|
Naropin (Ropivicaine) 0.5% 20mL vial [Med]
|
Facility
|
IP
|
$111.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
5591330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$56.57 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$69.26
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$85.50
|
|
|
Naropin (Ropivicaine) 0.5% 20mL vial [Med]
|
Facility
|
OP
|
$111.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
5591330
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$106.20 |
| Rate for Payer: Aetna Commercial |
$103.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$99.28
|
| Rate for Payer: Aetna Managed Medicare |
$32.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$57.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$55.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$61.18
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cash Price |
$33.30
|
| Rate for Payer: Cigna Commercial |
$106.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.09
|
| Rate for Payer: Health EOS Commercial |
$102.74
|
| Rate for Payer: HFN Commercial |
$106.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$86.58
|
| Rate for Payer: Multiplan Commercial |
$92.35
|
| Rate for Payer: NAPHCARE Commercial |
$69.26
|
| Rate for Payer: Preferred Network Access Commercial |
$106.20
|
| Rate for Payer: Quartz Beloit One Network |
$56.57
|
| Rate for Payer: Quartz Commercial |
$75.04
|
| Rate for Payer: Quartz Medicare Advantage |
$69.26
|
| Rate for Payer: The Alliance Commercial |
$0.21
|
| Rate for Payer: WEA Trust Commercial |
$63.49
|
| Rate for Payer: WPS Commercial |
$0.18
|
|
|
Naropin (Ropivicaine) 1% 20mL vial [Med]
|
Facility
|
IP
|
$87.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
2974966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$44.34 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$54.29
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$67.02
|
|
|
Naropin (Ropivicaine) 1% 20mL vial [Med]
|
Facility
|
OP
|
$87.00
|
|
|
Service Code
|
HCPCS J2795
|
| Hospital Charge Code |
2974966
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.09 |
| Max. Negotiated Rate |
$83.24 |
| Rate for Payer: Aetna Commercial |
$81.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$77.81
|
| Rate for Payer: Aetna Managed Medicare |
$25.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$45.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$43.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.95
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cash Price |
$26.10
|
| Rate for Payer: Cigna Commercial |
$83.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.09
|
| Rate for Payer: Health EOS Commercial |
$80.53
|
| Rate for Payer: HFN Commercial |
$83.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.86
|
| Rate for Payer: Multiplan Commercial |
$72.38
|
| Rate for Payer: NAPHCARE Commercial |
$54.29
|
| Rate for Payer: Preferred Network Access Commercial |
$83.24
|
| Rate for Payer: Quartz Beloit One Network |
$44.34
|
| Rate for Payer: Quartz Commercial |
$58.81
|
| Rate for Payer: Quartz Medicare Advantage |
$54.29
|
| Rate for Payer: The Alliance Commercial |
$0.21
|
| Rate for Payer: WEA Trust Commercial |
$49.76
|
| Rate for Payer: WPS Commercial |
$0.18
|
|
|
Nasal Cannula
|
Facility
|
IP
|
$48.00
|
|
| Hospital Charge Code |
3101746
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$24.46 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$29.95
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Nasal Cannula
|
Facility
|
OP
|
$48.00
|
|
| Hospital Charge Code |
3101746
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$13.98 |
| Max. Negotiated Rate |
$45.93 |
| Rate for Payer: Aetna Commercial |
$44.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42.93
|
| Rate for Payer: Aetna Managed Medicare |
$13.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26.46
|
| Rate for Payer: Cash Price |
$14.40
|
| Rate for Payer: Cigna Commercial |
$45.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$44.43
|
| Rate for Payer: HFN Commercial |
$45.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.44
|
| Rate for Payer: Multiplan Commercial |
$39.94
|
| Rate for Payer: NAPHCARE Commercial |
$29.95
|
| Rate for Payer: Preferred Network Access Commercial |
$45.93
|
| Rate for Payer: Quartz Beloit One Network |
$24.46
|
| Rate for Payer: Quartz Commercial |
$32.45
|
| Rate for Payer: Quartz Medicare Advantage |
$29.95
|
| Rate for Payer: The Alliance Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$27.46
|
| Rate for Payer: WPS Commercial |
