated Rate |
$314.79 |
| Rate for Payer: Aetna Commercial |
$307.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$294.26
|
| Rate for Payer: Aetna Managed Medicare |
$95.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$222.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$171.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$164.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$181.34
|
| Rate for Payer: Cash Price |
$98.70
|
| Rate for Payer: Cigna Commercial |
$314.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.48
|
| Rate for Payer: Health EOS Commercial |
$304.52
|
| Rate for Payer: HFN Commercial |
$314.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$256.62
|
| Rate for Payer: Multiplan Commercial |
$273.73
|
| Rate for Payer: NAPHCARE Commercial |
$205.30
|
| Rate for Payer: Preferred Network Access Commercial |
$314.79
|
| Rate for Payer: Quartz Beloit One Network |
$167.66
|
| Rate for Payer: Quartz Commercial |
$222.40
|
| Rate for Payer: Quartz Medicare Advantage |
$205.30
|
| Rate for Payer: The Alliance Commercial |
$171.08
|
| Rate for Payer: WEA Trust Commercial |
$188.19
|
| Rate for Payer: WPS Commercial |
$253.43
|
|
|
NEEDLE 22G X 2IN (50MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-74
|
Facility
|
OP
|
$281.00
|
|
| Hospital Charge Code |
6170123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$81.83 |
| Max. Negotiated Rate |
$268.86 |
| Rate for Payer: Aetna Commercial |
$263.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Aetna Managed Medicare |
$81.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$146.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$140.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.89
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$268.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$163.54
|
| Rate for Payer: Health EOS Commercial |
$260.09
|
| Rate for Payer: HFN Commercial |
$268.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.18
|
| Rate for Payer: Multiplan Commercial |
$233.79
|
| Rate for Payer: NAPHCARE Commercial |
$175.34
|
| Rate for Payer: Preferred Network Access Commercial |
$268.86
|
| Rate for Payer: Quartz Beloit One Network |
$143.20
|
| Rate for Payer: Quartz Commercial |
$189.96
|
| Rate for Payer: Quartz Medicare Advantage |
$175.34
|
| Rate for Payer: The Alliance Commercial |
$146.12
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: WPS Commercial |
$216.45
|
|
|
NEEDLE 22G X 2IN (50MM) SONOPLEX II NON-STIMULATING REGIONAL BLOCK 001281-74
|
Facility
|
IP
|
$281.00
|
|
| Hospital Charge Code |
6170123
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.20 |
| Max. Negotiated Rate |
$268.86 |
| Rate for Payer: Aetna Commercial |
$263.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$251.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.89
|
| Rate for Payer: Cash Price |
$84.30
|
| Rate for Payer: Cigna Commercial |
$268.86
|
| Rate for Payer: Health EOS Commercial |
$260.09
|
| Rate for Payer: HFN Commercial |
$268.86
|
| Rate for Payer: Multiplan Commercial |
$233.79
|
| Rate for Payer: Preferred Network Access Commercial |
$268.86
|
| Rate for Payer: Quartz Beloit One Network |
$143.20
|
| Rate for Payer: Quartz Commercial |
$175.34
|
| Rate for Payer: WEA Trust Commercial |
$160.73
|
| Rate for Payer: WPS Commercial |
$216.45
|
|
