|
NERVE BLOCK GENICULAR
|
Facility
|
OP
|
$1,289.00
|
|
| Hospital Charge Code |
5262657
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$375.36 |
| Max. Negotiated Rate |
$1,233.32 |
| Rate for Payer: Aetna Commercial |
$1,206.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,152.88
|
| Rate for Payer: Aetna Managed Medicare |
$375.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$871.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$670.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$643.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$710.50
|
| Rate for Payer: Cash Price |
$386.70
|
| Rate for Payer: Cigna Commercial |
$1,233.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$750.20
|
| Rate for Payer: Health EOS Commercial |
$1,193.10
|
| Rate for Payer: HFN Commercial |
$1,233.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,005.42
|
| Rate for Payer: Multiplan Commercial |
$1,072.45
|
| Rate for Payer: NAPHCARE Commercial |
$804.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,233.32
|
| Rate for Payer: Quartz Beloit One Network |
$656.87
|
| Rate for Payer: Quartz Commercial |
$871.36
|
| Rate for Payer: Quartz Medicare Advantage |
$804.34
|
| Rate for Payer: The Alliance Commercial |
$670.28
|
| Rate for Payer: WEA Trust Commercial |
$737.31
|
| Rate for Payer: WPS Commercial |
$992.92
|
|
|
NERVE BLOCK GREATER OCCIPITAL
|
Facility
|
IP
|
$312.00
|
|
| Hospital Charge Code |
5262633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$298.52 |
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.97
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$298.52
|
| Rate for Payer: Health EOS Commercial |
$288.79
|
| Rate for Payer: HFN Commercial |
$298.52
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: Preferred Network Access Commercial |
$298.52
|
| Rate for Payer: Quartz Beloit One Network |
$159.00
|
| Rate for Payer: Quartz Commercial |
$194.69
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: WPS Commercial |
$240.33
|
|
|
NERVE BLOCK GREATER OCCIPITAL
|
Facility
|
OP
|
$312.00
|
|
| Hospital Charge Code |
5262633
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$90.85 |
| Max. Negotiated Rate |
$298.52 |
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Aetna Managed Medicare |
$90.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$210.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$162.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$155.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.97
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$298.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.58
|
| Rate for Payer: Health EOS Commercial |
$288.79
|
| Rate for Payer: HFN Commercial |
$298.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$243.36
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: NAPHCARE Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$298.52
|
| Rate for Payer: Quartz Beloit One Network |
$159.00
|
| Rate for Payer: Quartz Commercial |
$210.91
|
| Rate for Payer: Quartz Medicare Advantage |
$194.69
|
| Rate for Payer: The Alliance Commercial |
$162.24
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: WPS Commercial |
$240.33
|
|
|
NERVE BLOCK ILIOINGUINAL/ILIOHYP
|
Facility
|
OP
|
$719.00
|
|
| Hospital Charge Code |
5262638
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$209.37 |
| Max. Negotiated Rate |
$687.94 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Aetna Managed Medicare |
$209.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$486.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$373.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$358.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.31
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$687.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$418.46
|
| Rate for Payer: Health EOS Commercial |
$665.51
|
| Rate for Payer: HFN Commercial |
$687.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$560.82
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: NAPHCARE Commercial |
$448.66
|
| Rate for Payer: Preferred Network Access Commercial |
$687.94
|
| Rate for Payer: Quartz Beloit One Network |
$366.40
|
| Rate for Payer: Quartz Commercial |
$486.04
|
| Rate for Payer: Quartz Medicare Advantage |
$448.66
|
| Rate for Payer: The Alliance Commercial |
$373.88
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: WPS Commercial |
$553.85
|
|
|
