|
EPIDURAL STEROID INJECTION
|
Facility
|
IP
|
$285.00
|
|
| Hospital Charge Code |
2960018
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$139.65 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$256.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$245.10
|
| 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
|
|
|
EPIDURAL STEROID INJECTION
|
Facility
|
OP
|
$285.00
|
|
| Hospital Charge Code |
2960018
|
|
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
|
|
|
EPIDURAL STEROID INJECTION, CERVICAL/THORACIC
|
Facility
|
OP
|
$2,099.00
|
|
| Hospital Charge Code |
2959922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$587.72 |
| Max. Negotiated Rate |
$8,396.00 |
| Rate for Payer: Aetna Commercial |
$1,889.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,805.14
|
| Rate for Payer: Aetna Managed Medicare |
$587.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,364.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,049.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,007.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,112.47
|
| Rate for Payer: Cash Price |
$629.70
|
| Rate for Payer: Cigna Commercial |
$1,931.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,174.60
|
| Rate for Payer: Health EOS Commercial |
$1,868.11
|
| Rate for Payer: HFN Commercial |
$1,931.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,574.25
|
| Rate for Payer: Multiplan Commercial |
$1,679.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,259.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,931.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,028.51
|
| Rate for Payer: Quartz Commercial |
$1,364.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,259.40
|
| Rate for Payer: The Alliance Commercial |
$8,396.00
|
| Rate for Payer: WEA Trust Commercial |
$1,154.45
|
| Rate for Payer: WPS Commercial |
$1,554.73
|
|
|
EPIDURAL STEROID INJECTION, CERVICAL/THORACIC
|
Facility
|
IP
|
$2,099.00
|
|
| Hospital Charge Code |
2959922
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,028.51 |
| Max. Negotiated Rate |
$1,931.08 |
| Rate for Payer: Aetna Commercial |
$1,889.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,805.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,112.47
|
| Rate for Payer: Cash Price |
$629.70
|
| Rate for Payer: Cigna Commercial |
$1,931.08
|
| Rate for Payer: Health EOS Commercial |
$1,868.11
|
| Rate for Payer: HFN Commercial |
$1,931.08
|
| Rate for Payer: Multiplan Commercial |
$1,679.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,259.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,931.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,028.51
|
| Rate for Payer: Quartz Commercial |
$1,259.40
|
| Rate for Payer: WEA Trust Commercial |
$1,154.45
|
| Rate for Payer: WPS Commercial |
$1,554.73
|
|
|
EPIDURAL STEROID INJECTION C/T TRANSFORAMINAL
|
Facility
|
IP
|
$2,485.00
|
|
| Hospital Charge Code |
5262679
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,217.65 |
| Max. Negotiated Rate |
$2,286.20 |
| Rate for Payer: Aetna Commercial |
$2,236.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,137.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,317.05
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$2,286.20
|
| Rate for Payer: Health EOS Commercial |
$2,211.65
|
| Rate for Payer: HFN Commercial |
$2,286.20
|
| Rate for Payer: Multiplan Commercial |
$1,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,491.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,286.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,217.65
|
| Rate for Payer: Quartz Commercial |
$1,491.00
|
| Rate for Payer: WEA Trust Commercial |
$1,366.75
|
| Rate for Payer: WPS Commercial |
$1,840.64
|
|
|
EPIDURAL STEROID INJECTION C/T TRANSFORAMINAL
|
Facility
|
OP
|
$2,485.00
|
|
| Hospital Charge Code |
5262679
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$695.80 |
| Max. Negotiated Rate |
$9,940.00 |
| Rate for Payer: Aetna Commercial |
$2,236.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,137.10
|
| Rate for Payer: Aetna Managed Medicare |
$695.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,615.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,242.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,192.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,317.05
|
| Rate for Payer: Cash Price |
$745.50
|
| Rate for Payer: Cigna Commercial |
$2,286.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,390.61
|
| Rate for Payer: Health EOS Commercial |
$2,211.65
|
| Rate for Payer: HFN Commercial |
$2,286.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,863.75
|
| Rate for Payer: Multiplan Commercial |
$1,988.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,491.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,286.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,217.65
|
| Rate for Payer: Quartz Commercial |
$1,615.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,491.00
