|
Needle Localization by Xray 77002
|
Professional
|
Both
|
$340.00
|
|
|
Service Code
|
CPT 77002
|
| Hospital Charge Code |
5008611
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$120.67 |
| Max. Negotiated Rate |
$603.36 |
| Rate for Payer: Aetna Commercial |
$335.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.10
|
| Rate for Payer: Aetna Managed Medicare |
$120.67
|
| Rate for Payer: Anthem Medicare Advantage |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$120.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$120.67
|
| 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 |
$335.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.67
|
| Rate for Payer: Health EOS Commercial |
$321.78
|
| Rate for Payer: HFN Commercial |
$335.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$411.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$411.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$120.67
|
| Rate for Payer: Multiplan Commercial |
$282.88
|
| Rate for Payer: NAPHCARE Commercial |
$181.01
|
| Rate for Payer: Preferred Network Access Commercial |
$335.92
|
| Rate for Payer: Quartz Beloit One Network |
$155.58
|
| Rate for Payer: Quartz Commercial |
$201.55
|
| Rate for Payer: Quartz Medicare Advantage |
$120.67
|
| Rate for Payer: The Alliance Commercial |
$458.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$120.67
|
| Rate for Payer: WEA Trust Commercial |
$194.48
|
| Rate for Payer: WPS Commercial |
$603.36
|
|
|
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 |
$27.05 |
| Max. Negotiated Rate |
$335.92 |
| Rate for Payer: Aetna Commercial |
$335.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.10
|
| Rate for Payer: Aetna Managed Medicare |
$27.05
|
| Rate for Payer: Anthem Medicare Advantage |
$27.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.05
|
| 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 |
$335.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$176.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.05
|
| Rate for Payer: Health EOS Commercial |
$321.78
|
| Rate for Payer: HFN Commercial |
$335.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.05
|
| Rate for Payer: Multiplan Commercial |
$282.88
|
| Rate for Payer: NAPHCARE Commercial |
$40.58
|
| Rate for Payer: Preferred Network Access Commercial |
$335.92
|
| Rate for Payer: Quartz Beloit One Network |
$155.58
|
| Rate for Payer: Quartz Commercial |
$201.55
|
| Rate for Payer: Quartz Medicare Advantage |
$27.05
|
| Rate for Payer: The Alliance Commercial |
$102.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.05
|
| Rate for Payer: WEA Trust Commercial |
$194.48
|
| Rate for Payer: WPS Commercial |
$135.25
|
|
|
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 |
$195.69 |
| Max. Negotiated Rate |
$367.41 |
| Rate for Payer: Aetna Commercial |
$359.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.66
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$367.41
|
| Rate for Payer: Health EOS Commercial |
$355.43
|
| Rate for Payer: HFN Commercial |
$367.41
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: Preferred Network Access Commercial |
$367.41
|
| Rate for Payer: Quartz Beloit One Network |
$195.69
|
| Rate for Payer: Quartz Commercial |
$239.62
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$295.80
|
|
|
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 |
$111.82 |
| Max. Negotiated Rate |
$367.41 |
| Rate for Payer: Aetna Commercial |
$359.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Aetna Managed Medicare |
$111.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$259.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.66
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$367.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$223.49
|
| Rate for Payer: Health EOS Commercial |
$355.43
|
| Rate for Payer: HFN Commercial |
$367.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$299.52
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: NAPHCARE Commercial |
$239.62
|
| Rate for Payer: Preferred Network Access Commercial |
$367.41
|
| Rate for Payer: Quartz Beloit One Network |
$195.69
|
| Rate for Payer: Quartz Commercial |
$259.58
|
| Rate for Payer: Quartz Medicare Advantage |
