|
NASAL SEPTAL SPLINT DOYLE II 1524050
|
Facility
|
OP
|
$623.00
|
|
| Hospital Charge Code |
2965315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$174.44 |
| Max. Negotiated Rate |
$2,492.00 |
| Rate for Payer: Aetna Commercial |
$560.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$535.78
|
| Rate for Payer: Aetna Managed Medicare |
$174.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$404.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$311.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$299.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.19
|
| Rate for Payer: Cash Price |
$186.90
|
| Rate for Payer: Cigna Commercial |
$573.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$348.63
|
| Rate for Payer: Health EOS Commercial |
$554.47
|
| Rate for Payer: HFN Commercial |
$573.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$467.25
|
| Rate for Payer: Multiplan Commercial |
$498.40
|
| Rate for Payer: NAPHCARE Commercial |
$373.80
|
| Rate for Payer: Preferred Network Access Commercial |
$573.16
|
| Rate for Payer: Quartz Beloit One Network |
$305.27
|
| Rate for Payer: Quartz Commercial |
$404.95
|
| Rate for Payer: Quartz Medicare Advantage |
$373.80
|
| Rate for Payer: The Alliance Commercial |
$2,492.00
|
| Rate for Payer: WEA Trust Commercial |
$342.65
|
| Rate for Payer: WPS Commercial |
$461.46
|
|
|
NASAL SEPTAL SPLINT DOYLE II 1524050
|
Facility
|
IP
|
$623.00
|
|
| Hospital Charge Code |
2965315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$305.27 |
| Max. Negotiated Rate |
$573.16 |
| Rate for Payer: Aetna Commercial |
$560.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$535.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$330.19
|
| Rate for Payer: Cash Price |
$186.90
|
| Rate for Payer: Cigna Commercial |
$573.16
|
| Rate for Payer: Health EOS Commercial |
$554.47
|
| Rate for Payer: HFN Commercial |
$573.16
|
| Rate for Payer: Multiplan Commercial |
$498.40
|
| Rate for Payer: NAPHCARE Commercial |
$373.80
|
| Rate for Payer: Preferred Network Access Commercial |
$573.16
|
| Rate for Payer: Quartz Beloit One Network |
$305.27
|
| Rate for Payer: Quartz Commercial |
$373.80
|
| Rate for Payer: WEA Trust Commercial |
$342.65
|
| Rate for Payer: WPS Commercial |
$461.46
|
|
|
Nasal/Sinus Endoscopy, 3123750
|
Professional
|
Both
|
$2,475.00
|
|
|
Service Code
|
CPT 31237 50
|
| Hospital Charge Code |
3171575
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.02 |
| Max. Negotiated Rate |
$2,351.25 |
| Rate for Payer: Aetna Commercial |
$2,351.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,128.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cash Price |
$742.50
|
| Rate for Payer: Cigna Commercial |
$2,351.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,485.00
|
| Rate for Payer: Health EOS Commercial |
$2,252.25
|
| Rate for Payer: HFN Commercial |
$2,351.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$524.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$524.81
|
| Rate for Payer: Multiplan Commercial |
$1,980.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,351.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,089.00
|
| Rate for Payer: Quartz Commercial |
$1,410.75
|
| Rate for Payer: The Alliance Commercial |
$1,237.50
|
| Rate for Payer: United Healthcare Medicaid |
$175.02
|
| Rate for Payer: WEA Trust Commercial |
$1,361.25
|
| Rate for Payer: WPS Commercial |
$1,833.23
|
|
|
Nasal/Sinus Endoscopy, Surg 31237
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
3147551
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.02 |
| Max. Negotiated Rate |
$1,176.10 |
| Rate for Payer: Aetna Commercial |
$1,176.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,176.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.80
|
| Rate for Payer: Health EOS Commercial |
$1,126.58
|
| Rate for Payer: HFN Commercial |
$1,176.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$524.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$524.81
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,176.10
|
| Rate for Payer: Quartz Beloit One Network |
$544.72
|
| Rate for Payer: Quartz Commercial |
$705.66
|
| Rate for Payer: The Alliance Commercial |
$619.00
|
| Rate for Payer: United Healthcare Medicaid |
$175.02
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| Rate for Payer: WPS Commercial |
$916.99
|
|
|
NASAL/SINUS ENDOSCOPY, SURG 31238
|
Professional
|
Both
|
$2,455.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
3014372
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$295.34 |
| Max. Negotiated Rate |
$2,332.25 |
| Rate for Payer: Aetna Commercial |
$2,332.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,111.30
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cigna Commercial |
