|
NASAL SPLINT SILICONE STERILE 20-10680S
|
Facility
|
OP
|
$186.00
|
|
| Hospital Charge Code |
5787669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$52.08 |
| Max. Negotiated Rate |
$744.00 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Aetna Managed Medicare |
$52.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$120.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.09
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.50
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$120.90
|
| Rate for Payer: Quartz Medicare Advantage |
$111.60
|
| Rate for Payer: The Alliance Commercial |
$744.00
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
NASAL SPLINT SILICONE STERILE 20-10680S
|
Facility
|
IP
|
$186.00
|
|
| Hospital Charge Code |
5787669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$91.14 |
| Max. Negotiated Rate |
$171.12 |
| Rate for Payer: Aetna Commercial |
$167.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.58
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$171.12
|
| Rate for Payer: Health EOS Commercial |
$165.54
|
| Rate for Payer: HFN Commercial |
$171.12
|
| Rate for Payer: Multiplan Commercial |
$148.80
|
| Rate for Payer: NAPHCARE Commercial |
$111.60
|
| Rate for Payer: Preferred Network Access Commercial |
$171.12
|
| Rate for Payer: Quartz Beloit One Network |
$91.14
|
| Rate for Payer: Quartz Commercial |
$111.60
|
| Rate for Payer: WEA Trust Commercial |
$102.30
|
| Rate for Payer: WPS Commercial |
$137.77
|
|
|
NASAL TAMPON 5.5cm #440412
|
Facility
|
OP
|
$513.00
|
|
| Hospital Charge Code |
2969535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.64 |
| Max. Negotiated Rate |
$2,052.00 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Aetna Managed Medicare |
$143.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$333.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$256.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$246.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.89
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$471.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$287.07
|
| Rate for Payer: Health EOS Commercial |
$456.57
|
| Rate for Payer: HFN Commercial |
$471.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$384.75
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: NAPHCARE Commercial |
$307.80
|
| Rate for Payer: Preferred Network Access Commercial |
$471.96
|
| Rate for Payer: Quartz Beloit One Network |
$251.37
|
| Rate for Payer: Quartz Commercial |
$333.45
|
| Rate for Payer: Quartz Medicare Advantage |
$307.80
|
| Rate for Payer: The Alliance Commercial |
$2,052.00
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
NASAL TAMPON 5.5cm #440412
|
Facility
|
IP
|
$513.00
|
|
| Hospital Charge Code |
2969535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$251.37 |
| Max. Negotiated Rate |
$471.96 |
| Rate for Payer: Aetna Commercial |
$461.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.89
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$471.96
|
| Rate for Payer: Health EOS Commercial |
$456.57
|
| Rate for Payer: HFN Commercial |
$471.96
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: NAPHCARE Commercial |
$307.80
|
| Rate for Payer: Preferred Network Access Commercial |
$471.96
|
| Rate for Payer: Quartz Beloit One Network |
$251.37
|
| Rate for Payer: Quartz Commercial |
$307.80
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
NASAL TAMPON,8.0cm #400411
|
Facility
|
OP
|
$511.00
|
|
| Hospital Charge Code |
2969534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$143.08 |
| Max. Negotiated Rate |
$2,044.00 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Aetna Managed Medicare |
$143.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$332.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$255.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$245.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.96
|
| Rate for Payer: Health EOS Commercial |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$383.25
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$332.15
|
| Rate for Payer: Quartz Medicare Advantage |
$306.60
|
| Rate for Payer: The Alliance Commercial |
$2,044.00
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
NASAL TAMPON,8.0cm #400411
|
Facility
|
IP
|
$511.00
|
|
| Hospital Charge Code |
2969534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.39 |
| Max. Negotiated Rate |
$470.12 |
| Rate for Payer: Aetna Commercial |
$459.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$270.83
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$470.12
|
| Rate for Payer: Health EOS Commercial |
$454.79
|
| Rate for Payer: HFN Commercial |
$470.12
|
| Rate for Payer: Multiplan Commercial |
$408.80
|
| Rate for Payer: NAPHCARE Commercial |
$306.60
|
| Rate for Payer: Preferred Network Access Commercial |
$470.12
|
| Rate for Payer: Quartz Beloit One Network |
$250.39
|
| Rate for Payer: Quartz Commercial |
$306.60
|
| Rate for Payer: WEA Trust Commercial |
$281.05
|
| Rate for Payer: WPS Commercial |
$378.50
|
|
|
NASAL TUMOR RESECTION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960347
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
NASAL TUMOR RESECTION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960347