$239.62
|
| Rate for Payer: The Alliance Commercial |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$295.80
|
|
|
NEEDLE MP w/WINGS
|
Facility
|
IP
|
$61.00
|
|
| Hospital Charge Code |
2971870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$31.09 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$38.06
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
NEEDLE MP w/WINGS
|
Facility
|
OP
|
$61.00
|
|
| Hospital Charge Code |
2971870
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$17.76 |
| Max. Negotiated Rate |
$58.36 |
| Rate for Payer: Aetna Commercial |
$57.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54.56
|
| Rate for Payer: Aetna Managed Medicare |
$17.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33.62
|
| Rate for Payer: Cash Price |
$18.30
|
| Rate for Payer: Cigna Commercial |
$58.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.50
|
| Rate for Payer: Health EOS Commercial |
$56.46
|
| Rate for Payer: HFN Commercial |
$58.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.58
|
| Rate for Payer: Multiplan Commercial |
$50.75
|
| Rate for Payer: NAPHCARE Commercial |
$38.06
|
| Rate for Payer: Preferred Network Access Commercial |
$58.36
|
| Rate for Payer: Quartz Beloit One Network |
$31.09
|
| Rate for Payer: Quartz Commercial |
$41.24
|
| Rate for Payer: Quartz Medicare Advantage |
$38.06
|
| Rate for Payer: The Alliance Commercial |
$31.72
|
| Rate for Payer: WEA Trust Commercial |
$34.89
|
| Rate for Payer: WPS Commercial |
$46.99
|
|
|
NEEDLE MYOJET 15m x 25g
|
Facility
|
IP
|
$568.00
|
|
| Hospital Charge Code |
2973337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$289.45 |
| Max. Negotiated Rate |
$543.46 |
| Rate for Payer: Aetna Commercial |
$531.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.08
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$543.46
|
| Rate for Payer: Health EOS Commercial |
$525.74
|
| Rate for Payer: HFN Commercial |
$543.46
|
| Rate for Payer: Multiplan Commercial |
$472.58
|
| Rate for Payer: Preferred Network Access Commercial |
$543.46
|
| Rate for Payer: Quartz Beloit One Network |
$289.45
|
| Rate for Payer: Quartz Commercial |
$354.43
|
| Rate for Payer: WEA Trust Commercial |
$324.90
|
| Rate for Payer: WPS Commercial |
$437.53
|
|
|
NEEDLE MYOJET 15m x 25g
|
Facility
|
OP
|
$568.00
|
|
| Hospital Charge Code |
2973337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$165.40 |
| Max. Negotiated Rate |
$543.46 |
| Rate for Payer: Aetna Commercial |
$531.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$508.02
|
| Rate for Payer: Aetna Managed Medicare |
$165.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$383.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$295.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$283.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$313.08
|
| Rate for Payer: Cash Price |
$170.40
|
| Rate for Payer: Cigna Commercial |
$543.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$330.58
|
| Rate for Payer: Health EOS Commercial |
$525.74
|
| Rate for Payer: HFN Commercial |
$543.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$443.04
|
| Rate for Payer: Multiplan Commercial |
$472.58
|
| Rate for Payer: NAPHCARE Commercial |
$354.43
|
| Rate for Payer: Preferred Network Access Commercial |
$543.46
|
| Rate for Payer: Quartz Beloit One Network |
$289.45
|
| Rate for Payer: Quartz Commercial |
$383.97
|
| Rate for Payer: Quartz Medicare Advantage |
$354.43
|
| Rate for Payer: The Alliance Commercial |
$295.36
|
| Rate for Payer: WEA Trust Commercial |
$324.90
|
| Rate for Payer: WPS Commercial |
$437.53
|
|
|
NEEDLE NERVE BLOCK 21G X 150MM AB-21150-SSE
|
Facility
|
OP
|
$267.00
|
|
| Hospital Charge Code |
5349365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$77.75 |
| Max. Negotiated Rate |
$255.47 |
| Rate for Payer: Aetna Commercial |
$249.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.80
|
| Rate for Payer: Aetna Managed Medicare |
$77.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$180.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$133.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.17
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna Commercial |
