|
Injection Facet US, Second Level 0217T50
|
Facility
|
IP
|
$391.00
|
|
|
Service Code
|
CPT 0217T 50
|
| Hospital Charge Code |
3382939
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.25 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$243.98
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
Injection Facet US, Second Level 0217T50
|
Facility
|
OP
|
$391.00
|
|
|
Service Code
|
CPT 0217T 50
|
| Hospital Charge Code |
3382939
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.86 |
| Max. Negotiated Rate |
$374.11 |
| Rate for Payer: Aetna Commercial |
$365.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Aetna Managed Medicare |
$113.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$264.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$195.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.52
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$374.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.56
|
| Rate for Payer: Health EOS Commercial |
$361.91
|
| Rate for Payer: HFN Commercial |
$374.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.98
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: NAPHCARE Commercial |
$243.98
|
| Rate for Payer: Preferred Network Access Commercial |
$374.11
|
| Rate for Payer: Quartz Beloit One Network |
$199.25
|
| Rate for Payer: Quartz Commercial |
$264.32
|
| Rate for Payer: Quartz Medicare Advantage |
$243.98
|
| Rate for Payer: The Alliance Commercial |
$203.32
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
Injection Facet US, Second Level 0217T50
|
Professional
|
Both
|
$391.00
|
|
|
Service Code
|
CPT 0217T 50
|
| Hospital Charge Code |
3382939
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$178.92 |
| Max. Negotiated Rate |
$386.31 |
| Rate for Payer: Aetna Commercial |
$386.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.71
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cash Price |
$117.30
|
| Rate for Payer: Cigna Commercial |
$386.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$243.98
|
| Rate for Payer: Health EOS Commercial |
$370.04
|
| Rate for Payer: HFN Commercial |
$386.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$329.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$329.27
|
| Rate for Payer: Multiplan Commercial |
$325.31
|
| Rate for Payer: Preferred Network Access Commercial |
$386.31
|
| Rate for Payer: Quartz Beloit One Network |
$178.92
|
| Rate for Payer: Quartz Commercial |
$231.78
|
| Rate for Payer: The Alliance Commercial |
$203.32
|
| Rate for Payer: WEA Trust Commercial |
$223.65
|
| Rate for Payer: WPS Commercial |
$301.19
|
|
|
Injection Foramen Epidural C/T 64479
|
Professional
|
Both
|
$1,387.00
|
|
|
Service Code
|
CPT 64479
|
| Hospital Charge Code |
5232639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.88 |
| Max. Negotiated Rate |
$1,370.36 |
| Rate for Payer: Aetna Commercial |
$1,370.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,240.53
|
| Rate for Payer: Aetna Managed Medicare |
$114.88
|
| Rate for Payer: Anthem Medicare Advantage |
$114.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.88
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cash Price |
$416.10
|
| Rate for Payer: Cigna Commercial |
$1,370.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$227.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.88
|
| Rate for Payer: Health EOS Commercial |
$1,312.66
|
| Rate for Payer: HFN Commercial |
$1,370.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$460.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$460.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.88
|
| Rate for Payer: Multiplan Commercial |
$1,153.98
|
| Rate for Payer: NAPHCARE Commercial |
$172.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,370.36
|
| Rate for Payer: Quartz Beloit One Network |
$634.69
|
| Rate for Payer: Quartz Commercial |
$822.21
|
| Rate for Payer: Quartz Medicare Advantage |
$114.88
|
| Rate for Payer: The Alliance Commercial |
$488.23
|
| Rate for Payer: United Healthcare Medicaid |
$227.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.88
|
| Rate for Payer: WEA Trust Commercial |
$793.36
|
| Rate for Payer: WPS Commercial |
$516.95
|
|
|
Injection Foramen Epidural L/S 64483
|
Professional
|
Both
|
$1,320.00
|
|
|
Service Code
|
CPT 64483
|
| Hospital Charge Code |
5226606
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.03 |
| Max. Negotiated Rate |
$1,304.16 |
