|
Blenoxane 15 units Charge
|
Facility
IP
|
$270.00
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
2958921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
Blenoxane 15 units Charge
|
Facility
OP
|
$270.00
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
2958921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$30.59 |
| Max. Negotiated Rate |
$7,402.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.59
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$7,402.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$57.80
|
|
|
Blenoxane 15 units Charge
|
Professional
|
$270.00
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
2958921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$21.02 |
| Max. Negotiated Rate |
$256.50 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$24.53
|
| Rate for Payer: Anthem Medicare Advantage |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.53
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$256.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.12
|
| Rate for Payer: Health EOS Commercial |
$245.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.53
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: Preferred Network Access Commercial |
$256.50
|
| Rate for Payer: Quartz Beloit One Network |
$118.80
|
| Rate for Payer: Quartz Commercial |
$153.90
|
| Rate for Payer: Quartz Medicare Advantage |
$24.53
|
| Rate for Payer: The Alliance Commercial |
$67.47
|
| Rate for Payer: United Healthcare Medicaid |
$21.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.53
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$57.80
|
|
|
BLEPHAROPLASTY/BLEPHARPTOSIS
|
Facility
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
BLEPHAROPLASTY/BLEPHARPTOSIS
|
Facility
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
Blepharoplasty With Excessive Skin Weighting Down Lid
|
Professional
|
$2,495.00
|
|
|
Service Code
|
CPT 15823
|
| Hospital Charge Code |
1188911
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$525.71 |
| Max. Negotiated Rate |
$2,370.25 |
| Rate for Payer: Aetna Commercial |
$2,370.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,145.70
|
| Rate for Payer: Aetna Managed Medicare |
$525.71
|
| Rate for Payer: Anthem Medicare Advantage |
$525.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$525.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$525.71
|
| Rate for Payer: Cash Price |
$748.50
|
| Rate for Payer: Cash Price |
$748.50
|
| Rate for Payer: Cigna Commercial |
$2,370.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,247.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$525.71
|
| Rate for Payer: Health EOS Commercial |
$2,270.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,858.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,858.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$525.71
|
| Rate for Payer: Multiplan Commercial |
$1,996.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,370.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,097.80
|
| Rate for Payer: Quartz Commercial |
$1,422.15
|
| Rate for Payer: Quartz Medicare Advantage |
$525.71
|
| Rate for Payer: The Alliance Commercial |
$2,234.27
|
| Rate for Payer: United Healthcare Medicaid |
$554.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$525.71
|
| Rate for Payer: WEA Trust Commercial |
$1,372.25
|
| Rate for Payer: WPS Commercial |
$2,365.70
|
|
|
BLEPHAROTOMY DRAINAGE ABSCESS EYELID, BILAT 6770050
|
Professional
|
$791.00
|
|
|
Service Code
|
CPT 67700 50
|
| Hospital Charge Code |
6182083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$348.04 |
| Max. Negotiated Rate |
$751.45 |
| Rate for Payer: Aetna Commercial |
$751.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$680.26
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$751.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$395.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$474.60
|
| Rate for Payer: Health EOS Commercial |
$719.81
|
| Rate for Payer: Multiplan Commercial |
$632.80
|
| Rate for Payer: Preferred Network Access Commercial |
$751.45
|
| Rate for Payer: Quartz Beloit One Network |
$348.04
|
| Rate for Payer: Quartz Commercial |
$450.87
|
| Rate for Payer: The Alliance Commercial |
$395.50
|
| Rate for Payer: WEA Trust Commercial |
$435.05
|
| Rate for Payer: WPS Commercial |
$585.89
|
|
|
Blepharotomy, Drainage Of Abscess Eyelid
|
Professional
|
$396.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
1190828
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.11 |
| Max. Negotiated Rate |
$496.89 |
| Rate for Payer: Aetna Commercial |
$376.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$340.56
|
| Rate for Payer: Aetna Managed Medicare |
$110.42
|
| Rate for Payer: Anthem Medicare Advantage |
$110.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.42
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$376.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$198.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$110.42
|
| Rate for Payer: Health EOS Commercial |
$360.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$389.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.42
|
| Rate for Payer: Multiplan Commercial |
$316.80
|
| Rate for Payer: Preferred Network Access Commercial |