$2,332.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$295.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,473.00
|
| Rate for Payer: Health EOS Commercial |
$2,234.05
|
| Rate for Payer: HFN Commercial |
$2,332.25
|
| 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 |
$1,964.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,332.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.20
|
| Rate for Payer: Quartz Commercial |
$1,399.35
|
| Rate for Payer: The Alliance Commercial |
$1,227.50
|
| Rate for Payer: United Healthcare Medicaid |
$295.34
|
| Rate for Payer: WEA Trust Commercial |
$1,350.25
|
| Rate for Payer: WPS Commercial |
$1,818.42
|
|
|
Nasal/Sinus Endoscopy, Surg 3123850
|
Professional
|
Both
|
$4,910.00
|
|
|
Service Code
|
CPT 31238 50
|
| Hospital Charge Code |
4063467
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$295.34 |
| Max. Negotiated Rate |
$4,664.50 |
| Rate for Payer: Aetna Commercial |
$4,664.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.60
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cash Price |
$1,473.00
|
| Rate for Payer: Cigna Commercial |
$4,664.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$295.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,946.00
|
| Rate for Payer: Health EOS Commercial |
$4,468.10
|
| Rate for Payer: HFN Commercial |
$4,664.50
|
| 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 |
$3,928.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,664.50
|
| Rate for Payer: Quartz Beloit One Network |
$2,160.40
|
| Rate for Payer: Quartz Commercial |
$2,798.70
|
| Rate for Payer: The Alliance Commercial |
$2,455.00
|
| Rate for Payer: United Healthcare Medicaid |
$295.34
|
| Rate for Payer: WEA Trust Commercial |
$2,700.50
|
| Rate for Payer: WPS Commercial |
$3,636.84
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$6,710.36
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,677.59 |
| Max. Negotiated Rate |
$6,710.36 |
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$6,710.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
|
Facility
|
OP
|
$6,710.36
|
|
|
Service Code
|
CPT 31240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,677.59 |
| Max. Negotiated Rate |
$6,710.36 |
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$6,710.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE
|
Facility
|
OP
|
$6,710.36
|
|
|
Service Code
|
CPT 31238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,677.59 |
| Max. Negotiated Rate |
$6,710.36 |
| Rate for Payer: Aetna Managed Medicare |
$1,677.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,677.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,677.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,677.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,677.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,240.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,677.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,677.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,677.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,677.59
|
| Rate for Payer: NAPHCARE Commercial |
$2,516.38
|
| Rate for Payer: Quartz Medicare Advantage |
$1,677.59
|
| Rate for Payer: The Alliance Commercial |
$6,710.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,677.59
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,677.59
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR)
|
Facility
|
OP
|
$27,059.80
|
|
|
Service Code
|
CPT 31255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,154.00 |
| Max. Negotiated Rate |
$27,059.80 |
| Rate for Payer: Aetna Managed Medicare |
$6,764.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,764.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,764.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,764.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,764.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,764.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,165.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,764.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,764.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,764.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,764.95
|
| Rate for Payer: NAPHCARE Commercial |
$10,147.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6,764.95
|
| Rate for Payer: The Alliance Commercial |
$27,059.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,764.95
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: Wellcare Medicare |
$6,764.95
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY, WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$27,059.80
|
|
|
Service Code
|
CPT 31259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,154.00 |
| Max. Negotiated Rate |
$27,059.80 |
| Rate for Payer: Aetna Managed Medicare |