| Rate for Payer: Aetna Commercial |
$1,304.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,180.61
|
| Rate for Payer: Aetna Managed Medicare |
$98.03
|
| Rate for Payer: Anthem Medicare Advantage |
$98.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$98.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$98.03
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cash Price |
$396.00
|
| Rate for Payer: Cigna Commercial |
$1,304.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$209.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.03
|
| Rate for Payer: Health EOS Commercial |
$1,249.25
|
| Rate for Payer: HFN Commercial |
$1,304.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$98.03
|
| Rate for Payer: Multiplan Commercial |
$1,098.24
|
| Rate for Payer: NAPHCARE Commercial |
$147.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,304.16
|
| Rate for Payer: Quartz Beloit One Network |
$604.03
|
| Rate for Payer: Quartz Commercial |
$782.50
|
| Rate for Payer: Quartz Medicare Advantage |
$98.03
|
| Rate for Payer: The Alliance Commercial |
$416.63
|
| Rate for Payer: United Healthcare Medicaid |
$209.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$98.03
|
| Rate for Payer: WEA Trust Commercial |
$755.04
|
| Rate for Payer: WPS Commercial |
$441.14
|
|
|
Injection Foramen Epidural L/S 6448350
|
Professional
|
Both
|
$2,640.00
|
|
|
Service Code
|
CPT 64483 50
|
| Hospital Charge Code |
5226612
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$209.87 |
| Max. Negotiated Rate |
$2,608.32 |
| Rate for Payer: Aetna Commercial |
$2,608.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,361.22
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$2,608.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$209.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,647.36
|
| Rate for Payer: Health EOS Commercial |
$2,498.50
|
| Rate for Payer: HFN Commercial |
$2,608.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$392.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$392.24
|
| Rate for Payer: Multiplan Commercial |
$2,196.48
|
| Rate for Payer: Preferred Network Access Commercial |
$2,608.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,208.06
|
| Rate for Payer: Quartz Commercial |
$1,564.99
|
| Rate for Payer: The Alliance Commercial |
$1,372.80
|
| Rate for Payer: United Healthcare Medicaid |
$209.87
|
| Rate for Payer: WEA Trust Commercial |
$1,510.08
|
| Rate for Payer: WPS Commercial |
$2,033.59
|
|
|
Injection Foramen Epidural L/S Add-on 64484
|
Professional
|
Both
|
$639.00
|
|
|
Service Code
|
CPT 64484
|
| Hospital Charge Code |
5232772
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.22 |
| Max. Negotiated Rate |
$631.33 |
| Rate for Payer: Aetna Commercial |
$631.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.52
|
| Rate for Payer: Aetna Managed Medicare |
$43.22
|
| Rate for Payer: Anthem Medicare Advantage |
$43.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.22
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cash Price |
$191.70
|
| Rate for Payer: Cigna Commercial |
$631.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.22
|
| Rate for Payer: Health EOS Commercial |
$604.75
|
| Rate for Payer: HFN Commercial |
$631.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$182.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$182.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.22
|
| Rate for Payer: Multiplan Commercial |
$531.65
|
| Rate for Payer: NAPHCARE Commercial |
$64.83
|
| Rate for Payer: Preferred Network Access Commercial |
$631.33
|
| Rate for Payer: Quartz Beloit One Network |
$292.41
|
| Rate for Payer: Quartz Commercial |
$378.80
|
| Rate for Payer: Quartz Medicare Advantage |
$43.22
|
| Rate for Payer: The Alliance Commercial |
$183.70
|
| Rate for Payer: United Healthcare Medicaid |
$122.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.22
|
| Rate for Payer: WEA Trust Commercial |
$365.51
|
| Rate for Payer: WPS Commercial |
$194.50
|
|
|
Injection Foramen Epidural L/S Add-on 6448450
|
Professional
|
Both
|
$1,277.00
|
|
|
Service Code
|
CPT 64484 50
|
| Hospital Charge Code |
5232773
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.28 |
| Max. Negotiated Rate |
$1,261.68 |
| Rate for Payer: Aetna Commercial |
$1,261.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,142.15
|
| Rate for Payer: Cash Price |
$383.10
|
| Rate for Payer: Cash Price |