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Nasogastric - Tube Type
|
Facility
|
IP
|
$180.00
|
|
| Hospital Charge Code |
3025913
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$88.20 |
| Max. Negotiated Rate |
$165.60 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$165.60
|
| Rate for Payer: Health EOS Commercial |
$160.20
|
| Rate for Payer: HFN Commercial |
$165.60
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: NAPHCARE Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$165.60
|
| Rate for Payer: Quartz Beloit One Network |
$88.20
|
| Rate for Payer: Quartz Commercial |
$108.00
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: WPS Commercial |
$133.33
|
|
|
Nasogastric - Tube Type
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
3025913
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$50.40 |
| Max. Negotiated Rate |
$720.00 |
| Rate for Payer: Aetna Commercial |
$162.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$154.80
|
| Rate for Payer: Aetna Managed Medicare |
$50.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$117.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$90.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$95.40
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$165.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.73
|
| Rate for Payer: Health EOS Commercial |
$160.20
|
| Rate for Payer: HFN Commercial |
$165.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.00
|
| Rate for Payer: Multiplan Commercial |
$144.00
|
| Rate for Payer: NAPHCARE Commercial |
$108.00
|
| Rate for Payer: Preferred Network Access Commercial |
$165.60
|
| Rate for Payer: Quartz Beloit One Network |
$88.20
|
| Rate for Payer: Quartz Commercial |
$117.00
|
| Rate for Payer: Quartz Medicare Advantage |
$108.00
|
| Rate for Payer: The Alliance Commercial |
$720.00
|
| Rate for Payer: WEA Trust Commercial |
$99.00
|
| Rate for Payer: WPS Commercial |
$133.33
|
|
|
Nasopharyngeal Airway
|
Facility
|
OP
|
$9.00
|
|
| Hospital Charge Code |
3040316
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.52 |
| Max. Negotiated Rate |
$36.00 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Aetna Managed Medicare |
$2.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.04
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.75
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5.40
|
| Rate for Payer: The Alliance Commercial |
$36.00
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
Nasopharyngeal Airway
|
Facility
|
IP
|
$9.00
|
|
| Hospital Charge Code |
3040316
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$4.41 |
| Max. Negotiated Rate |
$8.28 |
| Rate for Payer: Aetna Commercial |
$8.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.77
|
| Rate for Payer: Cash Price |
$2.70
|
| Rate for Payer: Cigna Commercial |
$8.28
|
| Rate for Payer: Health EOS Commercial |
$8.01
|
| Rate for Payer: HFN Commercial |
$8.28
|
| Rate for Payer: Multiplan Commercial |
$7.20
|
| Rate for Payer: NAPHCARE Commercial |
$5.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8.28
|
| Rate for Payer: Quartz Beloit One Network |
$4.41
|
| Rate for Payer: Quartz Commercial |
$5.40
|
| Rate for Payer: WEA Trust Commercial |
$4.95
|
| Rate for Payer: WPS Commercial |
$6.67
|
|
|
NASOPHARYNGEAL TUMOR RESECTION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
NASOPHARYNGEAL TUMOR RESECTION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Nasopharyngoscopy With Endoscope
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 92511
|
| Hospital Charge Code |
1152808
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$84.48 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$182.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$182.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.20
|
| Rate for Payer: Health EOS Commercial |
$174.72
|
| Rate for Payer: HFN Commercial |
$182.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.48
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$182.40
|
| Rate for Payer: Quartz Beloit One Network |
$84.48
|
| Rate for Payer: Quartz Commercial |
$109.44
|
| Rate for Payer: The Alliance Commercial |
$96.00
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Navantrone 5 mg Charge
|
Professional
|
Both
|
$1,410.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
2958926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$42.67 |
| Max. Negotiated Rate |
$1,339.50 |
| Rate for Payer: Aetna Commercial |
$1,339.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,212.60
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,339.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$42.67
|
| Rate for Payer: Health EOS Commercial |
$1,283.10
|
| Rate for Payer: HFN Commercial |
$1,339.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.04
|
| Rate for Payer: Multiplan Commercial |
$1,128.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,339.50
|
| Rate for Payer: Quartz Beloit One Network |
$620.40
|
| Rate for Payer: Quartz Commercial |
$803.70
|
| Rate for Payer: The Alliance Commercial |
$705.00
|
| Rate for Payer: United Healthcare Medicaid |
$42.67
|
| Rate for Payer: WEA Trust Commercial |
$775.50
|
| Rate for Payer: WPS Commercial |
$106.67
|
|
|
Navantrone 5 mg Charge
|
Facility
|
IP
|
$1,410.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