|
| Rate for Payer: The Alliance Commercial |
$9,940.00
|
| Rate for Payer: WEA Trust Commercial |
$1,366.75
|
| Rate for Payer: WPS Commercial |
$1,840.64
|
|
|
EPIDURAL STEROID INJECTION L/S TRANSFORAMINAL
|
Facility
|
IP
|
$2,495.00
|
|
| Hospital Charge Code |
4882606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,222.55 |
| Max. Negotiated Rate |
$2,295.40 |
| Rate for Payer: Aetna Commercial |
$2,245.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,145.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.35
|
| Rate for Payer: Cash Price |
$748.50
|
| Rate for Payer: Cigna Commercial |
$2,295.40
|
| Rate for Payer: Health EOS Commercial |
$2,220.55
|
| Rate for Payer: HFN Commercial |
$2,295.40
|
| Rate for Payer: Multiplan Commercial |
$1,996.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,295.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,222.55
|
| Rate for Payer: Quartz Commercial |
$1,497.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.25
|
| Rate for Payer: WPS Commercial |
$1,848.05
|
|
|
EPIDURAL STEROID INJECTION L/S TRANSFORAMINAL
|
Facility
|
OP
|
$2,495.00
|
|
| Hospital Charge Code |
4882606
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$698.60 |
| Max. Negotiated Rate |
$9,980.00 |
| Rate for Payer: Aetna Commercial |
$2,245.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,145.70
|
| Rate for Payer: Aetna Managed Medicare |
$698.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,621.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,247.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,197.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,322.35
|
| Rate for Payer: Cash Price |
$748.50
|
| Rate for Payer: Cigna Commercial |
$2,295.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,396.20
|
| Rate for Payer: Health EOS Commercial |
$2,220.55
|
| Rate for Payer: HFN Commercial |
$2,295.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,871.25
|
| Rate for Payer: Multiplan Commercial |
$1,996.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,497.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,295.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,222.55
|
| Rate for Payer: Quartz Commercial |
$1,621.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,497.00
|
| Rate for Payer: The Alliance Commercial |
$9,980.00
|
| Rate for Payer: WEA Trust Commercial |
$1,372.25
|
| Rate for Payer: WPS Commercial |
$1,848.05
|
|
|
EPIDURAL STEROID INJECTION L/S TRANS + LVL
|
Facility
|
OP
|
$870.00
|
|
| Hospital Charge Code |
5262680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$243.60 |
| Max. Negotiated Rate |
$3,480.00 |
| Rate for Payer: Aetna Commercial |
$783.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$748.20
|
| Rate for Payer: Aetna Managed Medicare |
$243.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$565.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$435.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$417.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$461.10
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$800.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$486.85
|
| Rate for Payer: Health EOS Commercial |
$774.30
|
| Rate for Payer: HFN Commercial |
$800.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$652.50
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: NAPHCARE Commercial |
$522.00
|
| Rate for Payer: Preferred Network Access Commercial |
$800.40
|
| Rate for Payer: Quartz Beloit One Network |
$426.30
|
| Rate for Payer: Quartz Commercial |
$565.50
|
| Rate for Payer: Quartz Medicare Advantage |
$522.00
|
| Rate for Payer: The Alliance Commercial |
$3,480.00
|
| Rate for Payer: WEA Trust Commercial |
$478.50
|
| Rate for Payer: WPS Commercial |
$644.41
|
|
|
EPIDURAL STEROID INJECTION L/S TRANS + LVL
|
Facility
|
IP
|
$870.00
|
|
| Hospital Charge Code |
5262680
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$426.30 |
| Max. Negotiated Rate |
$800.40 |
| Rate for Payer: Aetna Commercial |
$783.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$748.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$461.10
|
| Rate for Payer: Cash Price |
$261.00
|
| Rate for Payer: Cigna Commercial |
$800.40
|
| Rate for Payer: Health EOS Commercial |
$774.30
|
| Rate for Payer: HFN Commercial |
$800.40
|
| Rate for Payer: Multiplan Commercial |
$696.00
|
| Rate for Payer: NAPHCARE Commercial |
$522.00
|
| Rate for Payer: Preferred Network Access Commercial |
$800.40
|
| Rate for Payer: Quartz Beloit One Network |
$426.30
|
| Rate for Payer: Quartz Commercial |
$522.00
|
| Rate for Payer: WEA Trust Commercial |
$478.50
|
| Rate for Payer: WPS Commercial |
$644.41
|
|
|
EPIDURAL STEROID INJECTION, LUMBAR/SACRAL
|
Facility
|
IP
|
$1,075.00
|
|
| Hospital Charge Code |
2960564
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$526.75 |
| Max. Negotiated Rate |
$989.00 |
| Rate for Payer: Aetna Commercial |