$383.10
|
| Rate for Payer: Cash Price |
$383.10
|
| Rate for Payer: Cigna Commercial |
$1,261.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$122.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$796.85
|
| Rate for Payer: Health EOS Commercial |
$1,208.55
|
| Rate for Payer: HFN Commercial |
$1,261.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$182.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$182.57
|
| Rate for Payer: Multiplan Commercial |
$1,062.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,261.68
|
| Rate for Payer: Quartz Beloit One Network |
$584.36
|
| Rate for Payer: Quartz Commercial |
$757.01
|
| Rate for Payer: The Alliance Commercial |
$664.04
|
| Rate for Payer: United Healthcare Medicaid |
$122.28
|
| Rate for Payer: WEA Trust Commercial |
$730.44
|
| Rate for Payer: WPS Commercial |
$983.67
|
|
|
INJECTION FOR BLADDER X-RAY 51600
|
Professional
|
Both
|
$984.00
|
|
|
Service Code
|
CPT 51600
|
| Hospital Charge Code |
3014973
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$972.19 |
| Rate for Payer: Aetna Commercial |
$972.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$880.09
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cash Price |
$295.20
|
| Rate for Payer: Cigna Commercial |
$972.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$931.26
|
| Rate for Payer: HFN Commercial |
$972.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$153.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$153.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$818.69
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$972.19
|
| Rate for Payer: Quartz Beloit One Network |
$450.28
|
| Rate for Payer: Quartz Commercial |
$583.32
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$155.10
|
| Rate for Payer: United Healthcare Medicaid |
$25.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$562.85
|
| Rate for Payer: WPS Commercial |
$164.22
|
|
|
INJECTION FOR BLADDER X-RAY 51610
|
Professional
|
Both
|
$1,042.00
|
|
|
Service Code
|
CPT 51610
|
| Hospital Charge Code |
3014974
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$25.91 |
| Max. Negotiated Rate |
$1,029.50 |
| Rate for Payer: Aetna Commercial |
$1,029.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$931.96
|
| Rate for Payer: Aetna Managed Medicare |
$56.35
|
| Rate for Payer: Anthem Medicare Advantage |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56.35
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cash Price |
$312.60
|
| Rate for Payer: Cigna Commercial |
$1,029.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$25.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.35
|
| Rate for Payer: Health EOS Commercial |
$986.15
|
| Rate for Payer: HFN Commercial |
$1,029.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$221.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$221.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56.35
|
| Rate for Payer: Multiplan Commercial |
$866.94
|
| Rate for Payer: NAPHCARE Commercial |
$84.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,029.50
|
| Rate for Payer: Quartz Beloit One Network |
$476.82
|
| Rate for Payer: Quartz Commercial |
$617.70
|
| Rate for Payer: Quartz Medicare Advantage |
$56.35
|
| Rate for Payer: The Alliance Commercial |
$239.48
|
| Rate for Payer: United Healthcare Medicaid |
$25.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56.35
|
| Rate for Payer: WEA Trust Commercial |
$596.02
|
| Rate for Payer: WPS Commercial |
$253.56
|
|
|
INJECTION FOR HIP X-RAY 27095
|
Professional
|
Both
|
$1,213.00
|
|
|
Service Code
|
CPT 27095
|
| Hospital Charge Code |
3014015
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.72 |
| Max. Negotiated Rate |
$1,198.44 |
| Rate for Payer: Aetna Commercial |
$1,198.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,084.91
|
| Rate for Payer: Aetna Managed Medicare |
$66.72
|
| Rate for Payer: Anthem Medicare Advantage |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.72
|
| Rate for Payer: Cash Price |
$363.90
|
| Rate for Payer: Cash Price |
$363.90
|
| Rate for Payer: Cash Price |
$363.90
|
| Rate for Payer: Cigna Commercial |
$1,198.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.72
|
| Rate for Payer: Health EOS Commercial |
$1,147.98
|
| Rate for Payer: HFN Commercial |
$1,198.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$286.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.72