2958926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$690.90 |
| Max. Negotiated Rate |
$1,297.20 |
| Rate for Payer: Aetna Commercial |
$1,269.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,212.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$747.30
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,297.20
|
| Rate for Payer: Health EOS Commercial |
$1,254.90
|
| Rate for Payer: HFN Commercial |
$1,297.20
|
| Rate for Payer: Multiplan Commercial |
$1,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$846.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,297.20
|
| Rate for Payer: Quartz Beloit One Network |
$690.90
|
| Rate for Payer: Quartz Commercial |
$846.00
|
| Rate for Payer: WEA Trust Commercial |
$775.50
|
| Rate for Payer: WPS Commercial |
$1,044.39
|
|
|
Navantrone 5 mg Charge
|
Facility
|
OP
|
$1,410.00
|
|
|
Service Code
|
HCPCS J9293
|
| Hospital Charge Code |
2958926
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$43.58 |
| Max. Negotiated Rate |
$1,297.20 |
| Rate for Payer: Aetna Commercial |
$1,269.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,212.60
|
| Rate for Payer: Aetna Managed Medicare |
$43.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$916.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$705.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$676.80
|
| Rate for Payer: Anthem Medicare Advantage |
$43.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$747.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$43.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$43.58
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cash Price |
$423.00
|
| Rate for Payer: Cigna Commercial |
$1,297.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$43.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$43.58
|
| Rate for Payer: Health EOS Commercial |
$1,254.90
|
| Rate for Payer: HFN Commercial |
$1,297.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$162.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$43.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$43.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$43.58
|
| Rate for Payer: Multiplan Commercial |
$1,128.00
|
| Rate for Payer: NAPHCARE Commercial |
$65.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,297.20
|
| Rate for Payer: Quartz Beloit One Network |
$690.90
|
| Rate for Payer: Quartz Commercial |
$916.50
|
| Rate for Payer: Quartz Medicare Advantage |
$43.58
|
| Rate for Payer: The Alliance Commercial |
$174.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$43.58
|
| Rate for Payer: WEA Trust Commercial |
$775.50
|
| Rate for Payer: Wellcare Medicare |
$43.58
|
| Rate for Payer: WPS Commercial |
$106.67
|
|
|
NAVG Protection Filter
|
Facility
|
OP
|
$6,635.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
5460725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,857.80 |
| Max. Negotiated Rate |
$26,540.00 |
| Rate for Payer: Aetna Commercial |
$5,971.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,857.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,312.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,317.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,184.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,516.55
|
| Rate for Payer: Cash Price |
$1,990.50
|
| Rate for Payer: Cigna Commercial |
$6,104.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,712.95
|
| Rate for Payer: Health EOS Commercial |
$5,905.15
|
| Rate for Payer: HFN Commercial |
$6,104.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,976.25
|
| Rate for Payer: Multiplan Commercial |
$5,308.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,981.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,104.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.15
|
| Rate for Payer: Quartz Commercial |
$4,312.75
|
| Rate for Payer: Quartz Medicare Advantage |
$3,981.00
|
| Rate for Payer: The Alliance Commercial |
$26,540.00
|
| Rate for Payer: WEA Trust Commercial |
$3,649.25
|
| Rate for Payer: WPS Commercial |
$4,914.54
|
|
|
NAVG Protection Filter
|
Facility
|
IP
|
$6,635.00
|
|
|
Service Code
|
HCPCS C1884
|
| Hospital Charge Code |
5460725
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,251.15 |
| Max. Negotiated Rate |
$6,104.20 |
| Rate for Payer: Aetna Commercial |
$5,971.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,706.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,516.55
|
| Rate for Payer: Cash Price |
$1,990.50
|
| Rate for Payer: Cigna Commercial |
$6,104.20
|
| Rate for Payer: Health EOS Commercial |
$5,905.15
|
| Rate for Payer: HFN Commercial |
$6,104.20
|
| Rate for Payer: Multiplan Commercial |
$5,308.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,981.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,104.20
|
| Rate for Payer: Quartz Beloit One Network |
$3,251.15
|
| Rate for Payer: Quartz Commercial |
$3,981.00
|
| Rate for Payer: WEA Trust Commercial |
$3,649.25
|
| Rate for Payer: WPS Commercial |
$4,914.54
|
|
|
Navircross Support Catheter
|
Facility
|
IP
|
$2,640.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4534606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,293.60 |
| Max. Negotiated Rate |
$2,428.80 |
| Rate for Payer: Aetna Commercial |
$2,376.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,270.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,399.20