$967.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$569.75
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$989.00
|
| Rate for Payer: Health EOS Commercial |
$956.75
|
| Rate for Payer: HFN Commercial |
$989.00
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: NAPHCARE Commercial |
$645.00
|
| Rate for Payer: Preferred Network Access Commercial |
$989.00
|
| Rate for Payer: Quartz Beloit One Network |
$526.75
|
| Rate for Payer: Quartz Commercial |
$645.00
|
| Rate for Payer: WEA Trust Commercial |
$591.25
|
| Rate for Payer: WPS Commercial |
$796.25
|
|
|
EPIDURAL STEROID INJECTION, LUMBAR/SACRAL
|
Facility
|
OP
|
$1,075.00
|
|
| Hospital Charge Code |
2960564
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,300.00 |
| Rate for Payer: Aetna Commercial |
$967.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.50
|
| Rate for Payer: Aetna Managed Medicare |
$301.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$698.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$537.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$516.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$569.75
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$989.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$601.57
|
| Rate for Payer: Health EOS Commercial |
$956.75
|
| Rate for Payer: HFN Commercial |
$989.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$806.25
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: NAPHCARE Commercial |
$645.00
|
| Rate for Payer: Preferred Network Access Commercial |
$989.00
|
| Rate for Payer: Quartz Beloit One Network |
$526.75
|
| Rate for Payer: Quartz Commercial |
$698.75
|
| Rate for Payer: Quartz Medicare Advantage |
$645.00
|
| Rate for Payer: The Alliance Commercial |
$4,300.00
|
| Rate for Payer: WEA Trust Commercial |
$591.25
|
| Rate for Payer: WPS Commercial |
$796.25
|
|
|
EPIDURAL STEROID INJECTION WITH C-ARM
|
Facility
|
IP
|
$291.00
|
|
| Hospital Charge Code |
2960524
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$142.59 |
| Max. Negotiated Rate |
$267.72 |
| Rate for Payer: Aetna Commercial |
$261.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$250.26
|
| 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
|
|
|
EPIDURAL STEROID INJECTION WITH C-ARM
|
Facility
|
OP
|
$291.00
|
|
| Hospital Charge Code |
2960524
|
|
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
|
|
|
EPIDURAL WITH GENERAL ANES - SET-UP CHARGE
|
Facility
|
IP
|
$1,668.00
|
|
| Hospital Charge Code |
4519584
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$817.32 |
| Max. Negotiated Rate |
$1,534.56 |
| Rate for Payer: Aetna Commercial |
$1,501.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,434.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$884.04
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$1,534.56
|
| Rate for Payer: Health EOS Commercial |
$1,484.52
|
| Rate for Payer: HFN Commercial |
$1,534.56
|
| Rate for Payer: Multiplan Commercial |
$1,334.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,000.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,534.56
|
| Rate for Payer: Quartz Beloit One Network |
$817.32
|
| Rate for Payer: Quartz Commercial |
$1,000.80
|
| Rate for Payer: WEA Trust Commercial |
$917.40
|
| Rate for Payer: WPS Commercial |
$1,235.49
|
|
|
EPIDURAL WITH GENERAL ANES - SET-UP CHARGE
|
Facility
|
OP
|
$1,668.00
|
|
| Hospital Charge Code |
4519584
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$467.04 |
| Max. Negotiated Rate |
$6,672.00 |
| Rate for Payer: Aetna Commercial |
$1,501.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,434.48
|
| Rate for Payer: Aetna Managed Medicare |
$467.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,084.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$834.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$800.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$884.04
|
| Rate for Payer: Cash Price |
$500.40
|
| Rate for Payer: Cigna Commercial |
$1,534.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$933.41
|
| Rate for Payer: Health EOS Commercial |
$1,484.52
|
| Rate for Payer: HFN Commercial |
$1,534.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,251.00
|
| Rate for Payer: Multiplan Commercial |
$1,334.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,000.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,534.56
|
| Rate for Payer: Quartz Beloit One Network |
$817.32
|
| Rate for Payer: Quartz Commercial |
$1,084.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,000.80
|
| Rate for Payer: The Alliance Commercial |
$6,672.00
|
| Rate for Payer: WEA Trust Commercial |
$917.40
|
| Rate for Payer: WPS Commercial |
$1,235.49
|
|
|
Epidural (with IV Pump) - Individual Charges
|
Facility
|
IP
|
$1,054.00
|
|
| Hospital Charge Code |
3003916
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$516.46 |
| Max. Negotiated Rate |
$969.68 |
| Rate for Payer: Aetna Commercial |