|
| Rate for Payer: Multiplan Commercial |
$1,009.22
|
| Rate for Payer: NAPHCARE Commercial |
$100.07
|
| Rate for Payer: Preferred Network Access Commercial |
$1,198.44
|
| Rate for Payer: Quartz Beloit One Network |
$555.07
|
| Rate for Payer: Quartz Commercial |
$719.07
|
| Rate for Payer: Quartz Medicare Advantage |
$66.72
|
| Rate for Payer: The Alliance Commercial |
$283.54
|
| Rate for Payer: United Healthcare Medicaid |
$129.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.72
|
| Rate for Payer: WEA Trust Commercial |
$693.84
|
| Rate for Payer: WPS Commercial |
$300.22
|
|
|
INJECTION FOR URETER X-RAY 50690
|
Professional
|
Both
|
$1,107.00
|
|
|
Service Code
|
CPT 50690
|
| Hospital Charge Code |
3014950
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$21.92 |
| Max. Negotiated Rate |
$1,093.72 |
| Rate for Payer: Aetna Commercial |
$1,093.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$990.10
|
| Rate for Payer: Aetna Managed Medicare |
$60.84
|
| Rate for Payer: Anthem Medicare Advantage |
$60.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.84
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cash Price |
$332.10
|
| Rate for Payer: Cigna Commercial |
$1,093.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.84
|
| Rate for Payer: Health EOS Commercial |
$1,047.66
|
| Rate for Payer: HFN Commercial |
$1,093.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$242.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.84
|
| Rate for Payer: Multiplan Commercial |
$921.02
|
| Rate for Payer: NAPHCARE Commercial |
$91.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,093.72
|
| Rate for Payer: Quartz Beloit One Network |
$506.56
|
| Rate for Payer: Quartz Commercial |
$656.23
|
| Rate for Payer: Quartz Medicare Advantage |
$60.84
|
| Rate for Payer: The Alliance Commercial |
$258.57
|
| Rate for Payer: United Healthcare Medicaid |
$21.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.84
|
| Rate for Payer: WEA Trust Commercial |
$633.20
|
| Rate for Payer: WPS Commercial |
$273.78
|
|
|
Injection, hydroxyprogesterone caproate, (Makena) 10mg J1726
|
Professional
|
Both
|
$64.00
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
5438788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$29.29 |
| Max. Negotiated Rate |
$63.23 |
| Rate for Payer: Aetna Commercial |
$63.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$63.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.94
|
| Rate for Payer: Health EOS Commercial |
$60.57
|
| Rate for Payer: HFN Commercial |
$63.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42.29
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Preferred Network Access Commercial |
$63.23
|
| Rate for Payer: Quartz Beloit One Network |
$29.29
|
| Rate for Payer: Quartz Commercial |
$37.94
|
| Rate for Payer: The Alliance Commercial |
$33.28
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Injection, hydroxyprogesterone caproate, (Makena) 10mg J1726
|
Facility
|
OP
|
$64.00
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
5438788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$18.64 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Aetna Managed Medicare |
$18.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.25
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.92
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: NAPHCARE Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$43.26
|
| Rate for Payer: Quartz Medicare Advantage |
$39.94
|
| Rate for Payer: The Alliance Commercial |
$33.28
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Injection, hydroxyprogesterone caproate, (Makena) 10mg J1726
|
Facility
|
IP
|
$64.00
|
|
|
Service Code
|
HCPCS J1726
|
| Hospital Charge Code |
5438788
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$32.61 |
| Max. Negotiated Rate |
$61.24 |
| Rate for Payer: Aetna Commercial |
$59.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$35.28
|
| Rate for Payer: Cash Price |
$19.20
|
| Rate for Payer: Cigna Commercial |
$61.24
|
| Rate for Payer: Health EOS Commercial |
$59.24
|
| Rate for Payer: HFN Commercial |
$61.24
|
| Rate for Payer: Multiplan Commercial |
$53.25
|
| Rate for Payer: Preferred Network Access Commercial |
$61.24
|
| Rate for Payer: Quartz Beloit One Network |
$32.61
|
| Rate for Payer: Quartz Commercial |
$39.94
|
| Rate for Payer: WEA Trust Commercial |
$36.61
|
| Rate for Payer: WPS Commercial |