$36.97
|
|
|
Nasal Cannula - Adult
|
Facility
|
IP
|
$1.00
|
|
| Hospital Charge Code |
3040335
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Nasal Cannula - Adult
|
Facility
|
OP
|
$1.00
|
|
| Hospital Charge Code |
3040335
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$0.29 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Aetna Managed Medicare |
$0.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$0.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$0.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$0.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.58
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$0.78
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: NAPHCARE Commercial |
$0.62
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.68
|
| Rate for Payer: Quartz Medicare Advantage |
$0.62
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
Nasal Cannula Holder
|
Facility
|
OP
|
$29.00
|
|
| Hospital Charge Code |
4628703
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$8.44 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Aetna Managed Medicare |
$8.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.88
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.62
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: NAPHCARE Commercial |
$18.10
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$19.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18.10
|
| Rate for Payer: The Alliance Commercial |
$15.08
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
Nasal Cannula Holder
|
Facility
|
IP
|
$29.00
|
|
| Hospital Charge Code |
4628703
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.78 |
| Max. Negotiated Rate |
$27.75 |
| Rate for Payer: Aetna Commercial |
$27.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15.98
|
| Rate for Payer: Cash Price |
$8.70
|
| Rate for Payer: Cigna Commercial |
$27.75
|
| Rate for Payer: Health EOS Commercial |
$26.84
|
| Rate for Payer: HFN Commercial |
$27.75
|
| Rate for Payer: Multiplan Commercial |
$24.13
|
| Rate for Payer: Preferred Network Access Commercial |
$27.75
|
| Rate for Payer: Quartz Beloit One Network |
$14.78
|
| Rate for Payer: Quartz Commercial |
$18.10
|
| Rate for Payer: WEA Trust Commercial |
$16.59
|
| Rate for Payer: WPS Commercial |
$22.34
|
|
|
NASAL DRESSING 7.5CM INFLATABLE UNILATERAL RR750
|
Facility
|
OP
|
$674.00
|
|
| Hospital Charge Code |
2969616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$196.27 |
| Max. Negotiated Rate |
$644.88 |
| Rate for Payer: Aetna Commercial |
$630.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.83
|
| Rate for Payer: Aetna Managed Medicare |
$196.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$455.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$350.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$336.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.51
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$644.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$392.27
|
| Rate for Payer: Health EOS Commercial |
$623.85
|
| Rate for Payer: HFN Commercial |
$644.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.72
|
| Rate for Payer: Multiplan Commercial |
$560.77
|
| Rate for Payer: NAPHCARE Commercial |
$420.58
|
| Rate for Payer: Preferred Network Access Commercial |
$644.88
|
| Rate for Payer: Quartz Beloit One Network |
$343.47
|
| Rate for Payer: Quartz Commercial |
$455.62
|
| Rate for Payer: Quartz Medicare Advantage |
$420.58
|
| Rate for Payer: The Alliance Commercial |
$350.48
|
| Rate for Payer: WEA Trust Commercial |
$385.53
|
| Rate for Payer: WPS Commercial |
$519.18
|
|
|
NASAL DRESSING 7.5CM INFLATABLE UNILATERAL RR750
|
Facility
|
IP
|
$674.00
|
|
| Hospital Charge Code |
2969616
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$343.47 |
| Max. Negotiated Rate |
$644.88 |
| Rate for Payer: Aetna Commercial |
$630.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$602.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$371.51
|
| Rate for Payer: Cash Price |
$202.20
|
| Rate for Payer: Cigna Commercial |
$644.88
|
| Rate for Payer: Health EOS Commercial |
$623.85
|
| Rate for Payer: HFN Commercial |
$644.88
|
| Rate for Payer: Multiplan Commercial |
$560.77
|
| Rate for Payer: Preferred Network Access Commercial |
$644.88
|
| Rate for Payer: Quartz Beloit One Network |
$343.47
|
| Rate for Payer: Quartz Commercial |
$420.58
|
| Rate for Payer: WEA Trust Commercial |
$385.53
|
| Rate for Payer: WPS Commercial |
$519.18
|
|
|
NASAL DRESSING HEMOPORE 5400-020-208
|
Facility