$376.20
|
| Rate for Payer: Quartz Beloit One Network |
$174.24
|
| Rate for Payer: Quartz Commercial |
$225.72
|
| Rate for Payer: Quartz Medicare Advantage |
$110.42
|
| Rate for Payer: The Alliance Commercial |
$469.28
|
| Rate for Payer: United Healthcare Medicaid |
$30.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.42
|
| Rate for Payer: WEA Trust Commercial |
$217.80
|
| Rate for Payer: WPS Commercial |
$496.89
|
|
|
BLOCK, CAUDAL
|
Facility
OP
|
$270.00
|
|
| Hospital Charge Code |
2959919
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
BLOCK, CAUDAL
|
Facility
IP
|
$270.00
|
|
| Hospital Charge Code |
2959919
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
BLOCK CELIAC PLEXUS
|
Facility
IP
|
$2,332.00
|
|
| Hospital Charge Code |
5262688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,142.68 |
| Max. Negotiated Rate |
$2,145.44 |
| Rate for Payer: Aetna Commercial |
$2,098.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.96
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,145.44
|
| Rate for Payer: Health EOS Commercial |
$2,075.48
|
| Rate for Payer: HFN Commercial |
$2,145.44
|
| Rate for Payer: Multiplan Commercial |
$1,865.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,145.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.68
|
| Rate for Payer: Quartz Commercial |
$1,399.20
|
| Rate for Payer: WEA Trust Commercial |
$1,282.60
|
| Rate for Payer: WPS Commercial |
$1,727.31
|
|
|
BLOCK CELIAC PLEXUS
|
Facility
OP
|
$2,332.00
|
|
| Hospital Charge Code |
5262688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$652.96 |
| Max. Negotiated Rate |
$9,328.00 |
| Rate for Payer: Aetna Commercial |
$2,098.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,005.52
|
| Rate for Payer: Aetna Managed Medicare |
$652.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,515.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,166.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,119.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.96
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,145.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,304.99
|
| Rate for Payer: Health EOS Commercial |
$2,075.48
|
| Rate for Payer: HFN Commercial |
$2,145.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,749.00
|
| Rate for Payer: Multiplan Commercial |
$1,865.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,145.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.68
|
| Rate for Payer: Quartz Commercial |
$1,515.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,399.20
|
| Rate for Payer: The Alliance Commercial |
$9,328.00
|
| Rate for Payer: WEA Trust Commercial |
$1,282.60
|
| Rate for Payer: WPS Commercial |
$1,727.31
|
|
|
BLOCK FOAM R-LITE PINK SOFT #A908-6
|
Facility
IP
|
$42.00
|
|
| Hospital Charge Code |
2969661
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.58 |
| Max. Negotiated Rate |
$38.64 |
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Commercial |
$25.20
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
BLOCK FOAM R-LITE PINK SOFT #A908-6
|
Facility
OP
|
$42.00
|
|
| Hospital Charge Code |
2969661
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$11.76 |
| Max. Negotiated Rate |
$168.00 |
| Rate for Payer: Quartz Commercial |
$27.30
|
| Rate for Payer: Aetna Commercial |
$37.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36.12
|
| Rate for Payer: Aetna Managed Medicare |
$11.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.26
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$38.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.50
|
| Rate for Payer: Health EOS Commercial |
$37.38
|
| Rate for Payer: HFN Commercial |
$38.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.50
|
| Rate for Payer: Multiplan Commercial |
$33.60
|
| Rate for Payer: NAPHCARE Commercial |
$25.20
|
| Rate for Payer: Preferred Network Access Commercial |
$38.64
|
| Rate for Payer: Quartz Beloit One Network |
$20.58
|
| Rate for Payer: Quartz Medicare Advantage |
$25.20
|
| Rate for Payer: The Alliance Commercial |
$168.00
|
| Rate for Payer: WEA Trust Commercial |
$23.10
|
| Rate for Payer: WPS Commercial |
$31.11
|
|
|
BLOCK, INTERCOSTAL NERVE
|
Facility
OP
|
$291.00
|
|
| Hospital Charge Code |
2960157
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$81.48 |
| Max. Negotiated Rate |
$1,164.00 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| Rate for Payer: Aetna Managed Medicare |
$81.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$189.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$145.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$139.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.84
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$218.25
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$174.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$189.15
|
| Rate for Payer: Quartz Medicare Advantage |
$174.60
|
| Rate for Payer: The Alliance Commercial |
$1,164.00
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
BLOCK, INTERCOSTAL NERVE
|
Facility
IP
|
$291.00
|
|
| Hospital Charge Code |
2960157
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$267.72 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$154.23
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$267.72
|