$49.30
|
|
|
Injection, Intralesional <= 7 Lesions 11900
|
Professional
|
Both
|
$161.00
|
|
|
Service Code
|
CPT 11900
|
| Hospital Charge Code |
1188858
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.58 |
| Max. Negotiated Rate |
$159.07 |
| Rate for Payer: Aetna Commercial |
$159.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.00
|
| Rate for Payer: Aetna Managed Medicare |
$23.58
|
| Rate for Payer: Anthem Medicare Advantage |
$23.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.58
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cash Price |
$48.30
|
| Rate for Payer: Cigna Commercial |
$159.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.58
|
| Rate for Payer: Health EOS Commercial |
$152.37
|
| Rate for Payer: HFN Commercial |
$159.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$104.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$104.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.58
|
| Rate for Payer: Multiplan Commercial |
$133.95
|
| Rate for Payer: NAPHCARE Commercial |
$35.37
|
| Rate for Payer: Preferred Network Access Commercial |
$159.07
|
| Rate for Payer: Quartz Beloit One Network |
$73.67
|
| Rate for Payer: Quartz Commercial |
$95.44
|
| Rate for Payer: Quartz Medicare Advantage |
$23.58
|
| Rate for Payer: The Alliance Commercial |
$100.20
|
| Rate for Payer: United Healthcare Medicaid |
$24.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.58
|
| Rate for Payer: WEA Trust Commercial |
$92.09
|
| Rate for Payer: WPS Commercial |
$106.10
|
|
|
Injection of sclerosing solution; multiple veins, same leg 36471
|
Professional
|
Both
|
$577.00
|
|
|
Service Code
|
CPT 36471
|
| Hospital Charge Code |
1190870
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.14 |
| Max. Negotiated Rate |
$570.08 |
| Rate for Payer: Aetna Commercial |
$570.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$516.07
|
| Rate for Payer: Aetna Managed Medicare |
$62.14
|
| Rate for Payer: Anthem Medicare Advantage |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$62.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$62.14
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cash Price |
$173.10
|
| Rate for Payer: Cigna Commercial |
$570.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.14
|
| Rate for Payer: Health EOS Commercial |
$546.07
|
| Rate for Payer: HFN Commercial |
$570.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$254.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$62.14
|
| Rate for Payer: Multiplan Commercial |
$480.06
|
| Rate for Payer: NAPHCARE Commercial |
$93.21
|
| Rate for Payer: Preferred Network Access Commercial |
$570.08
|
| Rate for Payer: Quartz Beloit One Network |
$264.04
|
| Rate for Payer: Quartz Commercial |
$342.05
|
| Rate for Payer: Quartz Medicare Advantage |
$62.14
|
| Rate for Payer: The Alliance Commercial |
$264.10
|
| Rate for Payer: United Healthcare Medicaid |
$77.71
|
| Rate for Payer: United Healthcare Medicare Advantage |
$62.14
|
| Rate for Payer: WEA Trust Commercial |
$330.04
|
| Rate for Payer: WPS Commercial |
$279.63
|
|
|
Injection of sclerosing solution; single vein 36470
|
Professional
|
Both
|
$446.00
|
|
|
Service Code
|
CPT 36470
|
| Hospital Charge Code |
1190871
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$31.29 |
| Max. Negotiated Rate |
$440.65 |
| Rate for Payer: Aetna Commercial |
$440.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$398.90
|
| Rate for Payer: Aetna Managed Medicare |
$31.29
|
| Rate for Payer: Anthem Medicare Advantage |
$31.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.29
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cash Price |
$133.80
|
| Rate for Payer: Cigna Commercial |
$440.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.29
|
| Rate for Payer: Health EOS Commercial |
$422.09
|
| Rate for Payer: HFN Commercial |
$440.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.29
|
| Rate for Payer: Multiplan Commercial |
$371.07
|
| Rate for Payer: NAPHCARE Commercial |
$46.94
|
| Rate for Payer: Preferred Network Access Commercial |
$440.65
|
| Rate for Payer: Quartz Beloit One Network |
$204.09
|
| Rate for Payer: Quartz Commercial |
$264.39
|
| Rate for Payer: Quartz Medicare Advantage |
$31.29
|
| Rate for Payer: The Alliance Commercial |
$133.00
|
| Rate for Payer: United Healthcare Medicaid |
$51.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.29
|
