|
NEEDLE FORAMEN 5.0 X 18.5G INTERSTIM 041839
|
Facility
|
IP
|
$1,597.00
|
|
| Hospital Charge Code |
5603702
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$813.83 |
| Max. Negotiated Rate |
$1,528.01 |
| Rate for Payer: Aetna Commercial |
$1,494.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,428.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$880.27
|
| Rate for Payer: Cash Price |
$479.10
|
| Rate for Payer: Cigna Commercial |
$1,528.01
|
| Rate for Payer: Health EOS Commercial |
$1,478.18
|
| Rate for Payer: HFN Commercial |
$1,528.01
|
| Rate for Payer: Multiplan Commercial |
$1,328.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,528.01
|
| Rate for Payer: Quartz Beloit One Network |
$813.83
|
| Rate for Payer: Quartz Commercial |
$996.53
|
| Rate for Payer: WEA Trust Commercial |
$913.48
|
| Rate for Payer: WPS Commercial |
$1,230.17
|
|
|
NEEDLE FRENCH SPRING 1/2 CIR SIZE 3 1862
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
4400974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
NEEDLE FRENCH SPRING 1/2 CIR SIZE 3 1862
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
4400974
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
NEEDLE GUIDE SONOSITE L25 21G 58 PROBE COVER & GEL STERILE P09073-01
|
Facility
|
IP
|
$447.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6201017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$227.79 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$278.93
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
NEEDLE GUIDE SONOSITE L25 21G 58 PROBE COVER & GEL STERILE P09073-01
|
Facility
|
OP
|
$447.00
|
|
|
Service Code
|
HCPCS A4649
|
| Hospital Charge Code |
6201017
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$130.17 |
| Max. Negotiated Rate |
$427.69 |
| Rate for Payer: Aetna Commercial |
$418.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$399.80
|
| Rate for Payer: Aetna Managed Medicare |
$130.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$302.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$232.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$223.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$246.39
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$427.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.15
|
| Rate for Payer: Health EOS Commercial |
$413.74
|
| Rate for Payer: HFN Commercial |
$427.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$348.66
|
| Rate for Payer: Multiplan Commercial |
$371.90
|
| Rate for Payer: NAPHCARE Commercial |
$278.93
|
| Rate for Payer: Preferred Network Access Commercial |
$427.69
|
| Rate for Payer: Quartz Beloit One Network |
$227.79
|
| Rate for Payer: Quartz Commercial |
$302.17
|
| Rate for Payer: Quartz Medicare Advantage |
$278.93
|
| Rate for Payer: The Alliance Commercial |
$232.44
|
| Rate for Payer: WEA Trust Commercial |
$255.68
|
| Rate for Payer: WPS Commercial |
$344.32
|
|
|
NEEDLE HD SCORPION WITH MEGALOADER AR-13999HDN
|
Facility
|
OP
|
$1,936.00
|
|
| Hospital Charge Code |
6226159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$563.76 |
| Max. Negotiated Rate |
$1,852.36 |
| Rate for Payer: Aetna Commercial |
$1,812.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,731.56
|
| Rate for Payer: Aetna Managed Medicare |
$563.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,308.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,006.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$966.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,067.12
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna Commercial |
$1,852.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,126.75
|
| Rate for Payer: Health EOS Commercial |
$1,791.96
|
| Rate for Payer: HFN Commercial |
$1,852.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,510.08
|
| Rate for Payer: Multiplan Commercial |
$1,610.75
|
| Rate for Payer: NAPHCARE Commercial |
$1,208.06
|
| Rate for Payer: Preferred Network Access Commercial |
$1,852.36
|
| Rate for Payer: Quartz Beloit One Network |
$986.59
|
| Rate for Payer: Quartz Commercial |
$1,308.74
|
| Rate for Payer: Quartz Medicare Advantage |
$1,208.06
|
| Rate for Payer: The Alliance Commercial |
$1,006.72
|
| Rate for Payer: WEA Trust Commercial |
$1,107.39
|
| Rate for Payer: WPS Commercial |
$1,491.30
|
|
|
NEEDLE HD SCORPION WITH MEGALOADER AR-13999HDN
|
Facility
|
IP
|
$1,936.00
|
|
| Hospital Charge Code |
6226159
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$986.59 |
| Max. Negotiated Rate |
$1,852.36 |
| Rate for Payer: Aetna Commercial |
$1,812.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,731.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,067.12
|
| Rate for Payer: Cash Price |
$580.80
|
| Rate for Payer: Cigna Commercial |
$1,852.36
|
| Rate for Payer: Health EOS Commercial |
