|
Blenoxane 15 units Charge
|
Facility
|
IP
|
$270.00
|
|
|
Service Code
|
HCPCS J9040
|
| Hospital Charge Code |
2958921
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
BLEPHAROPLASTY/BLEPHARPTOSIS
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
BLEPHAROPLASTY/BLEPHARPTOSIS
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959851
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
Blepharoplasty With Excessive Skin Weighting Down Lid
|
Professional
|
Both
|
$2,495.00
|
|
|
Service Code
|
CPT 15823
|
| Hospital Charge Code |
1188911
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$476.46 |
| Max. Negotiated Rate |
$2,465.06 |
| Rate for Payer: Aetna Commercial |
$2,465.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,231.53
|
| Rate for Payer: Aetna Managed Medicare |
$476.46
|
| Rate for Payer: Anthem Medicare Advantage |
$476.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$476.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$476.46
|
| Rate for Payer: Cash Price |
$748.50
|
| Rate for Payer: Cash Price |
$748.50
|
| Rate for Payer: Cash Price |
$748.50
|
| Rate for Payer: Cigna Commercial |
$2,465.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$576.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.46
|
| Rate for Payer: Health EOS Commercial |
$2,361.27
|
| Rate for Payer: HFN Commercial |
$2,465.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,932.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,932.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$476.46
|
| Rate for Payer: Multiplan Commercial |
$2,075.84
|
| Rate for Payer: NAPHCARE Commercial |
$714.68
|
| Rate for Payer: Preferred Network Access Commercial |
$2,465.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.71
|
| Rate for Payer: Quartz Commercial |
$1,479.04
|
| Rate for Payer: Quartz Medicare Advantage |
$476.46
|
| Rate for Payer: The Alliance Commercial |
$2,024.93
|
| Rate for Payer: United Healthcare Medicaid |
$576.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$476.46
|
| Rate for Payer: WEA Trust Commercial |
$1,427.14
|
| Rate for Payer: WPS Commercial |
$2,144.05
|
|
|
BLEPHAROTOMY DRAINAGE ABSCESS EYELID, BILAT 6770050
|
Professional
|
Both
|
$791.00
|
|
|
Service Code
|
CPT 67700 50
|
| Hospital Charge Code |
6182083
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$781.51 |
| Rate for Payer: Aetna Commercial |
$781.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$707.47
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cash Price |
$237.30
|
| Rate for Payer: Cigna Commercial |
$781.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$493.58
|
| Rate for Payer: Health EOS Commercial |
$748.60
|
| Rate for Payer: HFN Commercial |
$781.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$405.56
|
| Rate for Payer: Multiplan Commercial |
$658.11
|
| Rate for Payer: Preferred Network Access Commercial |
$781.51
|
| Rate for Payer: Quartz Beloit One Network |
$361.96
|
| Rate for Payer: Quartz Commercial |
$468.90
|
| Rate for Payer: The Alliance Commercial |
$411.32
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: WEA Trust Commercial |
$452.45
|
| Rate for Payer: WPS Commercial |
$609.31
|
|
|
Blepharotomy, Drainage Of Abscess Eyelid
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 67700
|
| Hospital Charge Code |
1190828
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.31 |
| Max. Negotiated Rate |
$457.56 |
| Rate for Payer: Aetna Commercial |
$391.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Aetna Managed Medicare |
$101.68
|
| Rate for Payer: Anthem Medicare Advantage |
$101.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$101.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$101.68
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$391.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$101.68
|
| Rate for Payer: Health EOS Commercial |
$374.77
|
| Rate for Payer: HFN Commercial |
$391.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$405.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$405.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$101.68
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: NAPHCARE Commercial |
$152.52
|
| Rate for Payer: Preferred Network Access Commercial |
$391.25
|
| Rate for Payer: Quartz Beloit One Network |
$181.21
|
| Rate for Payer: Quartz Commercial |
$234.75
|
| Rate for Payer: Quartz Medicare Advantage |
$101.68
|
| Rate for Payer: The Alliance Commercial |
$432.14
|
| Rate for Payer: United Healthcare Medicaid |
$31.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$101.68
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: WPS Commercial |
$457.56
|
|
|
BLOCK BITE RETENT STRAP ENDOGUARD 48FR 69100
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
2974696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.92 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.42
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$55.54
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$55.54
|
| Rate for Payer: The Alliance Commercial |
$46.28
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
BLOCK BITE RETENT STRAP ENDOGUARD 48FR 69100
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
2974696
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
BLOCK, CAUDAL
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2959919
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
BLOCK, CAUDAL
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2959919