| Rate for Payer: WEA Trust Commercial |
$255.11
|
| Rate for Payer: WPS Commercial |
$140.82
|
|
|
Injection of Tendon Sheath or Ligament; Single 20550
|
Professional
|
Both
|
$88.00
|
|
|
Service Code
|
CPT 20550
|
| Hospital Charge Code |
1188964
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.05 |
| Max. Negotiated Rate |
$145.41 |
| Rate for Payer: Aetna Commercial |
$86.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$78.71
|
| Rate for Payer: Aetna Managed Medicare |
$32.31
|
| Rate for Payer: Anthem Medicare Advantage |
$32.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$32.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$32.31
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cash Price |
$26.40
|
| Rate for Payer: Cigna Commercial |
$86.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.31
|
| Rate for Payer: Health EOS Commercial |
$83.28
|
| Rate for Payer: HFN Commercial |
$86.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$32.31
|
| Rate for Payer: Multiplan Commercial |
$73.22
|
| Rate for Payer: NAPHCARE Commercial |
$48.47
|
| Rate for Payer: Preferred Network Access Commercial |
$86.94
|
| Rate for Payer: Quartz Beloit One Network |
$40.27
|
| Rate for Payer: Quartz Commercial |
$52.17
|
| Rate for Payer: Quartz Medicare Advantage |
$32.31
|
| Rate for Payer: The Alliance Commercial |
$137.33
|
| Rate for Payer: United Healthcare Medicaid |
$28.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$32.31
|
| Rate for Payer: WEA Trust Commercial |
$50.34
|
| Rate for Payer: WPS Commercial |
$145.41
|
|
|
Injection Paravert F Jnt C/T 1 Level 64490
|
Professional
|
Both
|
$1,041.00
|
|
|
Service Code
|
CPT 64490
|
| Hospital Charge Code |
5232645
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$92.59 |
| Max. Negotiated Rate |
$1,028.51 |
| Rate for Payer: Aetna Commercial |
$1,028.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$931.07
|
| Rate for Payer: Aetna Managed Medicare |
$92.59
|
| Rate for Payer: Anthem Medicare Advantage |
$92.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$92.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$92.59
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cash Price |
$312.30
|
| Rate for Payer: Cigna Commercial |
$1,028.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$92.59
|
| Rate for Payer: Health EOS Commercial |
$985.20
|
| Rate for Payer: HFN Commercial |
$1,028.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$92.59
|
| Rate for Payer: Multiplan Commercial |
$866.11
|
| Rate for Payer: NAPHCARE Commercial |
$138.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,028.51
|
| Rate for Payer: Quartz Beloit One Network |
$476.36
|
| Rate for Payer: Quartz Commercial |
$617.10
|
| Rate for Payer: Quartz Medicare Advantage |
$92.59
|
| Rate for Payer: The Alliance Commercial |
$393.51
|
| Rate for Payer: United Healthcare Medicaid |
$142.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$92.59
|
| Rate for Payer: WEA Trust Commercial |
$595.45
|
| Rate for Payer: WPS Commercial |
$416.66
|
|
|
Injection Paravert F Jnt C/T 1 Level 6449050
|
Professional
|
Both
|
$2,081.00
|
|
|
Service Code
|
CPT 64490 50
|
| Hospital Charge Code |
5232646
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$142.54 |
| Max. Negotiated Rate |
$2,056.03 |
| Rate for Payer: Aetna Commercial |
$2,056.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,861.25
|
| Rate for Payer: Cash Price |
$624.30
|
| Rate for Payer: Cash Price |
$624.30
|
| Rate for Payer: Cash Price |
$624.30
|
| Rate for Payer: Cigna Commercial |
$2,056.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$142.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,298.54
|
| Rate for Payer: Health EOS Commercial |
$1,969.46
|
| Rate for Payer: HFN Commercial |
$2,056.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.68
|
| Rate for Payer: Multiplan Commercial |
$1,731.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,056.03
|
| Rate for Payer: Quartz Beloit One Network |
$952.27
|
| Rate for Payer: Quartz Commercial |
$1,233.62
|
| Rate for Payer: The Alliance Commercial |
$1,082.12
|
| Rate for Payer: United Healthcare Medicaid |
$142.54
|
| Rate for Payer: WEA Trust Commercial |
$1,190.33
|
| Rate for Payer: WPS Commercial |
$1,602.99
|
|
|
Injection Paravert F Jnt C/T 2 Level 64491
|
Professional
|
Both
|
$780.00
|
|
|
Service Code
|
CPT 64491
|
| Hospital Charge Code |
5232647
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.74 |