$6,764.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,764.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,764.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,764.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,764.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,764.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,165.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,764.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,764.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,764.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,764.95
|
| Rate for Payer: NAPHCARE Commercial |
$10,147.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6,764.95
|
| Rate for Payer: The Alliance Commercial |
$27,059.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,764.95
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: Wellcare Medicare |
$6,764.95
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH FRONTAL SINUS EXPLORATION, INCLUDING REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$27,059.80
|
|
|
Service Code
|
CPT 31276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,154.00 |
| Max. Negotiated Rate |
$27,059.80 |
| Rate for Payer: Aetna Managed Medicare |
$6,764.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,764.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,764.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,764.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,764.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,764.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,165.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,764.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,764.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,764.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,764.95
|
| Rate for Payer: NAPHCARE Commercial |
$10,147.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6,764.95
|
| Rate for Payer: The Alliance Commercial |
$27,059.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,764.95
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: Wellcare Medicare |
$6,764.95
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY SINUS
|
Facility
|
OP
|
$27,059.80
|
|
|
Service Code
|
CPT 31267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,154.00 |
| Max. Negotiated Rate |
$27,059.80 |
| Rate for Payer: Aetna Managed Medicare |
$6,764.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,764.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,764.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,764.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,764.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,764.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,165.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,764.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,764.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,764.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,764.95
|
| Rate for Payer: NAPHCARE Commercial |
$10,147.42
|
| Rate for Payer: Quartz Medicare Advantage |
$6,764.95
|
| Rate for Payer: The Alliance Commercial |
$27,059.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,764.95
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: Wellcare Medicare |
$6,764.95
|
|
|
Nasal/Sinus Endoscopy With Debridement
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
1152807
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.02 |
| Max. Negotiated Rate |
$1,176.10 |
| Rate for Payer: Aetna Commercial |
$1,176.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,064.68
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cash Price |
$371.40
|
| Rate for Payer: Cigna Commercial |
$1,176.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$742.80
|
| Rate for Payer: Health EOS Commercial |
$1,126.58
|
| Rate for Payer: HFN Commercial |
$1,176.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$524.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$524.81
|
| Rate for Payer: Multiplan Commercial |
$990.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,176.10
|
| Rate for Payer: Quartz Beloit One Network |
$544.72
|
| Rate for Payer: Quartz Commercial |
$705.66
|
| Rate for Payer: The Alliance Commercial |
$619.00
|
| Rate for Payer: United Healthcare Medicaid |
$175.02
|
| Rate for Payer: WEA Trust Commercial |
$680.90
|
| Rate for Payer: WPS Commercial |
$916.99
|
|
|
NASAL/SINUS NDSC SURG W/DILATION FRNT&SPHN SINUS 31298
|
Professional
|
Both
|
$7,723.00
|
|
|
Service Code
|
CPT 31298
|
| Hospital Charge Code |
6149817
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$841.80 |
| Max. Negotiated Rate |
$7,336.85 |
| Rate for Payer: Aetna Commercial |
$7,336.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,641.78
|
| Rate for Payer: Cash Price |
$2,316.90
|
| Rate for Payer: Cash Price |
$2,316.90
|
| Rate for Payer: Cash Price |
$2,316.90