| Rate for Payer: Health EOS Commercial |
$258.99
|
| Rate for Payer: HFN Commercial |
$267.72
|
| Rate for Payer: Multiplan Commercial |
$232.80
|
| Rate for Payer: NAPHCARE Commercial |
$174.60
|
| Rate for Payer: Preferred Network Access Commercial |
$267.72
|
| Rate for Payer: Quartz Beloit One Network |
$142.59
|
| Rate for Payer: Quartz Commercial |
$174.60
|
| Rate for Payer: WEA Trust Commercial |
$160.05
|
| Rate for Payer: WPS Commercial |
$215.54
|
|
|
BLOCK, INTERSCALENE
|
Facility
OP
|
$270.00
|
|
| Hospital Charge Code |
2975775
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
BLOCK, INTERSCALENE
|
Facility
IP
|
$270.00
|
|
| Hospital Charge Code |
2975775
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
BLOCK L/T PARAVERTEBRAL
|
Facility
OP
|
$2,332.00
|
|
| Hospital Charge Code |
5262689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$652.96 |
| Max. Negotiated Rate |
$9,328.00 |
| Rate for Payer: Aetna Commercial |
$2,098.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,005.52
|
| Rate for Payer: Aetna Managed Medicare |
$652.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,515.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,166.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,119.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.96
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,145.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,304.99
|
| Rate for Payer: Health EOS Commercial |
$2,075.48
|
| Rate for Payer: HFN Commercial |
$2,145.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,749.00
|
| Rate for Payer: Multiplan Commercial |
$1,865.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,145.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.68
|
| Rate for Payer: Quartz Commercial |
$1,515.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,399.20
|
| Rate for Payer: The Alliance Commercial |
$9,328.00
|
| Rate for Payer: WEA Trust Commercial |
$1,282.60
|
| Rate for Payer: WPS Commercial |
$1,727.31
|
|
|
BLOCK L/T PARAVERTEBRAL
|
Facility
IP
|
$2,332.00
|
|
| Hospital Charge Code |
5262689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,142.68 |
| Max. Negotiated Rate |
$2,145.44 |
| Rate for Payer: Aetna Commercial |
$2,098.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,235.96
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,145.44
|
| Rate for Payer: Health EOS Commercial |
$2,075.48
|
| Rate for Payer: HFN Commercial |
$2,145.44
|
| Rate for Payer: Multiplan Commercial |
$1,865.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,399.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,145.44
|
| Rate for Payer: Quartz Beloit One Network |
$1,142.68
|
| Rate for Payer: Quartz Commercial |
$1,399.20
|
| Rate for Payer: WEA Trust Commercial |
$1,282.60
|
| Rate for Payer: WPS Commercial |
$1,727.31
|
|
|
BLOCK, LUMBAR SYMPATHETIC
|
Facility
IP
|
$270.00
|
|
| Hospital Charge Code |
2960397
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
BLOCK, LUMBAR SYMPATHETIC
|
Facility
OP
|
$270.00
|
|
| Hospital Charge Code |
2960397
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
BLOCK, NERVE
|
Facility
OP
|
$285.00
|
|
| Hospital Charge Code |
2960246
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$79.80 |
| Max. Negotiated Rate |
$1,140.00 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| Rate for Payer: Aetna Managed Medicare |
$79.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$185.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$142.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$136.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$159.49
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$213.75
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$185.25
|
| Rate for Payer: Quartz Medicare Advantage |
$171.00
|
| Rate for Payer: The Alliance Commercial |
$1,140.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
BLOCK, NERVE
|
Facility
IP
|
$285.00
|
|
| Hospital Charge Code |
2960246
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$151.05
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Health EOS Commercial |
$253.65
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Multiplan Commercial |
$228.00
|
| Rate for Payer: NAPHCARE Commercial |
$171.00
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$139.65
|
| Rate for Payer: Quartz Commercial |
$171.00
|
| Rate for Payer: WEA Trust Commercial |
$156.75
|
| Rate for Payer: WPS Commercial |
$211.10
|
|
|
BLOCK SPHENOPALATINE GANGLION
|
Facility
IP
|
$1,218.00
|
|
| Hospital Charge Code |
5262687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$596.82 |
| Max. Negotiated Rate |
$1,120.56 |
| Rate for Payer: Aetna Commercial |
$1,096.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$645.54
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,120.56
|
| Rate for Payer: Health EOS Commercial |
$1,084.02
|
| Rate for Payer: HFN Commercial |
$1,120.56
|
| Rate for Payer: Multiplan Commercial |
$974.40
|
| Rate for Payer: NAPHCARE Commercial |
$730.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,120.56
|
| Rate for Payer: Quartz Beloit One Network |
$596.82
|
| Rate for Payer: Quartz Commercial |
$730.80
|
| Rate for Payer: WEA Trust Commercial |
$669.90
|
| Rate for Payer: WPS Commercial |
$902.17
|
|