|
OP
|
$2,412.00
|
|
| Hospital Charge Code |
5106736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$702.37 |
| Max. Negotiated Rate |
$2,307.80 |
| Rate for Payer: Aetna Commercial |
$2,257.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Aetna Managed Medicare |
$702.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,630.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,254.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,204.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,329.49
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,307.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,403.78
|
| Rate for Payer: Health EOS Commercial |
$2,232.55
|
| Rate for Payer: HFN Commercial |
$2,307.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,881.36
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,505.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,307.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.16
|
| Rate for Payer: Quartz Commercial |
$1,630.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,505.09
|
| Rate for Payer: The Alliance Commercial |
$1,254.24
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: WPS Commercial |
$1,857.96
|
|
|
NASAL DRESSING HEMOPORE 5400-020-208
|
Facility
|
IP
|
$2,412.00
|
|
| Hospital Charge Code |
5106736
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,229.16 |
| Max. Negotiated Rate |
$2,307.80 |
| Rate for Payer: Aetna Commercial |
$2,257.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,329.49
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,307.80
|
| Rate for Payer: Health EOS Commercial |
$2,232.55
|
| Rate for Payer: HFN Commercial |
$2,307.80
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,307.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.16
|
| Rate for Payer: Quartz Commercial |
$1,505.09
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: WPS Commercial |
$1,857.96
|
|
|
NASAL DRESSING MEROCEL 8CM STD 440402
|
Facility
|
IP
|
$369.00
|
|
| Hospital Charge Code |
2965337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$188.04 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$230.26
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
NASAL DRESSING MEROCEL 8CM STD 440402
|
Facility
|
OP
|
$369.00
|
|
| Hospital Charge Code |
2965337
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$107.45 |
| Max. Negotiated Rate |
$353.06 |
| Rate for Payer: Aetna Commercial |
$345.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$330.03
|
| Rate for Payer: Aetna Managed Medicare |
$107.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$249.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$191.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$184.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$203.39
|
| Rate for Payer: Cash Price |
$110.70
|
| Rate for Payer: Cigna Commercial |
$353.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$214.76
|
| Rate for Payer: Health EOS Commercial |
$341.55
|
| Rate for Payer: HFN Commercial |
$353.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$287.82
|
| Rate for Payer: Multiplan Commercial |
$307.01
|
| Rate for Payer: NAPHCARE Commercial |
$230.26
|
| Rate for Payer: Preferred Network Access Commercial |
$353.06
|
| Rate for Payer: Quartz Beloit One Network |
$188.04
|
| Rate for Payer: Quartz Commercial |
$249.44
|
| Rate for Payer: Quartz Medicare Advantage |
$230.26
|
| Rate for Payer: The Alliance Commercial |
$191.88
|
| Rate for Payer: WEA Trust Commercial |
$211.07
|
| Rate for Payer: WPS Commercial |
$284.24
|
|
|
NASAL DRESSING & SINUS STENT MEROGEL INJECTABLE 15-18000
|
Facility
|
OP
|
$1,908.00
|
|
| Hospital Charge Code |
5240626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$555.61 |
| Max. Negotiated Rate |
$1,825.57 |
| Rate for Payer: Aetna Commercial |
$1,785.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,706.52
|
| Rate for Payer: Aetna Managed Medicare |
$555.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,289.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$992.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$952.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,051.69
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna Commercial |
$1,825.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,110.46
|
| Rate for Payer: Health EOS Commercial |
$1,766.04
|
| Rate for Payer: HFN Commercial |
$1,825.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,488.24
|
| Rate for Payer: Multiplan Commercial |
$1,587.46
|
| Rate for Payer: NAPHCARE Commercial |