$948.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$906.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$558.62
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$969.68
|
| Rate for Payer: Health EOS Commercial |
$938.06
|
| Rate for Payer: HFN Commercial |
$969.68
|
| Rate for Payer: Multiplan Commercial |
$843.20
|
| Rate for Payer: NAPHCARE Commercial |
$632.40
|
| Rate for Payer: Preferred Network Access Commercial |
$969.68
|
| Rate for Payer: Quartz Beloit One Network |
$516.46
|
| Rate for Payer: Quartz Commercial |
$632.40
|
| Rate for Payer: WEA Trust Commercial |
$579.70
|
| Rate for Payer: WPS Commercial |
$780.70
|
|
|
Epidural (with IV Pump) - Individual Charges
|
Facility
|
OP
|
$1,054.00
|
|
| Hospital Charge Code |
3003916
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$295.12 |
| Max. Negotiated Rate |
$4,216.00 |
| Rate for Payer: Aetna Commercial |
$948.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$906.44
|
| Rate for Payer: Aetna Managed Medicare |
$295.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$685.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$527.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$505.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$558.62
|
| Rate for Payer: Cash Price |
$316.20
|
| Rate for Payer: Cigna Commercial |
$969.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$589.82
|
| Rate for Payer: Health EOS Commercial |
$938.06
|
| Rate for Payer: HFN Commercial |
$969.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$790.50
|
| Rate for Payer: Multiplan Commercial |
$843.20
|
| Rate for Payer: NAPHCARE Commercial |
$632.40
|
| Rate for Payer: Preferred Network Access Commercial |
$969.68
|
| Rate for Payer: Quartz Beloit One Network |
$516.46
|
| Rate for Payer: Quartz Commercial |
$685.10
|
| Rate for Payer: Quartz Medicare Advantage |
$632.40
|
| Rate for Payer: The Alliance Commercial |
$4,216.00
|
| Rate for Payer: WEA Trust Commercial |
$579.70
|
| Rate for Payer: WPS Commercial |
$780.70
|
|
|
EPIFIX, PER SQ CM Q4186
|
Professional
|
Both
|
$868.00
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
5571280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$153.45 |
| Max. Negotiated Rate |
$824.60 |
| Rate for Payer: Aetna Commercial |
$824.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$746.48
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$824.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$160.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.45
|
| Rate for Payer: Health EOS Commercial |
$789.88
|
| Rate for Payer: HFN Commercial |
$824.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$543.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$543.37
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: Preferred Network Access Commercial |
$824.60
|
| Rate for Payer: Quartz Beloit One Network |
$381.92
|
| Rate for Payer: Quartz Commercial |
$494.76
|
| Rate for Payer: The Alliance Commercial |
$434.00
|
| Rate for Payer: United Healthcare Medicaid |
$160.02
|
| Rate for Payer: WEA Trust Commercial |
$477.40
|
| Rate for Payer: WPS Commercial |
$383.63
|
|
|
EPIFIX, PER SQ CM Q4186
|
Facility
|
OP
|
$868.00
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
5571280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$203.02 |
| Max. Negotiated Rate |
$3,472.00 |
| Rate for Payer: Aetna Commercial |
$781.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$746.48
|
| Rate for Payer: Aetna Managed Medicare |
$243.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$564.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$434.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$416.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.04
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$798.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$203.02
|
| Rate for Payer: Health EOS Commercial |
$772.52
|
| Rate for Payer: HFN Commercial |
$798.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$651.00
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: NAPHCARE Commercial |
$520.80
|
| Rate for Payer: Preferred Network Access Commercial |
$798.56
|
| Rate for Payer: Quartz Beloit One Network |
$425.32
|
| Rate for Payer: Quartz Commercial |
$564.20
|
| Rate for Payer: Quartz Medicare Advantage |
$520.80
|
| Rate for Payer: The Alliance Commercial |
$3,472.00
|
| Rate for Payer: WEA Trust Commercial |
$477.40
|
| Rate for Payer: WPS Commercial |
$383.63
|
|
|
EPIFIX, PER SQ CM Q4186
|
Facility
|
IP
|
$868.00
|
|
|
Service Code
|
HCPCS Q4186
|
| Hospital Charge Code |
5571280
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$425.32 |
| Max. Negotiated Rate |
$798.56 |
| Rate for Payer: Aetna Commercial |
$781.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$746.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$460.04
|
| Rate for Payer: Cash Price |
$260.40
|
| Rate for Payer: Cigna Commercial |
$798.56
|
| Rate for Payer: Health EOS Commercial |
$772.52
|
| Rate for Payer: HFN Commercial |