$1,791.96
|
| Rate for Payer: HFN Commercial |
$1,852.36
|
| Rate for Payer: Multiplan Commercial |
$1,610.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,852.36
|
| Rate for Payer: Quartz Beloit One Network |
$986.59
|
| Rate for Payer: Quartz Commercial |
$1,208.06
|
| Rate for Payer: WEA Trust Commercial |
$1,107.39
|
| Rate for Payer: WPS Commercial |
$1,491.30
|
|
|
NEEDLE HUBER 20G X 1.5SAFETY 0652015
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
2963149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$82.37
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
NEEDLE HUBER 20G X 1.5SAFETY 0652015
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
2963149
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$38.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.82
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.96
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$82.37
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$89.23
|
| Rate for Payer: Quartz Medicare Advantage |
$82.37
|
| Rate for Payer: The Alliance Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
NEEDLE HUBER 20Gx1 SAFETY 0652010
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
2963150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$38.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.82
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.96
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$82.37
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$89.23
|
| Rate for Payer: Quartz Medicare Advantage |
$82.37
|
| Rate for Payer: The Alliance Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
NEEDLE HUBER 20Gx1 SAFETY 0652010
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
2963150
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$82.37
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
NEEDLE HUBER 20G X .75 SAFETY 0652034
|
Facility
|
IP
|
$132.00
|
|
| Hospital Charge Code |
2963148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$82.37
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
NEEDLE HUBER 20G X .75 SAFETY 0652034
|
Facility
|
OP
|
$132.00
|
|
| Hospital Charge Code |
2963148
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$38.44 |
| Max. Negotiated Rate |
$126.30 |
| Rate for Payer: Aetna Commercial |
$123.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$118.06
|
| Rate for Payer: Aetna Managed Medicare |
$38.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$89.23
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$68.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$65.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$72.76
|
| Rate for Payer: Cash Price |
$39.60
|
| Rate for Payer: Cigna Commercial |
$126.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.82
|
| Rate for Payer: Health EOS Commercial |
$122.18
|
| Rate for Payer: HFN Commercial |
$126.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$102.96
|
| Rate for Payer: Multiplan Commercial |
$109.82
|
| Rate for Payer: NAPHCARE Commercial |
$82.37
|
| Rate for Payer: Preferred Network Access Commercial |
$126.30
|
| Rate for Payer: Quartz Beloit One Network |
$67.27
|
| Rate for Payer: Quartz Commercial |
$89.23
|
| Rate for Payer: Quartz Medicare Advantage |
$82.37
|
| Rate for Payer: The Alliance Commercial |
$68.64
|
| Rate for Payer: WEA Trust Commercial |
$75.50
|
| Rate for Payer: WPS Commercial |
$101.68
|
|
|
NEEDLE HUBER 22G X .75 SAFETY 0652234
|
Facility
|
OP
|
$215.00
|
|
| Hospital Charge Code |
2963147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$62.61 |
| Max. Negotiated Rate |
$205.71 |
| Rate for Payer: Aetna Commercial |
$201.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.30
|
| Rate for Payer: Aetna Managed Medicare |
$62.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$145.34
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$111.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.51
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$205.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$125.13
|
| Rate for Payer: Health EOS Commercial |
$199.00
|
| Rate for Payer: HFN Commercial |
$205.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$167.70
|
| Rate for Payer: Multiplan Commercial |
$178.88
|
| Rate for Payer: NAPHCARE Commercial |
$134.16
|
| Rate for Payer: Preferred Network Access Commercial |
$205.71
|
| Rate for Payer: Quartz Beloit One Network |
$109.56
|
| Rate for Payer: Quartz Commercial |
$145.34
|
| Rate for Payer: Quartz Medicare Advantage |
$134.16
|
| Rate for Payer: The Alliance Commercial |
$111.80
|
| Rate for Payer: WEA Trust Commercial |
$122.98
|
| Rate for Payer: WPS Commercial |
$165.61
|
|
|
NEEDLE HUBER 22G X .75 SAFETY 0652234
|
Facility
|
IP
|
$215.00
|
|
| Hospital Charge Code |
2963147