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
BLOCK CELIAC PLEXUS
|
Facility
|
IP
|
$2,332.00
|
|
| Hospital Charge Code |
5262688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,188.39 |
| Max. Negotiated Rate |
$2,231.26 |
| Rate for Payer: Aetna Commercial |
$2,182.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,085.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,285.40
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,231.26
|
| Rate for Payer: Health EOS Commercial |
$2,158.50
|
| Rate for Payer: HFN Commercial |
$2,231.26
|
| Rate for Payer: Multiplan Commercial |
$1,940.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,231.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.39
|
| Rate for Payer: Quartz Commercial |
$1,455.17
|
| Rate for Payer: WEA Trust Commercial |
$1,333.90
|
| Rate for Payer: WPS Commercial |
$1,796.34
|
|
|
BLOCK CELIAC PLEXUS
|
Facility
|
OP
|
$2,332.00
|
|
| Hospital Charge Code |
5262688
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$679.08 |
| Max. Negotiated Rate |
$2,231.26 |
| Rate for Payer: Aetna Commercial |
$2,182.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,085.74
|
| Rate for Payer: Aetna Managed Medicare |
$679.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,576.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,212.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,164.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,285.40
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,231.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,357.22
|
| Rate for Payer: Health EOS Commercial |
$2,158.50
|
| Rate for Payer: HFN Commercial |
$2,231.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,818.96
|
| Rate for Payer: Multiplan Commercial |
$1,940.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,455.17
|
| Rate for Payer: Preferred Network Access Commercial |
$2,231.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.39
|
| Rate for Payer: Quartz Commercial |
$1,576.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,455.17
|
| Rate for Payer: The Alliance Commercial |
$1,212.64
|
| Rate for Payer: WEA Trust Commercial |
$1,333.90
|
| Rate for Payer: WPS Commercial |
$1,796.34
|
|
|
BLOCK FOAM R-LITE PINK SOFT #A908-6
|
Facility
|
OP
|
$42.00
|
|
| Hospital Charge Code |
2969661
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$12.23 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Aetna Managed Medicare |
$12.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.44
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32.76
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: NAPHCARE Commercial |
$26.21
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$28.39
|
| Rate for Payer: Quartz Medicare Advantage |
$26.21
|
| Rate for Payer: The Alliance Commercial |
$21.84
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
BLOCK FOAM R-LITE PINK SOFT #A908-6
|
Facility
|
IP
|
$42.00
|
|
| Hospital Charge Code |
2969661
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.40 |
| Max. Negotiated Rate |
$40.19 |
| Rate for Payer: Aetna Commercial |
$39.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23.15
|
| Rate for Payer: Cash Price |
$12.60
|
| Rate for Payer: Cigna Commercial |
$40.19
|
| Rate for Payer: Health EOS Commercial |
$38.88
|
| Rate for Payer: HFN Commercial |
$40.19
|
| Rate for Payer: Multiplan Commercial |
$34.94
|
| Rate for Payer: Preferred Network Access Commercial |
$40.19
|
| Rate for Payer: Quartz Beloit One Network |
$21.40
|
| Rate for Payer: Quartz Commercial |
$26.21
|
| Rate for Payer: WEA Trust Commercial |
$24.02
|
| Rate for Payer: WPS Commercial |
$32.35
|
|
|
BLOCK, INTERCOSTAL NERVE
|
Facility
|
IP
|
$291.00
|
|
| Hospital Charge Code |
2960157
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$148.29 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$181.58
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
BLOCK, INTERCOSTAL NERVE
|
Facility
|
OP
|
$291.00
|
|
| Hospital Charge Code |
2960157
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$84.74 |
| Max. Negotiated Rate |
$278.43 |
| Rate for Payer: Aetna Commercial |
$272.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$260.27
|
| Rate for Payer: Aetna Managed Medicare |
$84.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$196.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$151.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$145.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$160.40
|
| Rate for Payer: Cash Price |
$87.30
|
| Rate for Payer: Cigna Commercial |
$278.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.36
|
| Rate for Payer: Health EOS Commercial |
$269.35
|
| Rate for Payer: HFN Commercial |
$278.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$226.98
|
| Rate for Payer: Multiplan Commercial |
$242.11
|
| Rate for Payer: NAPHCARE Commercial |
$181.58
|
| Rate for Payer: Preferred Network Access Commercial |
$278.43
|
| Rate for Payer: Quartz Beloit One Network |
$148.29
|
| Rate for Payer: Quartz Commercial |
$196.72
|
| Rate for Payer: Quartz Medicare Advantage |
$181.58
|
| Rate for Payer: The Alliance Commercial |
$151.32
|
| Rate for Payer: WEA Trust Commercial |
$166.45
|
| Rate for Payer: WPS Commercial |
$224.16
|
|
|
BLOCK, INTERSCALENE
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2975775
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
BLOCK, INTERSCALENE
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2975775