$1,190.59
|
| Rate for Payer: Preferred Network Access Commercial |
$1,825.57
|
| Rate for Payer: Quartz Beloit One Network |
$972.32
|
| Rate for Payer: Quartz Commercial |
$1,289.81
|
| Rate for Payer: Quartz Medicare Advantage |
$1,190.59
|
| Rate for Payer: The Alliance Commercial |
$992.16
|
| Rate for Payer: WEA Trust Commercial |
$1,091.38
|
| Rate for Payer: WPS Commercial |
$1,469.73
|
|
|
NASAL DRESSING & SINUS STENT MEROGEL INJECTABLE 15-18000
|
Facility
|
IP
|
$1,908.00
|
|
| Hospital Charge Code |
5240626
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$972.32 |
| Max. Negotiated Rate |
$1,825.57 |
| Rate for Payer: Aetna Commercial |
$1,785.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,706.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,051.69
|
| Rate for Payer: Cash Price |
$572.40
|
| Rate for Payer: Cigna Commercial |
$1,825.57
|
| Rate for Payer: Health EOS Commercial |
$1,766.04
|
| Rate for Payer: HFN Commercial |
$1,825.57
|
| Rate for Payer: Multiplan Commercial |
$1,587.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,825.57
|
| Rate for Payer: Quartz Beloit One Network |
$972.32
|
| Rate for Payer: Quartz Commercial |
$1,190.59
|
| Rate for Payer: WEA Trust Commercial |
$1,091.38
|
| Rate for Payer: WPS Commercial |
$1,469.73
|
|
|
Nasal Endoscopy, diagnostic
|
Professional
|
Both
|
$557.00
|
|
|
Service Code
|
CPT 31231
|
| Hospital Charge Code |
1152812
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$52.52 |
| Max. Negotiated Rate |
$550.32 |
| Rate for Payer: Aetna Commercial |
$550.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$498.18
|
| Rate for Payer: Aetna Managed Medicare |
$52.52
|
| Rate for Payer: Anthem Medicare Advantage |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$52.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$52.52
|
| 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 |
$550.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.52
|
| Rate for Payer: Health EOS Commercial |
$527.14
|
| Rate for Payer: HFN Commercial |
$550.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$52.52
|
| Rate for Payer: Multiplan Commercial |
$463.42
|
| Rate for Payer: NAPHCARE Commercial |
$78.78
|
| Rate for Payer: Preferred Network Access Commercial |
$550.32
|
| Rate for Payer: Quartz Beloit One Network |
$254.88
|
| Rate for Payer: Quartz Commercial |
$330.19
|
| Rate for Payer: Quartz Medicare Advantage |
$52.52
|
| Rate for Payer: The Alliance Commercial |
$223.21
|
| Rate for Payer: United Healthcare Medicaid |
$68.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$52.52
|
| Rate for Payer: WEA Trust Commercial |
$318.60
|
| Rate for Payer: WPS Commercial |
$236.34
|
|
|
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 |
$68.26 |
| Max. Negotiated Rate |
$1,094.70 |
| Rate for Payer: Aetna Commercial |
$1,094.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.00
|
| 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 |
$1,094.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$68.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$691.39
|
| Rate for Payer: Health EOS Commercial |
$1,048.61
|
| Rate for Payer: HFN Commercial |
$1,094.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.20
|
| Rate for Payer: Multiplan Commercial |
$921.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,094.70
|
| Rate for Payer: Quartz Beloit One Network |
$507.02
|
| Rate for Payer: Quartz Commercial |
$656.82
|
| Rate for Payer: The Alliance Commercial |
$576.16
|
| Rate for Payer: United Healthcare Medicaid |
$68.26
|
| Rate for Payer: WEA Trust Commercial |
$633.78
|
| Rate for Payer: WPS Commercial |
$853.49
|
|
|
NASAL EXAM, ENDOSCOPIC UNDER ANESTHESIA
|
Facility
|
IP
|
$5,511.00
|
|
| Hospital Charge Code |
2960006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,808.41 |
| Max. Negotiated Rate |
$5,272.92 |
| Rate for Payer: Aetna Commercial |
$5,158.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,929.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,037.66
|
| Rate for Payer: Cash Price |
$1,653.30
|
| Rate for Payer: Cigna Commercial |
$5,272.92
|
| Rate for Payer: Health EOS Commercial |
$5,100.98
|
| Rate for Payer: HFN Commercial |
$5,272.92
|
| Rate for Payer: Multiplan Commercial |
$4,585.15
|
| Rate for Payer: Preferred Network Access Commercial |
$5,272.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,808.41
|
| Rate for Payer: Quartz Commercial |
$3,438.86
|
| Rate for Payer: WEA Trust Commercial |
$3,152.29
|
| Rate for Payer: WPS Commercial |
$4,245.12
|
|
|
NASAL EXAM, ENDOSCOPIC UNDER ANESTHESIA