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$109.56 |
| Max. Negotiated Rate |
$205.71 |
| Rate for Payer: Aetna Commercial |
$201.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$192.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$118.51
|
| Rate for Payer: Cash Price |
$64.50
|
| Rate for Payer: Cigna Commercial |
$205.71
|
| Rate for Payer: Health EOS Commercial |
$199.00
|
| Rate for Payer: HFN Commercial |
$205.71
|
| Rate for Payer: Multiplan Commercial |
$178.88
|
| Rate for Payer: Preferred Network Access Commercial |
$205.71
|
| Rate for Payer: Quartz Beloit One Network |
$109.56
|
| Rate for Payer: Quartz Commercial |
$134.16
|
| Rate for Payer: WEA Trust Commercial |
$122.98
|
| Rate for Payer: WPS Commercial |
$165.61
|
|
|
Needle Ill.Aspiration 15Ga
|
Facility
|
OP
|
$32.00
|
|
| Hospital Charge Code |
3040330
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$9.32 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Aetna Managed Medicare |
$9.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: NAPHCARE Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$21.63
|
| Rate for Payer: Quartz Medicare Advantage |
$19.97
|
| Rate for Payer: The Alliance Commercial |
$16.64
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
Needle Ill.Aspiration 15Ga
|
Facility
|
IP
|
$32.00
|
|
| Hospital Charge Code |
3040330
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$19.97
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
NEEDLE INJECTION 25GA
|
Facility
|
OP
|
$800.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
2973102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$232.96 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Aetna Managed Medicare |
$232.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$540.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$416.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$399.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.60
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$624.00
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: NAPHCARE Commercial |
$499.20
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$540.80
|
| Rate for Payer: Quartz Medicare Advantage |
$499.20
|
| Rate for Payer: The Alliance Commercial |
$416.00
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.24
|
|
|
NEEDLE INJECTION 25GA
|
Facility
|
IP
|
$800.00
|
|
|
Service Code
|
HCPCS A4215
|
| Hospital Charge Code |
2973102
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$407.68 |
| Max. Negotiated Rate |
$765.44 |
| Rate for Payer: Aetna Commercial |
$748.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$715.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$440.96
|
| Rate for Payer: Cash Price |
$240.00
|
| Rate for Payer: Cigna Commercial |
$765.44
|
| Rate for Payer: Health EOS Commercial |
$740.48
|
| Rate for Payer: HFN Commercial |
$765.44
|
| Rate for Payer: Multiplan Commercial |
$665.60
|
| Rate for Payer: Preferred Network Access Commercial |
$765.44
|
| Rate for Payer: Quartz Beloit One Network |
$407.68
|
| Rate for Payer: Quartz Commercial |
$499.20
|
| Rate for Payer: WEA Trust Commercial |
$457.60
|
| Rate for Payer: WPS Commercial |
$616.24
|
|
|
NEEDLE INJECTION 25GA PEDS BX00711822
|
Facility
|
IP
|
$1,118.00
|
|
| Hospital Charge Code |
5458774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$569.73 |
| Max. Negotiated Rate |
$1,069.70 |
| Rate for Payer: Aetna Commercial |
$1,046.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.24
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$1,069.70
|
| Rate for Payer: Health EOS Commercial |
$1,034.82
|
| Rate for Payer: HFN Commercial |
$1,069.70
|
| Rate for Payer: Multiplan Commercial |
$930.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.70
|
| Rate for Payer: Quartz Beloit One Network |
$569.73
|
| Rate for Payer: Quartz Commercial |
$697.63
|
| Rate for Payer: WEA Trust Commercial |
$639.50
|
| Rate for Payer: WPS Commercial |
$861.20
|
|
|
NEEDLE INJECTION 25GA PEDS BX00711822
|
Facility
|
OP
|
$1,118.00
|
|
| Hospital Charge Code |
5458774
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$325.56 |
| Max. Negotiated Rate |
$1,069.70 |
| Rate for Payer: Aetna Commercial |
$1,046.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$999.94
|
| Rate for Payer: Aetna Managed Medicare |
$325.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$755.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$581.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$558.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.24
|
| Rate for Payer: Cash Price |
$335.40
|
| Rate for Payer: Cigna Commercial |
$1,069.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$650.68
|
| Rate for Payer: Health EOS Commercial |
$1,034.82
|
| Rate for Payer: HFN Commercial |
