|
NASAL DRESSING & SINUS STENT MEROGEL INJECTABLE 15-18000
|
Facility
|
IP
|
$1,908.00
|
|
| Hospital Charge Code |
5240626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$934.92 |
| Max. Negotiated Rate |
$1,755.36 |
| Rate for Payer: Aetna Commercial |
$1,717.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,011.24
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna Commercial |
$1,755.36
|
| Rate for Payer: Health EOS Commercial |
$1,698.12
|
| Rate for Payer: HFN Commercial |
$1,755.36
|
| Rate for Payer: Multiplan Commercial |
$1,526.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,755.36
|
| Rate for Payer: Quartz Beloit One Network |
$934.92
|
| Rate for Payer: Quartz Commercial |
$1,144.80
|
| Rate for Payer: WEA Trust Commercial |
$1,049.40
|
| Rate for Payer: WPS Commercial |
$1,413.26
|
|
|
NASAL DRESSING & SINUS STENT MEROGEL INJECTABLE 15-18000
|
Facility
|
OP
|
$1,908.00
|
|
| Hospital Charge Code |
5240626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$534.24 |
| Max. Negotiated Rate |
$7,632.00 |
| Rate for Payer: Aetna Commercial |
$1,717.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,640.88
|
| Rate for Payer: Aetna Managed Medicare |
$534.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,240.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$954.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$915.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,011.24
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna Commercial |
$1,755.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,067.72
|
| Rate for Payer: Health EOS Commercial |
$1,698.12
|
| Rate for Payer: HFN Commercial |
$1,755.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,431.00
|
| Rate for Payer: Multiplan Commercial |
$1,526.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,144.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,755.36
|
| Rate for Payer: Quartz Beloit One Network |
$934.92
|
| Rate for Payer: Quartz Commercial |
$1,240.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,144.80
|
| Rate for Payer: The Alliance Commercial |
$7,632.00
|
| Rate for Payer: WEA Trust Commercial |
$1,049.40
|
| Rate for Payer: WPS Commercial |
$1,413.26
|
|
|
Nasal Endoscopy, diagnostic
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
1152812
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$529.15 |
| Rate for Payer: Aetna Commercial |
$529.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$479.02
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cash Price |
$167.10
|
| Rate for Payer: Cigna Commercial |
$529.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$334.20
|
| Rate for Payer: Health EOS Commercial |
$506.87
|
| Rate for Payer: HFN Commercial |
$529.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.73
|
| Rate for Payer: Multiplan Commercial |
$445.60
|
| Rate for Payer: Preferred Network Access Commercial |
$529.15
|
| Rate for Payer: Quartz Beloit One Network |
$245.08
|
| Rate for Payer: Quartz Commercial |
$317.49
|
| Rate for Payer: The Alliance Commercial |
$278.50
|
| Rate for Payer: United Healthcare Medicaid |
$65.63
|
| Rate for Payer: WEA Trust Commercial |
$306.35
|
| Rate for Payer: WPS Commercial |
$412.57
|
|
|
Nasal Endoscopy, DX 3123150
|
Professional
|
Both
|
$1,108.00
|
|
|
Service Code
|
CPT 31231 50
|
| Hospital Charge Code |
3328173
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.63 |
| Max. Negotiated Rate |
$1,052.60 |
| Rate for Payer: Aetna Commercial |
$1,052.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$952.88
|
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cash Price |
$332.40
|
| Rate for Payer: Cigna Commercial |
$1,052.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$664.80
|
| Rate for Payer: Health EOS Commercial |
$1,008.28
|
| Rate for Payer: HFN Commercial |
$1,052.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$211.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$211.73
|
| Rate for Payer: Multiplan Commercial |
$886.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,052.60
|
| Rate for Payer: Quartz Beloit One Network |
$487.52
|
| Rate for Payer: Quartz Commercial |
$631.56
|
| Rate for Payer: The Alliance Commercial |
$554.00
|
| Rate for Payer: United Healthcare Medicaid |
$65.63
|
| Rate for Payer: WEA Trust Commercial |
$609.40
|
| Rate for Payer: WPS Commercial |
$820.70
|
|
|
NASAL EXAM, ENDOSCOPIC UNDER ANESTHESIA
|
Facility
|
OP
|
$5,511.00
|
|
| Hospital Charge Code |
2960006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,543.08 |
| Max. Negotiated Rate |
$22,044.00 |
| Rate for Payer: Aetna Commercial |
$4,959.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,739.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,543.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,582.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,755.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,645.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,920.83