NERVE BLOCK ILIOINGUINAL/ILIOHYP
|
Facility
|
IP
|
$719.00
|
|
| Hospital Charge Code |
5262638
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$366.40 |
| Max. Negotiated Rate |
$687.94 |
| Rate for Payer: Aetna Commercial |
$672.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$643.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$396.31
|
| Rate for Payer: Cash Price |
$215.70
|
| Rate for Payer: Cigna Commercial |
$687.94
|
| Rate for Payer: Health EOS Commercial |
$665.51
|
| Rate for Payer: HFN Commercial |
$687.94
|
| Rate for Payer: Multiplan Commercial |
$598.21
|
| Rate for Payer: Preferred Network Access Commercial |
$687.94
|
| Rate for Payer: Quartz Beloit One Network |
$366.40
|
| Rate for Payer: Quartz Commercial |
$448.66
|
| Rate for Payer: WEA Trust Commercial |
$411.27
|
| Rate for Payer: WPS Commercial |
$553.85
|
|
|
Nerve Block Injection Femerol Nerve, Single 64447
|
Professional
|
Both
|
$764.00
|
|
|
Service Code
|
CPT 64447
|
| Hospital Charge Code |
4924608
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$59.77 |
| Max. Negotiated Rate |
$754.83 |
| Rate for Payer: Aetna Commercial |
$754.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$683.32
|
| Rate for Payer: Aetna Managed Medicare |
$59.77
|
| Rate for Payer: Anthem Medicare Advantage |
$59.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.77
|
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cash Price |
$229.20
|
| Rate for Payer: Cigna Commercial |
$754.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.77
|
| Rate for Payer: Health EOS Commercial |
$723.05
|
| Rate for Payer: HFN Commercial |
$754.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$186.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.77
|
| Rate for Payer: Multiplan Commercial |
$635.65
|
| Rate for Payer: NAPHCARE Commercial |
$89.65
|
| Rate for Payer: Preferred Network Access Commercial |
$754.83
|
| Rate for Payer: Quartz Beloit One Network |
$349.61
|
| Rate for Payer: Quartz Commercial |
$452.90
|
| Rate for Payer: Quartz Medicare Advantage |
$59.77
|
| Rate for Payer: The Alliance Commercial |
$254.02
|
| Rate for Payer: United Healthcare Medicaid |
$70.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.77
|
| Rate for Payer: WEA Trust Commercial |
$437.01
|
| Rate for Payer: WPS Commercial |
$268.96
|
|
|
Nerve Block Injection Occipital Nerve 64405
|
Professional
|
Both
|
$652.00
|
|
|
Service Code
|
CPT 64405
|
| Hospital Charge Code |
4924609
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.53 |
| Max. Negotiated Rate |
$644.18 |
| Rate for Payer: Aetna Commercial |
$644.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$583.15
|
| Rate for Payer: Aetna Managed Medicare |
$42.53
|
| Rate for Payer: Anthem Medicare Advantage |
$42.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42.53
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cash Price |
$195.60
|
| Rate for Payer: Cigna Commercial |
$644.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.53
|
| Rate for Payer: Health EOS Commercial |
$617.05
|
| Rate for Payer: HFN Commercial |
$644.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42.53
|
| Rate for Payer: Multiplan Commercial |
$542.46
|
| Rate for Payer: NAPHCARE Commercial |
$63.79
|
| Rate for Payer: Preferred Network Access Commercial |
$644.18
|
| Rate for Payer: Quartz Beloit One Network |
$298.36
|
| Rate for Payer: Quartz Commercial |
$386.51
|
| Rate for Payer: Quartz Medicare Advantage |
$42.53
|
| Rate for Payer: The Alliance Commercial |
$180.73
|
| Rate for Payer: United Healthcare Medicaid |
$46.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42.53
|
| Rate for Payer: WEA Trust Commercial |
$372.94
|
| Rate for Payer: WPS Commercial |
$191.37
|
|
|
Nerve Block Injection Occipital Nerve 6440550
|
Professional
|
Both
|
$1,305.00
|
|
|
Service Code
|
CPT 64405 50
|
| Hospital Charge Code |
4848606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.80 |
| Max. Negotiated Rate |
$1,289.34 |
| Rate for Payer: Aetna Commercial |
$1,289.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.19
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cash Price |
$391.50
|
| Rate for Payer: Cigna Commercial |
$1,289.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$814.32
|
| Rate for Payer: Health EOS Commercial |
$1,235.05
|
| Rate for Payer: HFN Commercial |
$1,289.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.05
|
| Rate for Payer: Multiplan Commercial |