|
| Rate for Payer: Cigna Commercial |
$7,336.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,019.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,633.80
|
| Rate for Payer: Health EOS Commercial |
$7,027.93
|
| Rate for Payer: HFN Commercial |
$7,336.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$841.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$6,178.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,336.85
|
| Rate for Payer: Quartz Beloit One Network |
$3,398.12
|
| Rate for Payer: Quartz Commercial |
$4,402.11
|
| Rate for Payer: The Alliance Commercial |
$3,861.50
|
| Rate for Payer: United Healthcare Medicaid |
$3,019.46
|
| Rate for Payer: WEA Trust Commercial |
$4,247.65
|
| Rate for Payer: WPS Commercial |
$5,720.43
|
|
|
NASAL SPLINT AQUAPLAST
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
5264938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.24 |
| Max. Negotiated Rate |
$132.00 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.38
|
| Rate for Payer: Aetna Managed Medicare |
$9.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.49
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$30.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.47
|
| Rate for Payer: Health EOS Commercial |
$29.37
|
| Rate for Payer: HFN Commercial |
$30.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.75
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.80
|
| Rate for Payer: Preferred Network Access Commercial |
$30.36
|
| Rate for Payer: Quartz Beloit One Network |
$16.17
|
| Rate for Payer: Quartz Commercial |
$21.45
|
| Rate for Payer: Quartz Medicare Advantage |
$19.80
|
| Rate for Payer: The Alliance Commercial |
$132.00
|
| Rate for Payer: WEA Trust Commercial |
$18.15
|
| Rate for Payer: WPS Commercial |
$24.44
|
|
|
NASAL SPLINT AQUAPLAST
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
5264938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.17 |
| Max. Negotiated Rate |
$30.36 |
| Rate for Payer: Aetna Commercial |
$29.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.49
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$30.36
|
| Rate for Payer: Health EOS Commercial |
$29.37
|
| Rate for Payer: HFN Commercial |
$30.36
|
| Rate for Payer: Multiplan Commercial |
$26.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.80
|
| Rate for Payer: Preferred Network Access Commercial |
$30.36
|
| Rate for Payer: Quartz Beloit One Network |
$16.17
|
| Rate for Payer: Quartz Commercial |
$19.80
|
| Rate for Payer: WEA Trust Commercial |
$18.15
|
| Rate for Payer: WPS Commercial |
$24.44
|
|
|
NASAL SPLINT AQUAPLAST EXTERNAL PERFORATED 3 X 3 IN (7.6 X 7.6 CM) IVORY SGYAQF0521
|
Facility
|
IP
|
$201.00
|
|
| Hospital Charge Code |
5937637
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$98.49 |
| Max. Negotiated Rate |
$184.92 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$120.60
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$120.60
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
NASAL SPLINT AQUAPLAST EXTERNAL PERFORATED 3 X 3 IN (7.6 X 7.6 CM) IVORY SGYAQF0521
|
Facility
|
OP
|
$201.00
|
|
| Hospital Charge Code |
5937637
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$56.28 |
| Max. Negotiated Rate |
$804.00 |
| Rate for Payer: Aetna Commercial |
$180.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Aetna Managed Medicare |
$56.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$96.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$106.53
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$184.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$112.48
|
| Rate for Payer: Health EOS Commercial |
$178.89
|
| Rate for Payer: HFN Commercial |
$184.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$150.75
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: NAPHCARE Commercial |
$120.60
|
| Rate for Payer: Preferred Network Access Commercial |
$184.92
|
| Rate for Payer: Quartz Beloit One Network |
$98.49
|
| Rate for Payer: Quartz Commercial |
$130.65
|
| Rate for Payer: Quartz Medicare Advantage |
$120.60
|
| Rate for Payer: The Alliance Commercial |
$804.00
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
NASAL SPLINT DENVER SM/MED 150010NKS
|
Facility
|
IP
|
$430.00
|
|
| Hospital Charge Code |
2965530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$210.70 |
| Max. Negotiated Rate |
$395.60 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$258.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
NASAL SPLINT DENVER SM/MED 150010NKS
|
Facility
|
OP
|
$430.00
|
|
| Hospital Charge Code |
2965530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.40 |
| Max. Negotiated Rate |
$1,720.00 |
| Rate for Payer: Aetna Commercial |
$387.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$369.80
|
| Rate for Payer: Aetna Managed Medicare |