| Max. Negotiated Rate |
$770.64 |
| Rate for Payer: Aetna Commercial |
$770.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$697.63
|
| Rate for Payer: Aetna Managed Medicare |
$49.74
|
| Rate for Payer: Anthem Medicare Advantage |
$49.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.74
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cash Price |
$234.00
|
| Rate for Payer: Cigna Commercial |
$770.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.74
|
| Rate for Payer: Health EOS Commercial |
$738.19
|
| Rate for Payer: HFN Commercial |
$770.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.74
|
| Rate for Payer: Multiplan Commercial |
$648.96
|
| Rate for Payer: NAPHCARE Commercial |
$74.61
|
| Rate for Payer: Preferred Network Access Commercial |
$770.64
|
| Rate for Payer: Quartz Beloit One Network |
$356.93
|
| Rate for Payer: Quartz Commercial |
$462.38
|
| Rate for Payer: Quartz Medicare Advantage |
$49.74
|
| Rate for Payer: The Alliance Commercial |
$211.41
|
| Rate for Payer: United Healthcare Medicaid |
$70.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.74
|
| Rate for Payer: WEA Trust Commercial |
$446.16
|
| Rate for Payer: WPS Commercial |
$223.84
|
|
|
Injection Paravert F Jnt C/T 2 Level 6449150
|
Professional
|
Both
|
$1,560.00
|
|
|
Service Code
|
CPT 64491 50
|
| Hospital Charge Code |
5232648
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.40 |
| Max. Negotiated Rate |
$1,541.28 |
| Rate for Payer: Aetna Commercial |
$1,541.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,395.26
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cash Price |
$468.00
|
| Rate for Payer: Cigna Commercial |
$1,541.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$973.44
|
| Rate for Payer: Health EOS Commercial |
$1,476.38
|
| Rate for Payer: HFN Commercial |
$1,541.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.25
|
| Rate for Payer: Multiplan Commercial |
$1,297.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,541.28
|
| Rate for Payer: Quartz Beloit One Network |
$713.86
|
| Rate for Payer: Quartz Commercial |
$924.77
|
| Rate for Payer: The Alliance Commercial |
$811.20
|
| Rate for Payer: United Healthcare Medicaid |
$70.40
|
| Rate for Payer: WEA Trust Commercial |
$892.32
|
| Rate for Payer: WPS Commercial |
$1,201.67
|
|
|
INJECTION PARVERTEBRAL FACET C/T 2ND LEVEL (+)
|
Facility
|
OP
|
$968.00
|
|
| Hospital Charge Code |
5262682
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.88 |
| Max. Negotiated Rate |
$926.18 |
| Rate for Payer: Aetna Commercial |
$906.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.78
|
| Rate for Payer: Aetna Managed Medicare |
$281.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$654.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$483.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.56
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$926.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$563.38
|
| Rate for Payer: Health EOS Commercial |
$895.98
|
| Rate for Payer: HFN Commercial |
$926.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$755.04
|
| Rate for Payer: Multiplan Commercial |
$805.38
|
| Rate for Payer: NAPHCARE Commercial |
$604.03
|
| Rate for Payer: Preferred Network Access Commercial |
$926.18
|
| Rate for Payer: Quartz Beloit One Network |
$493.29
|
| Rate for Payer: Quartz Commercial |
$654.37
|
| Rate for Payer: Quartz Medicare Advantage |
$604.03
|
| Rate for Payer: The Alliance Commercial |
$503.36
|
| Rate for Payer: WEA Trust Commercial |
$553.70
|
| Rate for Payer: WPS Commercial |
$745.65
|
|
|
INJECTION PARVERTEBRAL FACET C/T 2ND LEVEL (+)
|
Facility
|
IP
|
$968.00
|
|
| Hospital Charge Code |
5262682
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$493.29 |
| Max. Negotiated Rate |
$926.18 |
| Rate for Payer: Aetna Commercial |
$906.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.56
|
| Rate for Payer: Cash Price |
$290.40
|
| Rate for Payer: Cigna Commercial |
$926.18
|
| Rate for Payer: Health EOS Commercial |
$895.98
|
| Rate for Payer: HFN Commercial |
$926.18
|
| Rate for Payer: Multiplan Commercial |
$805.38
|
| Rate for Payer: Preferred Network Access Commercial |
$926.18
|
| Rate for Payer: Quartz Beloit One Network |
$493.29
|
| Rate for Payer: Quartz Commercial |
$604.03
|
| Rate for Payer: WEA Trust Commercial |
$553.70
|
| Rate for Payer: WPS Commercial |
$745.65
|
|