$255.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.39
|
| Rate for Payer: Health EOS Commercial |
$247.14
|
| Rate for Payer: HFN Commercial |
$255.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$208.26
|
| Rate for Payer: Multiplan Commercial |
$222.14
|
| Rate for Payer: NAPHCARE Commercial |
$166.61
|
| Rate for Payer: Preferred Network Access Commercial |
$255.47
|
| Rate for Payer: Quartz Beloit One Network |
$136.06
|
| Rate for Payer: Quartz Commercial |
$180.49
|
| Rate for Payer: Quartz Medicare Advantage |
$166.61
|
| Rate for Payer: The Alliance Commercial |
$138.84
|
| Rate for Payer: WEA Trust Commercial |
$152.72
|
| Rate for Payer: WPS Commercial |
$205.67
|
|
|
NEEDLE NERVE BLOCK 21G X 150MM AB-21150-SSE
|
Facility
|
IP
|
$267.00
|
|
| Hospital Charge Code |
5349365
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$136.06 |
| Max. Negotiated Rate |
$255.47 |
| Rate for Payer: Aetna Commercial |
$249.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.17
|
| Rate for Payer: Cash Price |
$80.10
|
| Rate for Payer: Cigna Commercial |
$255.47
|
| Rate for Payer: Health EOS Commercial |
$247.14
|
| Rate for Payer: HFN Commercial |
$255.47
|
| Rate for Payer: Multiplan Commercial |
$222.14
|
| Rate for Payer: Preferred Network Access Commercial |
$255.47
|
| Rate for Payer: Quartz Beloit One Network |
$136.06
|
| Rate for Payer: Quartz Commercial |
$166.61
|
| Rate for Payer: WEA Trust Commercial |
$152.72
|
| Rate for Payer: WPS Commercial |
$205.67
|
|
|
NEEDLE ORO-TRACHEAL LARYNGEAL INJECTOR 1650050
|
Facility
|
OP
|
$535.00
|
|
| Hospital Charge Code |
5831659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$155.79 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Aetna Managed Medicare |
$155.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$361.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$278.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$267.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.37
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$417.30
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: NAPHCARE Commercial |
$333.84
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$361.66
|
| Rate for Payer: Quartz Medicare Advantage |
$333.84
|
| Rate for Payer: The Alliance Commercial |
$278.20
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
NEEDLE ORO-TRACHEAL LARYNGEAL INJECTOR 1650050
|
Facility
|
IP
|
$535.00
|
|
| Hospital Charge Code |
5831659
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$272.64 |
| Max. Negotiated Rate |
$511.89 |
| Rate for Payer: Aetna Commercial |
$500.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$478.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$294.89
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$511.89
|
| Rate for Payer: Health EOS Commercial |
$495.20
|
| Rate for Payer: HFN Commercial |
$511.89
|
| Rate for Payer: Multiplan Commercial |
$445.12
|
| Rate for Payer: Preferred Network Access Commercial |
$511.89
|
| Rate for Payer: Quartz Beloit One Network |
$272.64
|
| Rate for Payer: Quartz Commercial |
$333.84
|
| Rate for Payer: WEA Trust Commercial |
$306.02
|
| Rate for Payer: WPS Commercial |
$412.11
|
|
|
NEEDLE PAJUNK SONOBLOCK 22G X 2IN 50MM 001280-74
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
5957630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
NEEDLE PAJUNK SONOBLOCK 22G X 2IN 50MM 001280-74
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
5957630
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
NEEDLE PARACENTESIS 18ga
|
Facility
|
OP
|
$421.00
|
|
| Hospital Charge Code |
2963225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$122.60 |
| Max. Negotiated Rate |
$402.81 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Aetna Managed Medicare |
$122.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$284.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$218.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$210.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$245.02
|
| Rate for Payer: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$328.38
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: NAPHCARE Commercial |
$262.70
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$284.60