$1,085.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,289.34
|
| Rate for Payer: Quartz Beloit One Network |
$597.17
|
| Rate for Payer: Quartz Commercial |
$773.60
|
| Rate for Payer: The Alliance Commercial |
$678.60
|
| Rate for Payer: United Healthcare Medicaid |
$46.80
|
| Rate for Payer: WEA Trust Commercial |
$746.46
|
| Rate for Payer: WPS Commercial |
$1,005.24
|
|
|
Nerve Block Injection Sciatic Single 64445
|
Professional
|
Both
|
$582.00
|
|
|
Service Code
|
CPT 64445
|
| Hospital Charge Code |
5232785
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.99 |
| Max. Negotiated Rate |
$575.02 |
| Rate for Payer: Aetna Commercial |
$575.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$520.54
|
| Rate for Payer: Aetna Managed Medicare |
$64.49
|
| Rate for Payer: Anthem Medicare Advantage |
$64.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$64.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$64.49
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cash Price |
$174.60
|
| Rate for Payer: Cigna Commercial |
$575.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$46.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.49
|
| Rate for Payer: Health EOS Commercial |
$550.80
|
| Rate for Payer: HFN Commercial |
$575.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$188.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$64.49
|
| Rate for Payer: Multiplan Commercial |
$484.22
|
| Rate for Payer: NAPHCARE Commercial |
$96.74
|
| Rate for Payer: Preferred Network Access Commercial |
$575.02
|
| Rate for Payer: Quartz Beloit One Network |
$266.32
|
| Rate for Payer: Quartz Commercial |
$345.01
|
| Rate for Payer: Quartz Medicare Advantage |
$64.49
|
| Rate for Payer: The Alliance Commercial |
$274.08
|
| Rate for Payer: United Healthcare Medicaid |
$46.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$64.49
|
| Rate for Payer: WEA Trust Commercial |
$332.90
|
| Rate for Payer: WPS Commercial |
$290.21
|
|
|
NERVE BLOCK INTERCOSTAL, MULT/REG
|
Facility
|
OP
|
$2,511.00
|
|
| Hospital Charge Code |
5262637
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$731.20 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Aetna Managed Medicare |
$731.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,697.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,305.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.40
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,958.58
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,697.44
|
| Rate for Payer: Quartz Medicare Advantage |
$1,566.86
|
| Rate for Payer: The Alliance Commercial |
$1,305.72
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
NERVE BLOCK INTERCOSTAL, MULT/REG
|
Facility
|
IP
|
$2,511.00
|
|
| Hospital Charge Code |
5262637
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,279.61 |
| Max. Negotiated Rate |
$2,402.52 |
| Rate for Payer: Aetna Commercial |
$2,350.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,245.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.06
|
| Rate for Payer: Cash Price |
$753.30
|
| Rate for Payer: Cigna Commercial |
$2,402.52
|
| Rate for Payer: Health EOS Commercial |
$2,324.18
|
| Rate for Payer: HFN Commercial |
$2,402.52
|
| Rate for Payer: Multiplan Commercial |
$2,089.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,402.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.61
|
| Rate for Payer: Quartz Commercial |
$1,566.86
|
| Rate for Payer: WEA Trust Commercial |
$1,436.29
|
| Rate for Payer: WPS Commercial |
$1,934.22
|
|
|
NERVE BLOCK INTERCOSTAL, SINGLE
|
Facility
|
OP
|
$1,640.00
|
|
| Hospital Charge Code |
5262636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$477.57 |
| Max. Negotiated Rate |
$1,569.15 |
| Rate for Payer: Aetna Commercial |
$1,535.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,466.82
|
| Rate for Payer: Aetna Managed Medicare |
$477.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,108.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$852.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$818.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$903.97
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$1,569.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$954.48
|
| Rate for Payer: Health EOS Commercial |
$1,517.98
|
| Rate for Payer: HFN Commercial |
$1,569.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,279.20
|
| Rate for Payer: Multiplan Commercial |