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$2,428.80
|
| Rate for Payer: Health EOS Commercial |
$2,349.60
|
| Rate for Payer: HFN Commercial |
$2,428.80
|
| Rate for Payer: Multiplan Commercial |
$2,112.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,584.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,428.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,293.60
|
| Rate for Payer: Quartz Commercial |
$1,584.00
|
| Rate for Payer: WEA Trust Commercial |
$1,452.00
|
| Rate for Payer: WPS Commercial |
$1,955.45
|
|
|
Navircross Support Catheter
|
Facility
|
OP
|
$2,640.00
|
|
|
Service Code
|
HCPCS C1887
|
| Hospital Charge Code |
4534606
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$739.20 |
| Max. Negotiated Rate |
$10,560.00 |
| Rate for Payer: Aetna Commercial |
$2,376.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,270.40
|
| Rate for Payer: Aetna Managed Medicare |
$739.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,716.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,320.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,267.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,399.20
|
| Rate for Payer: Cash Price |
$792.00
|
| Rate for Payer: Cigna Commercial |
$2,428.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,477.34
|
| Rate for Payer: Health EOS Commercial |
$2,349.60
|
| Rate for Payer: HFN Commercial |
$2,428.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,980.00
|
| Rate for Payer: Multiplan Commercial |
$2,112.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,584.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,428.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,293.60
|
| Rate for Payer: Quartz Commercial |
$1,716.00
|
| Rate for Payer: Quartz Medicare Advantage |
$1,584.00
|
| Rate for Payer: The Alliance Commercial |
$10,560.00
|
| Rate for Payer: WEA Trust Commercial |
$1,452.00
|
| Rate for Payer: WPS Commercial |
$1,955.45
|
|
|
N BLOCK INJ, ILIO-ING/HYPOGI 64425
|
Professional
|
Both
|
$974.00
|
|
|
Service Code
|
CPT 64425
|
| Hospital Charge Code |
3015187
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$75.33 |
| Max. Negotiated Rate |
$925.30 |
| Rate for Payer: Aetna Commercial |
$925.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$837.64
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cash Price |
$292.20
|
| Rate for Payer: Cigna Commercial |
$925.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$584.40
|
| Rate for Payer: Health EOS Commercial |
$886.34
|
| Rate for Payer: HFN Commercial |
$925.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$186.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$186.35
|
| Rate for Payer: Multiplan Commercial |
$779.20
|
| Rate for Payer: Preferred Network Access Commercial |
$925.30
|
| Rate for Payer: Quartz Beloit One Network |
$428.56
|
| Rate for Payer: Quartz Commercial |
$555.18
|
| Rate for Payer: The Alliance Commercial |
$487.00
|
| Rate for Payer: United Healthcare Medicaid |
$75.33
|
| Rate for Payer: WEA Trust Commercial |
$535.70
|
| Rate for Payer: WPS Commercial |
$721.44
|
|
|
N Block Inj Intercostal MLT/Regional Block 64421
|
Professional
|
Both
|
$1,132.00
|
|
|
Service Code
|
CPT 64421
|
| Hospital Charge Code |
5232633
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$1,075.40 |
| Rate for Payer: Aetna Commercial |
$1,075.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$973.52
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$1,075.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$679.20
|
| Rate for Payer: Health EOS Commercial |
$1,030.12
|
| Rate for Payer: HFN Commercial |
$1,075.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$84.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$84.30
|
| Rate for Payer: Multiplan Commercial |
$905.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,075.40
|
| Rate for Payer: Quartz Beloit One Network |
$498.08
|
| Rate for Payer: Quartz Commercial |
$645.24
|
| Rate for Payer: The Alliance Commercial |
$566.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$622.60
|
| Rate for Payer: WPS Commercial |
$838.47
|
|
|
N BLOCK INJ, INTERCOST, SNG 64420
|
Professional
|
Both
|
$1,285.00
|
|
|
Service Code
|
CPT 64420
|
| Hospital Charge Code |
3015186
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.18 |
| Max. Negotiated Rate |
$1,220.75 |
| Rate for Payer: Aetna Commercial |
$1,220.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,105.10
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cash Price |
$385.50
|
| Rate for Payer: Cigna Commercial |
$1,220.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$771.00
|
| Rate for Payer: Health EOS Commercial |
$1,169.35
|
| Rate for Payer: HFN Commercial |
$1,220.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$199.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$199.69
|
| Rate for Payer: Multiplan Commercial |
$1,028.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,220.75
|
| Rate for Payer: Quartz Beloit One Network |
$565.40
|
| Rate for Payer: Quartz Commercial |
$732.45
|
| Rate for Payer: The Alliance Commercial |
$642.50
|
| Rate for Payer: United Healthcare Medicaid |
$45.18
|
| Rate for Payer: WEA Trust Commercial |
$706.75
|
| Rate for Payer: WPS Commercial |
$951.80
|
|