|
| Rate for Payer: Cash Price |
$1,653.30
|
| Rate for Payer: Cigna Commercial |
$5,070.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,083.96
|
| Rate for Payer: Health EOS Commercial |
$4,904.79
|
| Rate for Payer: HFN Commercial |
$5,070.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,133.25
|
| Rate for Payer: Multiplan Commercial |
$4,408.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,070.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,700.39
|
| Rate for Payer: Quartz Commercial |
$3,582.15
|
| Rate for Payer: Quartz Medicare Advantage |
$3,306.60
|
| Rate for Payer: The Alliance Commercial |
$22,044.00
|
| Rate for Payer: WEA Trust Commercial |
$3,031.05
|
| Rate for Payer: WPS Commercial |
$4,082.00
|
|
|
NASAL EXAM, ENDOSCOPIC UNDER ANESTHESIA
|
Facility
|
IP
|
$5,511.00
|
|
| Hospital Charge Code |
2960006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,700.39 |
| Max. Negotiated Rate |
$5,070.12 |
| Rate for Payer: Aetna Commercial |
$4,959.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,739.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,920.83
|
| Rate for Payer: Cash Price |
$1,653.30
|
| Rate for Payer: Cigna Commercial |
$5,070.12
|
| Rate for Payer: Health EOS Commercial |
$4,904.79
|
| Rate for Payer: HFN Commercial |
$5,070.12
|
| Rate for Payer: Multiplan Commercial |
$4,408.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,070.12
|
| Rate for Payer: Quartz Beloit One Network |
$2,700.39
|
| Rate for Payer: Quartz Commercial |
$3,306.60
|
| Rate for Payer: WEA Trust Commercial |
$3,031.05
|
| Rate for Payer: WPS Commercial |
$4,082.00
|
|
|
Nasal Hemorrahage 31238
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
1152804
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$187.00 |
| Max. Negotiated Rate |
$549.76 |
| Rate for Payer: Aetna Commercial |
$403.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$365.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cash Price |
$127.50
|
| Rate for Payer: Cigna Commercial |
$403.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$295.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.00
|
| Rate for Payer: Health EOS Commercial |
$386.75
|
| Rate for Payer: HFN Commercial |
$403.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$549.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$549.76
|
| Rate for Payer: Multiplan Commercial |
$340.00
|
| Rate for Payer: Preferred Network Access Commercial |
$403.75
|
| Rate for Payer: Quartz Beloit One Network |
$187.00
|
| Rate for Payer: Quartz Commercial |
$242.25
|
| Rate for Payer: The Alliance Commercial |
$212.50
|
| Rate for Payer: United Healthcare Medicaid |
$295.34
|
| Rate for Payer: WEA Trust Commercial |
$233.75
|
| Rate for Payer: WPS Commercial |
$314.80
|
|
|
NASAL IMPLANT LATERA ABSORBABLE SYSTEM 2 PACK LATSYS20
|
Facility
|
OP
|
$8,950.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
5799683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,506.00 |
| Max. Negotiated Rate |
$35,800.00 |
| Rate for Payer: Aetna Commercial |
$8,055.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,697.00
|
| Rate for Payer: Aetna Managed Medicare |
$2,506.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,817.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,475.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,296.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,743.50
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,234.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,008.42
|
| Rate for Payer: Health EOS Commercial |
$7,965.50
|
| Rate for Payer: HFN Commercial |
$8,234.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,712.50
|
| Rate for Payer: Multiplan Commercial |
$7,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,370.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,234.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,385.50
|
| Rate for Payer: Quartz Commercial |
$5,817.50
|
| Rate for Payer: Quartz Medicare Advantage |
$5,370.00
|
| Rate for Payer: The Alliance Commercial |
$35,800.00
|
| Rate for Payer: WEA Trust Commercial |
$4,922.50
|
| Rate for Payer: WPS Commercial |
$6,629.26
|
|
|
NASAL IMPLANT LATERA ABSORBABLE SYSTEM 2 PACK LATSYS20
|
Facility
|
IP
|
$8,950.00
|
|
|
Service Code
|
HCPCS C1889
|
| Hospital Charge Code |
5799683
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,385.50 |
| Max. Negotiated Rate |
$8,234.00 |
| Rate for Payer: Aetna Commercial |
$8,055.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,697.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,743.50
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,234.00
|
| Rate for Payer: Health EOS Commercial |
$7,965.50
|
| Rate for Payer: HFN Commercial |
$8,234.00
|
| Rate for Payer: Multiplan Commercial |
$7,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$5,370.00