$120.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$279.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$215.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$206.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$227.90
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$395.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.63
|
| Rate for Payer: Health EOS Commercial |
$382.70
|
| Rate for Payer: HFN Commercial |
$395.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$322.50
|
| Rate for Payer: Multiplan Commercial |
$344.00
|
| Rate for Payer: NAPHCARE Commercial |
$258.00
|
| Rate for Payer: Preferred Network Access Commercial |
$395.60
|
| Rate for Payer: Quartz Beloit One Network |
$210.70
|
| Rate for Payer: Quartz Commercial |
$279.50
|
| Rate for Payer: Quartz Medicare Advantage |
$258.00
|
| Rate for Payer: The Alliance Commercial |
$1,720.00
|
| Rate for Payer: WEA Trust Commercial |
$236.50
|
| Rate for Payer: WPS Commercial |
$318.50
|
|
|
NASAL SPLINT MEROCEL SILICONE 400561
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
3157464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$502.25 |
| Max. Negotiated Rate |
$943.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$615.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
NASAL SPLINT MEROCEL SILICONE 400561
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
3157464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$287.00 |
| Max. Negotiated Rate |
$4,100.00 |
| Rate for Payer: Aetna Commercial |
$922.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$881.50
|
| Rate for Payer: Aetna Managed Medicare |
$287.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$666.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$512.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$492.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$543.25
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$943.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$573.59
|
| Rate for Payer: Health EOS Commercial |
$912.25
|
| Rate for Payer: HFN Commercial |
$943.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$768.75
|
| Rate for Payer: Multiplan Commercial |
$820.00
|
| Rate for Payer: NAPHCARE Commercial |
$615.00
|
| Rate for Payer: Preferred Network Access Commercial |
$943.00
|
| Rate for Payer: Quartz Beloit One Network |
$502.25
|
| Rate for Payer: Quartz Commercial |
$666.25
|
| Rate for Payer: Quartz Medicare Advantage |
$615.00
|
| Rate for Payer: The Alliance Commercial |
$4,100.00
|
| Rate for Payer: WEA Trust Commercial |
$563.75
|
| Rate for Payer: WPS Commercial |
$759.22
|
|
|
NASAL SPLINT REUTER LARGE PAIR 1527010
|
Facility
|
OP
|
$553.00
|
|
| Hospital Charge Code |
5415537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$154.84 |
| Max. Negotiated Rate |
$2,212.00 |
| Rate for Payer: Aetna Commercial |
$497.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.58
|
| Rate for Payer: Aetna Managed Medicare |
$154.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$359.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$276.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$265.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.09
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$508.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$309.46
|
| Rate for Payer: Health EOS Commercial |
$492.17
|
| Rate for Payer: HFN Commercial |
$508.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$414.75
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: NAPHCARE Commercial |
$331.80
|
| Rate for Payer: Preferred Network Access Commercial |
$508.76
|
| Rate for Payer: Quartz Beloit One Network |
$270.97
|
| Rate for Payer: Quartz Commercial |
$359.45
|
| Rate for Payer: Quartz Medicare Advantage |
$331.80
|
| Rate for Payer: The Alliance Commercial |
$2,212.00
|
| Rate for Payer: WEA Trust Commercial |
$304.15
|
| Rate for Payer: WPS Commercial |
$409.61
|
|
|
NASAL SPLINT REUTER LARGE PAIR 1527010
|
Facility
|
IP
|
$553.00
|
|
| Hospital Charge Code |
5415537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$270.97 |
| Max. Negotiated Rate |
$508.76 |
| Rate for Payer: Aetna Commercial |
$497.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$475.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$293.09
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$508.76
|
| Rate for Payer: Health EOS Commercial |
$492.17
|
| Rate for Payer: HFN Commercial |
$508.76
|
| Rate for Payer: Multiplan Commercial |
$442.40
|
| Rate for Payer: NAPHCARE Commercial |
$331.80
|
| Rate for Payer: Preferred Network Access Commercial |
$508.76
|
| Rate for Payer: Quartz Beloit One Network |
$270.97
|
| Rate for Payer: Quartz Commercial |
$331.80
|
| Rate for Payer: WEA Trust Commercial |
$304.15
|
| Rate for Payer: WPS Commercial |
$409.61
|
|