$1,364.48
|
| Rate for Payer: NAPHCARE Commercial |
$1,023.36
|
| Rate for Payer: Preferred Network Access Commercial |
$1,569.15
|
| Rate for Payer: Quartz Beloit One Network |
$835.74
|
| Rate for Payer: Quartz Commercial |
$1,108.64
|
| Rate for Payer: Quartz Medicare Advantage |
$1,023.36
|
| Rate for Payer: The Alliance Commercial |
$852.80
|
| Rate for Payer: WEA Trust Commercial |
$938.08
|
| Rate for Payer: WPS Commercial |
$1,263.29
|
|
|
NERVE BLOCK INTERCOSTAL, SINGLE
|
Facility
|
IP
|
$1,640.00
|
|
| Hospital Charge Code |
5262636
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$835.74 |
| Max. Negotiated Rate |
$1,569.15 |
| Rate for Payer: Aetna Commercial |
$1,535.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,466.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$903.97
|
| Rate for Payer: Cash Price |
$492.00
|
| Rate for Payer: Cigna Commercial |
$1,569.15
|
| Rate for Payer: Health EOS Commercial |
$1,517.98
|
| Rate for Payer: HFN Commercial |
$1,569.15
|
| Rate for Payer: Multiplan Commercial |
$1,364.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,569.15
|
| Rate for Payer: Quartz Beloit One Network |
$835.74
|
| Rate for Payer: Quartz Commercial |
$1,023.36
|
| Rate for Payer: WEA Trust Commercial |
$938.08
|
| Rate for Payer: WPS Commercial |
$1,263.29
|
|
|
Nerve Block Lumbar/Thoracic 64520
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
CPT 64520
|
| Hospital Charge Code |
5232689
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.75 |
| Max. Negotiated Rate |
$1,118.42 |
| Rate for Payer: Aetna Commercial |
$1,118.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,012.46
|
| Rate for Payer: Aetna Managed Medicare |
$75.75
|
| Rate for Payer: Anthem Medicare Advantage |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$75.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$75.75
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$1,118.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.75
|
| Rate for Payer: Health EOS Commercial |
$1,071.32
|
| Rate for Payer: HFN Commercial |
$1,118.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$295.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$75.75
|
| Rate for Payer: Multiplan Commercial |
$941.82
|
| Rate for Payer: NAPHCARE Commercial |
$113.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.42
|
| Rate for Payer: Quartz Beloit One Network |
$518.00
|
| Rate for Payer: Quartz Commercial |
$671.05
|
| Rate for Payer: Quartz Medicare Advantage |
$75.75
|
| Rate for Payer: The Alliance Commercial |
$321.95
|
| Rate for Payer: United Healthcare Medicaid |
$164.83
|
| Rate for Payer: United Healthcare Medicare Advantage |
$75.75
|
| Rate for Payer: WEA Trust Commercial |
$647.50
|
| Rate for Payer: WPS Commercial |
$340.89
|
|
|
Nerve Block Lumbar/Thoracic 6452050
|
Professional
|
Both
|
$2,263.00
|
|
|
Service Code
|
CPT 64520 50
|
| Hospital Charge Code |
5232690
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$164.83 |
| Max. Negotiated Rate |
$2,235.84 |
| Rate for Payer: Aetna Commercial |
$2,235.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,024.03
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cash Price |
$678.90
|
| Rate for Payer: Cigna Commercial |
$2,235.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,412.11
|
| Rate for Payer: Health EOS Commercial |
$2,141.70
|
| Rate for Payer: HFN Commercial |
$2,235.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$295.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$295.28
|
| Rate for Payer: Multiplan Commercial |
$1,882.82
|
| Rate for Payer: Preferred Network Access Commercial |
$2,235.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,035.55
|
| Rate for Payer: Quartz Commercial |
$1,341.51
|
| Rate for Payer: The Alliance Commercial |
$1,176.76
|
| Rate for Payer: United Healthcare Medicaid |
$164.83
|
| Rate for Payer: WEA Trust Commercial |
$1,294.44
|
| Rate for Payer: WPS Commercial |
$1,743.19
|
|
|
NERVE BLOCK NEEDLE 21GX3.5 AB-21090-SSE"
|
Facility
|
OP
|
$320.00
|
|
| Hospital Charge Code |
3065504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.18 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Aetna Managed Medicare |
$93.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.38
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.24
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.60