|
| Rate for Payer: Preferred Network Access Commercial |
$8,234.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,385.50
|
| Rate for Payer: Quartz Commercial |
$5,370.00
|
| Rate for Payer: WEA Trust Commercial |
$4,922.50
|
| Rate for Payer: WPS Commercial |
$6,629.26
|
|
|
NASAL IMPLANT LATERA ABSORBABLE SYSTEM LATSYS/LATDD24/LATAN124
|
Facility
|
OP
|
$9,088.00
|
|
|
Service Code
|
HCPCS C9749
|
| Hospital Charge Code |
5264751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,544.64 |
| Max. Negotiated Rate |
$36,352.00 |
| Rate for Payer: Aetna Commercial |
$8,179.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,815.68
|
| Rate for Payer: Aetna Managed Medicare |
$2,544.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,907.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,544.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,362.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,816.64
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cigna Commercial |
$8,360.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,085.64
|
| Rate for Payer: Health EOS Commercial |
$8,088.32
|
| Rate for Payer: HFN Commercial |
$8,360.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,816.00
|
| Rate for Payer: Multiplan Commercial |
$7,270.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,452.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,360.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,453.12
|
| Rate for Payer: Quartz Commercial |
$5,907.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,452.80
|
| Rate for Payer: The Alliance Commercial |
$36,352.00
|
| Rate for Payer: WEA Trust Commercial |
$4,998.40
|
| Rate for Payer: WPS Commercial |
$6,731.48
|
|
|
NASAL IMPLANT LATERA ABSORBABLE SYSTEM LATSYS/LATDD24/LATAN124
|
Facility
|
IP
|
$9,088.00
|
|
|
Service Code
|
HCPCS C9749
|
| Hospital Charge Code |
5264751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,453.12 |
| Max. Negotiated Rate |
$8,360.96 |
| Rate for Payer: Aetna Commercial |
$8,179.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,815.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,816.64
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cigna Commercial |
$8,360.96
|
| Rate for Payer: Health EOS Commercial |
$8,088.32
|
| Rate for Payer: HFN Commercial |
$8,360.96
|
| Rate for Payer: Multiplan Commercial |
$7,270.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,452.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,360.96
|
| Rate for Payer: Quartz Beloit One Network |
$4,453.12
|
| Rate for Payer: Quartz Commercial |
$5,452.80
|
| Rate for Payer: WEA Trust Commercial |
$4,998.40
|
| Rate for Payer: WPS Commercial |
$6,731.48
|
|
|
Nasal Oxisensor Transducer R15
|
Facility
|
IP
|
$521.00
|
|
| Hospital Charge Code |
3101751
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$255.29 |
| Max. Negotiated Rate |
$479.32 |
| Rate for Payer: Aetna Commercial |
$468.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.13
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$479.32
|
| Rate for Payer: Health EOS Commercial |
$463.69
|
| Rate for Payer: HFN Commercial |
$479.32
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: NAPHCARE Commercial |
$312.60
|
| Rate for Payer: Preferred Network Access Commercial |
$479.32
|
| Rate for Payer: Quartz Beloit One Network |
$255.29
|
| Rate for Payer: Quartz Commercial |
$312.60
|
| Rate for Payer: WEA Trust Commercial |
$286.55
|
| Rate for Payer: WPS Commercial |
$385.90
|
|
|
Nasal Oxisensor Transducer R15
|
Facility
|
OP
|
$521.00
|
|
| Hospital Charge Code |
3101751
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$145.88 |
| Max. Negotiated Rate |
$2,084.00 |
| Rate for Payer: Aetna Commercial |
$468.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.06
|
| Rate for Payer: Aetna Managed Medicare |
$145.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$338.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.13
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$479.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$291.55
|
| Rate for Payer: Health EOS Commercial |
$463.69
|
| Rate for Payer: HFN Commercial |
$479.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$390.75
|
| Rate for Payer: Multiplan Commercial |
$416.80
|
| Rate for Payer: NAPHCARE Commercial |
$312.60
|
| Rate for Payer: Preferred Network Access Commercial |
$479.32
|
| Rate for Payer: Quartz Beloit One Network |
$255.29
|
| Rate for Payer: Quartz Commercial |
$338.65
|
| Rate for Payer: Quartz Medicare Advantage |
$312.60
|
| Rate for Payer: The Alliance Commercial |
$2,084.00
|
| Rate for Payer: WEA Trust Commercial |
$286.55
|
| Rate for Payer: WPS Commercial |
$385.90
|
|
|
Nasal packing - Epistaxis Treatment
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
3025912