|
| Rate for Payer: Quartz Medicare Advantage |
$262.70
|
| Rate for Payer: The Alliance Commercial |
$218.92
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
NEEDLE PARACENTESIS 18ga
|
Facility
|
IP
|
$421.00
|
|
| Hospital Charge Code |
2963225
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$214.54 |
| Max. Negotiated Rate |
$402.81 |
| Rate for Payer: Aetna Commercial |
$394.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$376.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$232.06
|
| Rate for Payer: Cash Price |
$126.30
|
| Rate for Payer: Cigna Commercial |
$402.81
|
| Rate for Payer: Health EOS Commercial |
$389.68
|
| Rate for Payer: HFN Commercial |
$402.81
|
| Rate for Payer: Multiplan Commercial |
$350.27
|
| Rate for Payer: Preferred Network Access Commercial |
$402.81
|
| Rate for Payer: Quartz Beloit One Network |
$214.54
|
| Rate for Payer: Quartz Commercial |
$262.70
|
| Rate for Payer: WEA Trust Commercial |
$240.81
|
| Rate for Payer: WPS Commercial |
$324.30
|
|
|
NEEDLE POLYESTER DOUBLE ARMED
|
Facility
|
OP
|
$682.00
|
|
| Hospital Charge Code |
2964930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$198.60 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Aetna Managed Medicare |
$198.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$461.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$354.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$340.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$396.92
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$531.96
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: NAPHCARE Commercial |
$425.57
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$461.03
|
| Rate for Payer: Quartz Medicare Advantage |
$425.57
|
| Rate for Payer: The Alliance Commercial |
$354.64
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
NEEDLE POLYESTER DOUBLE ARMED
|
Facility
|
IP
|
$682.00
|
|
| Hospital Charge Code |
2964930
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$347.55 |
| Max. Negotiated Rate |
$652.54 |
| Rate for Payer: Aetna Commercial |
$638.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$609.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$375.92
|
| Rate for Payer: Cash Price |
$204.60
|
| Rate for Payer: Cigna Commercial |
$652.54
|
| Rate for Payer: Health EOS Commercial |
$631.26
|
| Rate for Payer: HFN Commercial |
$652.54
|
| Rate for Payer: Multiplan Commercial |
$567.42
|
| Rate for Payer: Preferred Network Access Commercial |
$652.54
|
| Rate for Payer: Quartz Beloit One Network |
$347.55
|
| Rate for Payer: Quartz Commercial |
$425.57
|
| Rate for Payer: WEA Trust Commercial |
$390.10
|
| Rate for Payer: WPS Commercial |
$525.34
|
|
|
NEEDLE PROCORE ECHO-HD-22-EBUS-O-C G34281
|
Facility
|
OP
|
$2,843.00
|
|
| Hospital Charge Code |
5384683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$827.88 |
| Max. Negotiated Rate |
$2,720.18 |
| Rate for Payer: Aetna Commercial |
$2,661.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,542.78
|
| Rate for Payer: Aetna Managed Medicare |
$827.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,921.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,478.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,419.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,567.06
|
| Rate for Payer: Cash Price |
$852.90
|
| Rate for Payer: Cigna Commercial |
$2,720.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,654.63
|
| Rate for Payer: Health EOS Commercial |
$2,631.48
|
| Rate for Payer: HFN Commercial |
$2,720.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,217.54
|
| Rate for Payer: Multiplan Commercial |
$2,365.38
|
| Rate for Payer: NAPHCARE Commercial |
$1,774.03
|
| Rate for Payer: Preferred Network Access Commercial |
$2,720.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,448.79
|
| Rate for Payer: Quartz Commercial |
$1,921.87
|
| Rate for Payer: Quartz Medicare Advantage |
$1,774.03
|
| Rate for Payer: The Alliance Commercial |
$1,478.36
|
| Rate for Payer: WEA Trust Commercial |
$1,626.20
|
| Rate for Payer: WPS Commercial |
$2,189.96
|
|
|
NEEDLE PROCORE ECHO-HD-22-EBUS-O-C G34281
|
Facility
|
IP
|
$2,843.00
|
|
| Hospital Charge Code |
5384683
