|
N BLOCK INJ, PUDENDAL 6443050
|
Professional
|
Both
|
$2,013.00
|
|
|
Service Code
|
CPT 64430 50
|
| Hospital Charge Code |
5412941
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$63.06 |
| Max. Negotiated Rate |
$1,988.84 |
| Rate for Payer: Aetna Commercial |
$1,988.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,800.43
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Cash Price |
$603.90
|
| Rate for Payer: Cigna Commercial |
$1,988.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$63.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,256.11
|
| Rate for Payer: Health EOS Commercial |
$1,905.10
|
| Rate for Payer: HFN Commercial |
$1,988.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$190.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$190.94
|
| Rate for Payer: Multiplan Commercial |
$1,674.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,988.84
|
| Rate for Payer: Quartz Beloit One Network |
$921.15
|
| Rate for Payer: Quartz Commercial |
$1,193.31
|
| Rate for Payer: The Alliance Commercial |
$1,046.76
|
| Rate for Payer: United Healthcare Medicaid |
$63.06
|
| Rate for Payer: WEA Trust Commercial |
$1,151.44
|
| Rate for Payer: WPS Commercial |
$1,550.61
|
|
|
N Block Inj Suprascapular Nerve 64418
|
Professional
|
Both
|
$566.00
|
|
|
Service Code
|
CPT 64418
|
| Hospital Charge Code |
5232627
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.00 |
| Max. Negotiated Rate |
$559.21 |
| Rate for Payer: Aetna Commercial |
$559.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$506.23
|
| Rate for Payer: Aetna Managed Medicare |
$47.00
|
| Rate for Payer: Anthem Medicare Advantage |
$47.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.00
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$559.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.00
|
| Rate for Payer: Health EOS Commercial |
$535.66
|
| Rate for Payer: HFN Commercial |
$559.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.00
|
| Rate for Payer: Multiplan Commercial |
$470.91
|
| Rate for Payer: NAPHCARE Commercial |
$70.50
|
| Rate for Payer: Preferred Network Access Commercial |
$559.21
|
| Rate for Payer: Quartz Beloit One Network |
$259.00
|
| Rate for Payer: Quartz Commercial |
$335.52
|
| Rate for Payer: Quartz Medicare Advantage |
$47.00
|
| Rate for Payer: The Alliance Commercial |
$199.74
|
| Rate for Payer: United Healthcare Medicaid |
$120.37
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.00
|
| Rate for Payer: WEA Trust Commercial |
$323.75
|
| Rate for Payer: WPS Commercial |
$211.49
|
|
|
N BLOCK, OTHER PERIPHERAL 64450
|
Professional
|
Both
|
$808.00
|
|
|
Service Code
|
CPT 64450
|
| Hospital Charge Code |
3015190
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.75 |
| Max. Negotiated Rate |
$798.30 |
| Rate for Payer: Aetna Commercial |
$798.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$722.68
|
| Rate for Payer: Aetna Managed Medicare |
$37.75
|
| Rate for Payer: Anthem Medicare Advantage |
$37.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.75
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cash Price |
$242.40
|
| Rate for Payer: Cigna Commercial |
$798.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.75
|
| Rate for Payer: Health EOS Commercial |
$764.69
|
| Rate for Payer: HFN Commercial |
$798.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.75
|
| Rate for Payer: Multiplan Commercial |
$672.26
|
| Rate for Payer: NAPHCARE Commercial |
$56.63
|
| Rate for Payer: Preferred Network Access Commercial |
$798.30
|
| Rate for Payer: Quartz Beloit One Network |
$369.74
|
| Rate for Payer: Quartz Commercial |
$478.98
|
| Rate for Payer: Quartz Medicare Advantage |
$37.75
|
| Rate for Payer: The Alliance Commercial |
$160.45
|
| Rate for Payer: United Healthcare Medicaid |
$77.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.75
|
| Rate for Payer: WEA Trust Commercial |
$462.18
|
| Rate for Payer: WPS Commercial |
$169.88
|
|
|
N Block Trigeminal Nerve 64400
|
Professional
|
Both
|
$592.00
|
|
|
Service Code
|
CPT 64400
|
| Hospital Charge Code |
5232614
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$584.90 |
| Rate for Payer: Aetna Commercial |
$584.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$529.48
|
| Rate for Payer: Aetna Managed Medicare |
$43.58
|
| Rate for Payer: Anthem Medicare Advantage |
$43.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.58
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cash Price |
$177.60
|
| Rate for Payer: Cigna Commercial |
$584.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.58
|
| Rate for Payer: Health EOS Commercial |
$560.27
|
| Rate for Payer: HFN Commercial |
$584.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$167.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.58
|
| Rate for Payer: Multiplan Commercial |
$492.54
|
| Rate for Payer: NAPHCARE Commercial |
$65.36
|
| Rate for Payer: Preferred Network Access Commercial |
$584.90
|
| Rate for Payer: Quartz Beloit One Network |
$270.90
|
| Rate for Payer: Quartz Commercial |
$350.94
|
| Rate for Payer: Quartz Medicare Advantage |
$43.58
|
| Rate for Payer: The Alliance Commercial |
$185.20
|
| Rate for Payer: United Healthcare Medicaid |
$97.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.58
|
| Rate for Payer: WEA Trust Commercial |
$338.62
|
| Rate for Payer: WPS Commercial |
$196.09
|
|
|
Nebulizer Kit PARI LCD
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3153476
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Nebulizer Kit PARI LCD
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3153476
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
NEBULIZER MINI HEART HI-FLO
|
Facility
|
OP
|
$261.00
|
|
| Hospital Charge Code |
2969759
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.00 |
| Max. Negotiated Rate |
$249.72 |
| Rate for Payer: Aetna Commercial |
$244.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$233.44
|
| Rate for Payer: Aetna Managed Medicare |
$76.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$176.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.29
|
| 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: Dean Health DHI/DHP/ASO |
$151.90
|
| Rate for Payer: Health EOS Commercial |
$241.58
|
| Rate for Payer: HFN Commercial |
$249.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$203.58
|
| Rate for Payer: Multiplan Commercial |
$217.15
|
| Rate for Payer: NAPHCARE Commercial |
$162.86
|
| Rate for Payer: Preferred Network Access Commercial |
$249.72
|
| Rate for Payer: Quartz Beloit One Network |
$133.01
|
| Rate for Payer: Quartz Commercial |
$176.44
|
| Rate for Payer: Quartz Medicare Advantage |
$162.86
|
| Rate for Payer: The Alliance Commercial |
$135.72
|
| Rate for Payer: WEA Trust Commercial |
$149.29
|
| Rate for Payer: WPS Commercial |
$201.05
|
|
|
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
|
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 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 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
|
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 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 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 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 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 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 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 (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 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 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 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
|
|