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
BLOCK L/T PARAVERTEBRAL
|
Facility
|
OP
|
$2,332.00
|
|
| Hospital Charge Code |
5262689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$679.08 |
| Max. Negotiated Rate |
$2,231.26 |
| Rate for Payer: Aetna Commercial |
$2,182.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,085.74
|
| Rate for Payer: Aetna Managed Medicare |
$679.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,576.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,212.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,164.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,285.40
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,231.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,357.22
|
| Rate for Payer: Health EOS Commercial |
$2,158.50
|
| Rate for Payer: HFN Commercial |
$2,231.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,818.96
|
| Rate for Payer: Multiplan Commercial |
$1,940.22
|
| Rate for Payer: NAPHCARE Commercial |
$1,455.17
|
| Rate for Payer: Preferred Network Access Commercial |
$2,231.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.39
|
| Rate for Payer: Quartz Commercial |
$1,576.43
|
| Rate for Payer: Quartz Medicare Advantage |
$1,455.17
|
| Rate for Payer: The Alliance Commercial |
$1,212.64
|
| Rate for Payer: WEA Trust Commercial |
$1,333.90
|
| Rate for Payer: WPS Commercial |
$1,796.34
|
|
|
BLOCK L/T PARAVERTEBRAL
|
Facility
|
IP
|
$2,332.00
|
|
| Hospital Charge Code |
5262689
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,188.39 |
| Max. Negotiated Rate |
$2,231.26 |
| Rate for Payer: Aetna Commercial |
$2,182.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,085.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,285.40
|
| Rate for Payer: Cash Price |
$699.60
|
| Rate for Payer: Cigna Commercial |
$2,231.26
|
| Rate for Payer: Health EOS Commercial |
$2,158.50
|
| Rate for Payer: HFN Commercial |
$2,231.26
|
| Rate for Payer: Multiplan Commercial |
$1,940.22
|
| Rate for Payer: Preferred Network Access Commercial |
$2,231.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,188.39
|
| Rate for Payer: Quartz Commercial |
$1,455.17
|
| Rate for Payer: WEA Trust Commercial |
$1,333.90
|
| Rate for Payer: WPS Commercial |
$1,796.34
|
|
|
BLOCK, LUMBAR SYMPATHETIC
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2960397
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
BLOCK, LUMBAR SYMPATHETIC
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2960397
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
BLOCK, NERVE
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2960246
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$82.99 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Aetna Managed Medicare |
$82.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$192.66
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$148.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$142.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.87
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$222.30
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: NAPHCARE Commercial |
$177.84
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$192.66
|
| Rate for Payer: Quartz Medicare Advantage |
$177.84
|
| Rate for Payer: The Alliance Commercial |
$148.20
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
BLOCK, NERVE
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2960246
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$145.24 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$266.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$254.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$157.09
|
| Rate for Payer: Cash Price |
$85.50
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Health EOS Commercial |
$263.80
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Multiplan Commercial |
$237.12
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$145.24
|
| Rate for Payer: Quartz Commercial |
$177.84
|
| Rate for Payer: WEA Trust Commercial |
$163.02
|
| Rate for Payer: WPS Commercial |
$219.54
|
|
|
BLOCK SPHENOPALATINE GANGLION
|
Facility
|
OP
|
$1,218.00
|
|
| Hospital Charge Code |
5262687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$354.68 |
| Max. Negotiated Rate |
$1,165.38 |
| Rate for Payer: Aetna Commercial |
$1,140.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,089.38
|
| Rate for Payer: Aetna Managed Medicare |
$354.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$823.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$633.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$608.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$671.36
|
| Rate for Payer: Cash Price |
$365.40
|
| Rate for Payer: Cigna Commercial |
$1,165.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$708.88
|
| Rate for Payer: Health EOS Commercial |
$1,127.38
|
| Rate for Payer: HFN Commercial |
$1,165.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$950.04
|
| Rate for Payer: Multiplan Commercial |
$1,013.38
|
| Rate for Payer: NAPHCARE Commercial |
$760.03
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.38
|
| Rate for Payer: Quartz Beloit One Network |
$620.69
|
| Rate for Payer: Quartz Commercial |
$823.37
|
| Rate for Payer: Quartz Medicare Advantage |
$760.03
|
| Rate for Payer: The Alliance Commercial |
$633.36
|
| Rate for Payer: WEA Trust Commercial |
$696.70
|
| Rate for Payer: WPS Commercial |
$938.23
|
|