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$126.26 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$733.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.90
|
| Rate for Payer: Aetna Managed Medicare |
$126.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$407.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$391.20
|
| Rate for Payer: Anthem Medicare Advantage |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$126.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$126.26
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$749.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$126.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$126.26
|
| Rate for Payer: Health EOS Commercial |
$725.35
|
| Rate for Payer: HFN Commercial |
$749.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$126.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$126.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$126.26
|
| Rate for Payer: Multiplan Commercial |
$652.00
|
| Rate for Payer: NAPHCARE Commercial |
$189.39
|
| Rate for Payer: Preferred Network Access Commercial |
$749.80
|
| Rate for Payer: Quartz Beloit One Network |
$399.35
|
| Rate for Payer: Quartz Commercial |
$529.75
|
| Rate for Payer: Quartz Medicare Advantage |
$126.26
|
| Rate for Payer: The Alliance Commercial |
$505.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$126.26
|
| Rate for Payer: WEA Trust Commercial |
$448.25
|
| Rate for Payer: Wellcare Medicare |
$126.26
|
| Rate for Payer: WPS Commercial |
$603.67
|
|
|
Nasal packing - Epistaxis Treatment
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
3025912
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$399.35 |
| Max. Negotiated Rate |
$749.80 |
| Rate for Payer: Aetna Commercial |
$733.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$700.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$431.95
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$749.80
|
| Rate for Payer: Health EOS Commercial |
$725.35
|
| Rate for Payer: HFN Commercial |
$749.80
|
| Rate for Payer: Multiplan Commercial |
$652.00
|
| Rate for Payer: NAPHCARE Commercial |
$489.00
|
| Rate for Payer: Preferred Network Access Commercial |
$749.80
|
| Rate for Payer: Quartz Beloit One Network |
$399.35
|
| Rate for Payer: Quartz Commercial |
$489.00
|
| Rate for Payer: WEA Trust Commercial |
$448.25
|
| Rate for Payer: WPS Commercial |
$603.67
|
|
|
NASAL PACKING NOVAPAK CS3600-2
|
Facility
|
IP
|
$333.00
|
|
| Hospital Charge Code |
6049646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.17 |
| Max. Negotiated Rate |
$306.36 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$199.80
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
NASAL PACKING NOVAPAK CS3600-2
|
Facility
|
OP
|
$333.00
|
|
| Hospital Charge Code |
6049646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$93.24 |
| Max. Negotiated Rate |
$1,332.00 |
| Rate for Payer: Aetna Commercial |
$299.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$286.38
|
| Rate for Payer: Aetna Managed Medicare |
$93.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$216.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$166.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$159.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$176.49
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$306.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.35
|
| Rate for Payer: Health EOS Commercial |
$296.37
|
| Rate for Payer: HFN Commercial |
$306.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$249.75
|
| Rate for Payer: Multiplan Commercial |
$266.40
|
| Rate for Payer: NAPHCARE Commercial |
$199.80
|
| Rate for Payer: Preferred Network Access Commercial |
$306.36
|
| Rate for Payer: Quartz Beloit One Network |
$163.17
|
| Rate for Payer: Quartz Commercial |
$216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$199.80
|
| Rate for Payer: The Alliance Commercial |
$1,332.00
|
| Rate for Payer: WEA Trust Commercial |
$183.15
|
| Rate for Payer: WPS Commercial |
$246.65
|
|
|
NASAL PACKING NOVASHIELD CG 1000
|
Facility
|
IP
|
$1,529.00
|
|
| Hospital Charge Code |
4493730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$749.21 |
| Max. Negotiated Rate |
$1,406.68 |
| Rate for Payer: Aetna Commercial |
$1,376.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,314.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$810.37
|
| Rate for Payer: Cash Price |
$458.70
|
| Rate for Payer: Cigna Commercial |
$1,406.68
|
| Rate for Payer: Health EOS Commercial |
$1,360.81
|
| Rate for Payer: HFN Commercial |
$1,406.68
|
| Rate for Payer: Multiplan Commercial |
$1,223.20
|
| Rate for Payer: NAPHCARE Commercial |
$917.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,406.68
|
| Rate for Payer: Quartz Beloit One Network |
$749.21
|
| Rate for Payer: Quartz Commercial |
$917.40
|
| Rate for Payer: WEA Trust Commercial |
$840.95
|
| Rate for Payer: WPS Commercial |
$1,132.53
|
|
|
NASAL PACKING NOVASHIELD CG 1000