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: NAPHCARE Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$216.32
|
| Rate for Payer: Quartz Medicare Advantage |
$199.68
|
| Rate for Payer: The Alliance Commercial |
$166.40
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
NERVE BLOCK NEEDLE 21GX3.5 AB-21090-SSE"
|
Facility
|
IP
|
$320.00
|
|
| Hospital Charge Code |
3065504
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.07 |
| Max. Negotiated Rate |
$306.18 |
| Rate for Payer: Aetna Commercial |
$299.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.38
|
| Rate for Payer: Cash Price |
$96.00
|
| Rate for Payer: Cigna Commercial |
$306.18
|
| Rate for Payer: Health EOS Commercial |
$296.19
|
| Rate for Payer: HFN Commercial |
$306.18
|
| Rate for Payer: Multiplan Commercial |
$266.24
|
| Rate for Payer: Preferred Network Access Commercial |
$306.18
|
| Rate for Payer: Quartz Beloit One Network |
$163.07
|
| Rate for Payer: Quartz Commercial |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$183.04
|
| Rate for Payer: WPS Commercial |
$246.50
|
|
|
NERVE BLOCK OTHER PERIPHERAL
|
Facility
|
IP
|
$335.00
|
|
| Hospital Charge Code |
5262653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$170.72 |
| Max. Negotiated Rate |
$320.53 |
| Rate for Payer: Aetna Commercial |
$313.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.65
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$320.53
|
| Rate for Payer: Health EOS Commercial |
$310.08
|
| Rate for Payer: HFN Commercial |
$320.53
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: Preferred Network Access Commercial |
$320.53
|
| Rate for Payer: Quartz Beloit One Network |
$170.72
|
| Rate for Payer: Quartz Commercial |
$209.04
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: WPS Commercial |
$258.05
|
|
|
NERVE BLOCK OTHER PERIPHERAL
|
Facility
|
OP
|
$335.00
|
|
| Hospital Charge Code |
5262653
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$97.55 |
| Max. Negotiated Rate |
$320.53 |
| Rate for Payer: Aetna Commercial |
$313.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$299.62
|
| Rate for Payer: Aetna Managed Medicare |
$97.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$226.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$174.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$167.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$184.65
|
| Rate for Payer: Cash Price |
$100.50
|
| Rate for Payer: Cigna Commercial |
$320.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.97
|
| Rate for Payer: Health EOS Commercial |
$310.08
|
| Rate for Payer: HFN Commercial |
$320.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$261.30
|
| Rate for Payer: Multiplan Commercial |
$278.72
|
| Rate for Payer: NAPHCARE Commercial |
$209.04
|
| Rate for Payer: Preferred Network Access Commercial |
$320.53
|
| Rate for Payer: Quartz Beloit One Network |
$170.72
|
| Rate for Payer: Quartz Commercial |
$226.46
|
| Rate for Payer: Quartz Medicare Advantage |
$209.04
|
| Rate for Payer: The Alliance Commercial |
$174.20
|
| Rate for Payer: WEA Trust Commercial |
$191.62
|
| Rate for Payer: WPS Commercial |
$258.05
|
|
|
NERVE BLOCK PUDENDAL
|
Facility
|
IP
|
$916.00
|
|
| Hospital Charge Code |
5262642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$466.79 |
| Max. Negotiated Rate |
$876.43 |
| Rate for Payer: Aetna Commercial |
$857.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.90
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$876.43
|
| Rate for Payer: Health EOS Commercial |
$847.85
|
| Rate for Payer: HFN Commercial |
$876.43
|
| Rate for Payer: Multiplan Commercial |
$762.11
|
| Rate for Payer: Preferred Network Access Commercial |
$876.43
|
| Rate for Payer: Quartz Beloit One Network |
$466.79
|
| Rate for Payer: Quartz Commercial |
$571.58
|
| Rate for Payer: WEA Trust Commercial |
$523.95
|
| Rate for Payer: WPS Commercial |
$705.59
|
|
|
NERVE BLOCK PUDENDAL
|
Facility
|
OP
|
$916.00
|
|
| Hospital Charge Code |
5262642
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$266.74 |
| Max. Negotiated Rate |
$876.43 |
| Rate for Payer: Aetna Commercial |
$857.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$819.27
|
| Rate for Payer: Aetna Managed Medicare |
$266.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$619.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$476.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$457.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.90
|