$1,069.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$872.04
|
| Rate for Payer: Multiplan Commercial |
$930.18
|
| Rate for Payer: NAPHCARE Commercial |
$697.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,069.70
|
| Rate for Payer: Quartz Beloit One Network |
$569.73
|
| Rate for Payer: Quartz Commercial |
$755.77
|
| Rate for Payer: Quartz Medicare Advantage |
$697.63
|
| Rate for Payer: The Alliance Commercial |
$581.36
|
| Rate for Payer: WEA Trust Commercial |
$639.50
|
| Rate for Payer: WPS Commercial |
$861.20
|
|
|
NEEDLE INSUFFLATION 14GA 120MM C2201
|
Facility
|
OP
|
$562.00
|
|
| Hospital Charge Code |
2963861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.65 |
| Max. Negotiated Rate |
$537.72 |
| Rate for Payer: Aetna Commercial |
$526.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$502.65
|
| Rate for Payer: Aetna Managed Medicare |
$163.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$379.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$292.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$280.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.77
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$537.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.08
|
| Rate for Payer: Health EOS Commercial |
$520.19
|
| Rate for Payer: HFN Commercial |
$537.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$438.36
|
| Rate for Payer: Multiplan Commercial |
$467.58
|
| Rate for Payer: NAPHCARE Commercial |
$350.69
|
| Rate for Payer: Preferred Network Access Commercial |
$537.72
|
| Rate for Payer: Quartz Beloit One Network |
$286.40
|
| Rate for Payer: Quartz Commercial |
$379.91
|
| Rate for Payer: Quartz Medicare Advantage |
$350.69
|
| Rate for Payer: The Alliance Commercial |
$292.24
|
| Rate for Payer: WEA Trust Commercial |
$321.46
|
| Rate for Payer: WPS Commercial |
$432.91
|
|
|
NEEDLE INSUFFLATION 14GA 120MM C2201
|
Facility
|
IP
|
$562.00
|
|
| Hospital Charge Code |
2963861
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$286.40 |
| Max. Negotiated Rate |
$537.72 |
| Rate for Payer: HFN Commercial |
$537.72
|
| Rate for Payer: Aetna Commercial |
$526.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$502.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$309.77
|
| Rate for Payer: Cash Price |
$168.60
|
| Rate for Payer: Cigna Commercial |
$537.72
|
| Rate for Payer: Health EOS Commercial |
$520.19
|
| Rate for Payer: Multiplan Commercial |
$467.58
|
| Rate for Payer: Preferred Network Access Commercial |
$537.72
|
| Rate for Payer: Quartz Beloit One Network |
$286.40
|
| Rate for Payer: Quartz Commercial |
$350.69
|
| Rate for Payer: WEA Trust Commercial |
$321.46
|
| Rate for Payer: WPS Commercial |
$432.91
|
|
|
NEEDLE INSUFFLATION 14GA 150MM
|
Facility
|
IP
|
$505.00
|
|
| Hospital Charge Code |
2962995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$257.35 |
| Max. Negotiated Rate |
$483.18 |
| Rate for Payer: Aetna Commercial |
$472.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.36
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$483.18
|
| Rate for Payer: Health EOS Commercial |
$467.43
|
| Rate for Payer: HFN Commercial |
$483.18
|
| Rate for Payer: Multiplan Commercial |
$420.16
|
| Rate for Payer: Preferred Network Access Commercial |
$483.18
|
| Rate for Payer: Quartz Beloit One Network |
$257.35
|
| Rate for Payer: Quartz Commercial |
$315.12
|
| Rate for Payer: WEA Trust Commercial |
$288.86
|
| Rate for Payer: WPS Commercial |
$389.00
|
|
|
NEEDLE INSUFFLATION 14GA 150MM
|
Facility
|
OP
|
$505.00
|
|
| Hospital Charge Code |
2962995
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$147.06 |
| Max. Negotiated Rate |
$483.18 |
| Rate for Payer: Aetna Commercial |
$472.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.67
|
| Rate for Payer: Aetna Managed Medicare |
$147.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$341.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$262.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$252.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$278.36
|
| Rate for Payer: Cash Price |
$151.50
|
| Rate for Payer: Cigna Commercial |
$483.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$293.91
|
| Rate for Payer: Health EOS Commercial |
$467.43
|
| Rate for Payer: HFN Commercial |
$483.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$393.90
|
| Rate for Payer: Multiplan Commercial |
$420.16
|
| Rate for Payer: NAPHCARE Commercial |
$315.12
|
| Rate for Payer: Preferred Network Access Commercial |
$483.18
|
| Rate for Payer: Quartz Beloit One Network |
$257.35
|
| Rate for Payer: Quartz Commercial |
$341.38
|
| Rate for Payer: Quartz Medicare Advantage |
$315.12
|
| Rate for Payer: The Alliance Commercial |
$262.60
|
| Rate for Payer: WEA Trust Commercial |
$288.86
|
| Rate for Payer: WPS Commercial |
$389.00
|
|