|
Facility
|
OP
|
$1,529.00
|
|
| Hospital Charge Code |
4493730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$428.12 |
| Max. Negotiated Rate |
$6,116.00 |
| Rate for Payer: Aetna Commercial |
$1,376.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,314.94
|
| Rate for Payer: Aetna Managed Medicare |
$428.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$993.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$764.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$733.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$810.37
|
| Rate for Payer: Cash Price |
$458.70
|
| Rate for Payer: Cigna Commercial |
$1,406.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$855.63
|
| Rate for Payer: Health EOS Commercial |
$1,360.81
|
| Rate for Payer: HFN Commercial |
$1,406.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,146.75
|
| Rate for Payer: Multiplan Commercial |
$1,223.20
|
| Rate for Payer: NAPHCARE Commercial |
$917.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,406.68
|
| Rate for Payer: Quartz Beloit One Network |
$749.21
|
| Rate for Payer: Quartz Commercial |
$993.85
|
| Rate for Payer: Quartz Medicare Advantage |
$917.40
|
| Rate for Payer: The Alliance Commercial |
$6,116.00
|
| Rate for Payer: WEA Trust Commercial |
$840.95
|
| Rate for Payer: WPS Commercial |
$1,132.53
|
|
|
NASAL PILLOW MIRAGE SWIFT LRG
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
2970384
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Managed Medicare |
$14.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.98
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$30.00
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$32.50
|
| Rate for Payer: Quartz Medicare Advantage |
$30.00
|
| Rate for Payer: The Alliance Commercial |
$200.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
NASAL PILLOW MIRAGE SWIFT LRG
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
2970384
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$30.00
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
NASAL PILLOW MIRAGE SWIFT MED
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
2970383
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.99 |
| Max. Negotiated Rate |
$46.92 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$30.60
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
NASAL PILLOW MIRAGE SWIFT MED
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
2970383
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.28 |
| Max. Negotiated Rate |
$204.00 |
| Rate for Payer: Aetna Commercial |
$45.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.86
|
| Rate for Payer: Aetna Managed Medicare |
$14.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.03
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$46.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28.54
|
| Rate for Payer: Health EOS Commercial |
$45.39
|
| Rate for Payer: HFN Commercial |
$46.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.25
|
| Rate for Payer: Multiplan Commercial |
$40.80
|
| Rate for Payer: NAPHCARE Commercial |
$30.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46.92
|
| Rate for Payer: Quartz Beloit One Network |
$24.99
|
| Rate for Payer: Quartz Commercial |
$33.15
|
| Rate for Payer: Quartz Medicare Advantage |
$30.60
|
| Rate for Payer: The Alliance Commercial |
$204.00
|
| Rate for Payer: WEA Trust Commercial |
$28.05
|
| Rate for Payer: WPS Commercial |
$37.78
|
|
|
NASAL PILLOW MIRAGE SWIFT SMAL
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
2970382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.00 |
| Max. Negotiated Rate |
$200.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Aetna Managed Medicare |
$14.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.98
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.50
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$30.00
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$32.50
|
| Rate for Payer: Quartz Medicare Advantage |
$30.00
|
| Rate for Payer: The Alliance Commercial |
$200.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
|
NASAL PILLOW MIRAGE SWIFT SMAL
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
2970382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.50 |
| Max. Negotiated Rate |
$46.00 |
| Rate for Payer: Aetna Commercial |
$45.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.50
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$46.00
|
| Rate for Payer: Health EOS Commercial |
$44.50
|
| Rate for Payer: HFN Commercial |
$46.00
|
| Rate for Payer: Multiplan Commercial |
$40.00
|
| Rate for Payer: NAPHCARE Commercial |
$30.00
|
| Rate for Payer: Preferred Network Access Commercial |
$46.00
|
| Rate for Payer: Quartz Beloit One Network |
$24.50
|
| Rate for Payer: Quartz Commercial |
$30.00
|
| Rate for Payer: WEA Trust Commercial |
$27.50
|
| Rate for Payer: WPS Commercial |
$37.04
|
|