$798.56
|
| Rate for Payer: Multiplan Commercial |
$694.40
|
| Rate for Payer: NAPHCARE Commercial |
$520.80
|
| Rate for Payer: Preferred Network Access Commercial |
$798.56
|
| Rate for Payer: Quartz Beloit One Network |
$425.32
|
| Rate for Payer: Quartz Commercial |
$520.80
|
| Rate for Payer: WEA Trust Commercial |
$477.40
|
| Rate for Payer: WPS Commercial |
$642.93
|
|
|
EP Induction Of Arrhythmia
|
Facility
|
OP
|
$18,016.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
3052506
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,176.34 |
| Max. Negotiated Rate |
$29,139.00 |
| Rate for Payer: Aetna Commercial |
$16,214.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,493.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,176.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,139.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,420.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,100.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,176.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,548.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,176.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,176.34
|
| Rate for Payer: Cash Price |
$5,404.80
|
| Rate for Payer: Cash Price |
$5,404.80
|
| Rate for Payer: Cash Price |
$5,404.80
|
| Rate for Payer: Cigna Commercial |
$16,574.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,176.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,081.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,176.34
|
| Rate for Payer: Health EOS Commercial |
$16,034.24
|
| Rate for Payer: HFN Commercial |
$16,574.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,375.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,176.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,176.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,176.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,176.34
|
| Rate for Payer: Multiplan Commercial |
$14,412.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,764.51
|
| Rate for Payer: Preferred Network Access Commercial |
$16,574.72
|
| Rate for Payer: Quartz Beloit One Network |
$8,827.84
|
| Rate for Payer: Quartz Commercial |
$11,710.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,176.34
|
| Rate for Payer: The Alliance Commercial |
$4,705.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,176.34
|
| Rate for Payer: WEA Trust Commercial |
$9,908.80
|
| Rate for Payer: Wellcare Medicare |
$1,176.34
|
| Rate for Payer: WPS Commercial |
$13,344.45
|
|
|
EP Induction Of Arrhythmia
|
Facility
|
IP
|
$18,016.00
|
|
|
Service Code
|
CPT 93618
|
| Hospital Charge Code |
3052506
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,827.84 |
| Max. Negotiated Rate |
$16,574.72 |
| Rate for Payer: Aetna Commercial |
$16,214.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,493.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,548.48
|
| Rate for Payer: Cash Price |
$5,404.80
|
| Rate for Payer: Cigna Commercial |
$16,574.72
|
| Rate for Payer: Health EOS Commercial |
$16,034.24
|
| Rate for Payer: HFN Commercial |
$16,574.72
|
| Rate for Payer: Multiplan Commercial |
$14,412.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,809.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,574.72
|
| Rate for Payer: Quartz Beloit One Network |
$8,827.84
|
| Rate for Payer: Quartz Commercial |
$10,809.60
|
| Rate for Payer: WEA Trust Commercial |
$9,908.80
|
| Rate for Payer: WPS Commercial |
$13,344.45
|
|
|
Epinephrine 1:1000 1mg/1ml ampule [Med]
|
Facility
|
OP
|
$23.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2974934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1.07 |
| Max. Negotiated Rate |
$92.00 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Aetna Managed Medicare |
$6.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1.07
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.25
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$14.95
|
| Rate for Payer: Quartz Medicare Advantage |
$13.80
|
| Rate for Payer: The Alliance Commercial |
$92.00
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$2.03
|
|
|
Epinephrine 1:1000 1mg/1ml ampule [Med]
|
Facility
|
IP
|
$23.00
|
|
|
Service Code
|
HCPCS J0171
|
| Hospital Charge Code |
2974934
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.27 |
| Max. Negotiated Rate |
$21.16 |
| Rate for Payer: Aetna Commercial |
$20.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.19
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$21.16
|
| Rate for Payer: Health EOS Commercial |
$20.47
|
| Rate for Payer: HFN Commercial |
$21.16
|
| Rate for Payer: Multiplan Commercial |
$18.40
|
| Rate for Payer: NAPHCARE Commercial |
$13.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21.16
|
| Rate for Payer: Quartz Beloit One Network |
$11.27
|
| Rate for Payer: Quartz Commercial |
$13.80
|
| Rate for Payer: WEA Trust Commercial |
$12.65
|
| Rate for Payer: WPS Commercial |
$17.04
|
|