| Rate for Payer: Cash Price |
$274.80
|
| Rate for Payer: Cigna Commercial |
$876.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$533.11
|
| Rate for Payer: Health EOS Commercial |
$847.85
|
| Rate for Payer: HFN Commercial |
$876.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$714.48
|
| Rate for Payer: Multiplan Commercial |
$762.11
|
| Rate for Payer: NAPHCARE Commercial |
$571.58
|
| Rate for Payer: Preferred Network Access Commercial |
$876.43
|
| Rate for Payer: Quartz Beloit One Network |
$466.79
|
| Rate for Payer: Quartz Commercial |
$619.22
|
| Rate for Payer: Quartz Medicare Advantage |
$571.58
|
| Rate for Payer: The Alliance Commercial |
$476.32
|
| Rate for Payer: WEA Trust Commercial |
$523.95
|
| Rate for Payer: WPS Commercial |
$705.59
|
|
|
NERVE BLOCK SCIATIC
|
Facility
|
OP
|
$691.00
|
|
| Hospital Charge Code |
5262647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.22 |
| Max. Negotiated Rate |
$661.15 |
| Rate for Payer: Aetna Commercial |
$646.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Aetna Managed Medicare |
$201.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$467.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$359.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$344.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$380.88
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$661.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.16
|
| Rate for Payer: Health EOS Commercial |
$639.59
|
| Rate for Payer: HFN Commercial |
$661.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$538.98
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: NAPHCARE Commercial |
$431.18
|
| Rate for Payer: Preferred Network Access Commercial |
$661.15
|
| Rate for Payer: Quartz Beloit One Network |
$352.13
|
| Rate for Payer: Quartz Commercial |
$467.12
|
| Rate for Payer: Quartz Medicare Advantage |
$431.18
|
| Rate for Payer: The Alliance Commercial |
$359.32
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$532.28
|
|
|
NERVE BLOCK SCIATIC
|
Facility
|
IP
|
$691.00
|
|
| Hospital Charge Code |
5262647
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$352.13 |
| Max. Negotiated Rate |
$661.15 |
| Rate for Payer: Aetna Commercial |
$646.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$618.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$380.88
|
| Rate for Payer: Cash Price |
$207.30
|
| Rate for Payer: Cigna Commercial |
$661.15
|
| Rate for Payer: Health EOS Commercial |
$639.59
|
| Rate for Payer: HFN Commercial |
$661.15
|
| Rate for Payer: Multiplan Commercial |
$574.91
|
| Rate for Payer: Preferred Network Access Commercial |
$661.15
|
| Rate for Payer: Quartz Beloit One Network |
$352.13
|
| Rate for Payer: Quartz Commercial |
$431.18
|
| Rate for Payer: WEA Trust Commercial |
$395.25
|
| Rate for Payer: WPS Commercial |
$532.28
|
|
|
NERVE BLOCK SUPRASCAPULAR
|
Facility
|
IP
|
$714.00
|
|
| Hospital Charge Code |
5262635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$363.85 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$445.54
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
|
NERVE BLOCK SUPRASCAPULAR
|
Facility
|
OP
|
$714.00
|
|
| Hospital Charge Code |
5262635
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$207.92 |
| Max. Negotiated Rate |
$683.16 |
| Rate for Payer: Aetna Commercial |
$668.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.60
|
| Rate for Payer: Aetna Managed Medicare |
$207.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$482.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$371.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$356.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.56
|
| Rate for Payer: Cash Price |
$214.20
|
| Rate for Payer: Cigna Commercial |
$683.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.55
|
| Rate for Payer: Health EOS Commercial |
$660.88
|
| Rate for Payer: HFN Commercial |
$683.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.92
|
| Rate for Payer: Multiplan Commercial |
$594.05
|
| Rate for Payer: NAPHCARE Commercial |
$445.54
|
| Rate for Payer: Preferred Network Access Commercial |
$683.16
|
| Rate for Payer: Quartz Beloit One Network |
$363.85
|
| Rate for Payer: Quartz Commercial |
$482.66
|
| Rate for Payer: Quartz Medicare Advantage |
$445.54
|
| Rate for Payer: The Alliance Commercial |
$371.28
|
| Rate for Payer: WEA Trust Commercial |
$408.41
|
| Rate for Payer: WPS Commercial |
$549.99
|
|