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,448.79 |
| Max. Negotiated Rate |
$2,720.18 |
| Rate for Payer: Aetna Commercial |
$2,661.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,542.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,567.06
|
| Rate for Payer: Cash Price |
$852.90
|
| Rate for Payer: Cigna Commercial |
$2,720.18
|
| Rate for Payer: Health EOS Commercial |
$2,631.48
|
| Rate for Payer: HFN Commercial |
$2,720.18
|
| Rate for Payer: Multiplan Commercial |
$2,365.38
|
| Rate for Payer: Preferred Network Access Commercial |
$2,720.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,448.79
|
| Rate for Payer: Quartz Commercial |
$1,774.03
|
| Rate for Payer: WEA Trust Commercial |
$1,626.20
|
| Rate for Payer: WPS Commercial |
$2,189.96
|
|
|
NEEDLE RETROBULBAR 23G X 1 1/4 585001
|
Facility
|
OP
|
$156.00
|
|
| Hospital Charge Code |
6172536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$45.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.79
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$97.34
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$105.46
|
| Rate for Payer: Quartz Medicare Advantage |
$97.34
|
| Rate for Payer: The Alliance Commercial |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
NEEDLE RETROBULBAR 23G X 1 1/4 585001
|
Facility
|
IP
|
$156.00
|
|
| Hospital Charge Code |
6172536
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
NEEDLE RETROBULBAR 23G X 1.5 581638
|
Facility
|
OP
|
$147.00
|
|
| Hospital Charge Code |
2968991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Aetna Managed Medicare |
$42.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$99.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.55
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.66
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: NAPHCARE Commercial |
$91.73
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$99.37
|
| Rate for Payer: Quartz Medicare Advantage |
$91.73
|
| Rate for Payer: The Alliance Commercial |
$76.44
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
NEEDLE RETROBULBAR 23G X 1.5 581638
|
Facility
|
IP
|
$147.00
|
|
| Hospital Charge Code |
2968991
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$74.91 |
| Max. Negotiated Rate |
$140.65 |
| Rate for Payer: Aetna Commercial |
$137.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$81.03
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$140.65
|
| Rate for Payer: Health EOS Commercial |
$136.06
|
| Rate for Payer: HFN Commercial |
$140.65
|
| Rate for Payer: Multiplan Commercial |
$122.30
|
| Rate for Payer: Preferred Network Access Commercial |
$140.65
|
| Rate for Payer: Quartz Beloit One Network |
$74.91
|
| Rate for Payer: Quartz Commercial |
$91.73
|
| Rate for Payer: WEA Trust Commercial |
$84.08
|
| Rate for Payer: WPS Commercial |
$113.23
|
|
|
NEEDLE RIDGED 16GA-25GA X 25CM 17DEG TIP PROLARYN 9010MO
|
Facility
|
OP
|
$923.00
|
|
| Hospital Charge Code |
6181259
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$268.78 |
| Max. Negotiated Rate |
$883.13 |
| Rate for Payer: Aetna Commercial |
$863.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$825.53
|
| Rate for Payer: Aetna Managed Medicare |
$268.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$623.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$479.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$460.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$508.76
|
| Rate for Payer: Cash Price |
$276.90
|
| Rate for Payer: Cigna Commercial |
$883.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$537.19
|
| Rate for Payer: Health EOS Commercial |
$854.33
|
| Rate for Payer: HFN Commercial |
$883.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$719.94
|
| Rate for Payer: Multiplan Commercial |
$767.94
|
| Rate for Payer: NAPHCARE Commercial |
$575.95
|
| Rate for Payer: Preferred Network Access Commercial |
$883.13
|
| Rate for Payer: Quartz Beloit One Network |
$470.36
|
| Rate for Payer: Quartz Commercial |
$623.95
|
| Rate for Payer: Quartz Medicare Advantage |
$575.95
|
| Rate for Payer: The Alliance Commercial |
$479.96
|
| Rate for Payer: WEA Trust Commercial |
$527.96
|
| Rate for Payer: WPS Commercial |
$710.99
|
|