|
Facility
|
OP
|
$5,511.00
|
|
| Hospital Charge Code |
2960006
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,604.80 |
| Max. Negotiated Rate |
$5,272.92 |
| Rate for Payer: Aetna Commercial |
$5,158.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,929.04
|
| Rate for Payer: Aetna Managed Medicare |
$1,604.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,725.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,865.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,751.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,037.66
|
| Rate for Payer: Cash Price |
$1,653.30
|
| Rate for Payer: Cigna Commercial |
$5,272.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,207.40
|
| Rate for Payer: Health EOS Commercial |
$5,100.98
|
| Rate for Payer: HFN Commercial |
$5,272.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,298.58
|
| Rate for Payer: Multiplan Commercial |
$4,585.15
|
| Rate for Payer: NAPHCARE Commercial |
$3,438.86
|
| Rate for Payer: Preferred Network Access Commercial |
$5,272.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,808.41
|
| Rate for Payer: Quartz Commercial |
$3,725.44
|
| Rate for Payer: Quartz Medicare Advantage |
$3,438.86
|
| Rate for Payer: The Alliance Commercial |
$2,865.72
|
| Rate for Payer: WEA Trust Commercial |
$3,152.29
|
| Rate for Payer: WPS Commercial |
$4,245.12
|
|
|
Nasal Hemorrahage 31238
|
Professional
|
Both
|
$425.00
|
|
|
Service Code
|
CPT 31238
|
| Hospital Charge Code |
1152804
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$138.85 |
| Max. Negotiated Rate |
$624.83 |
| Rate for Payer: Aetna Commercial |
$419.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$380.12
|
| Rate for Payer: Aetna Managed Medicare |
$138.85
|
| Rate for Payer: Anthem Medicare Advantage |
$138.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$138.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$138.85
|
| 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 |
$419.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$307.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.85
|
| Rate for Payer: Health EOS Commercial |
$402.22
|
| Rate for Payer: HFN Commercial |
$419.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$571.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$571.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$138.85
|
| Rate for Payer: Multiplan Commercial |
$353.60
|
| Rate for Payer: NAPHCARE Commercial |
$208.28
|
| Rate for Payer: Preferred Network Access Commercial |
$419.90
|
| Rate for Payer: Quartz Beloit One Network |
$194.48
|
| Rate for Payer: Quartz Commercial |
$251.94
|
| Rate for Payer: Quartz Medicare Advantage |
$138.85
|
| Rate for Payer: The Alliance Commercial |
$590.11
|
| Rate for Payer: United Healthcare Medicaid |
$307.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$138.85
|
| Rate for Payer: WEA Trust Commercial |
$243.10
|
| Rate for Payer: WPS Commercial |
$624.83
|
|
|
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 |
$2,606.24 |
| Max. Negotiated Rate |
$8,563.36 |
| Rate for Payer: Aetna Commercial |
$8,377.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,004.88
|
| Rate for Payer: Aetna Managed Medicare |
$2,606.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,050.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,654.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,467.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,933.24
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,563.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,208.90
|
| Rate for Payer: Health EOS Commercial |
$8,284.12
|
| Rate for Payer: HFN Commercial |
$8,563.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,981.00
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: NAPHCARE Commercial |
$5,584.80
|
| Rate for Payer: Preferred Network Access Commercial |
$8,563.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,560.92
|
| Rate for Payer: Quartz Commercial |
$6,050.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,584.80
|
| Rate for Payer: The Alliance Commercial |
$4,654.00
|
| Rate for Payer: WEA Trust Commercial |
$5,119.40
|
| Rate for Payer: WPS Commercial |
$6,894.19
|
|
|
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 |
$4,560.92 |
| Max. Negotiated Rate |
$8,563.36 |
| Rate for Payer: Aetna Commercial |
$8,377.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,004.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,933.24
|
| Rate for Payer: Cash Price |
$2,685.00
|
| Rate for Payer: Cigna Commercial |
$8,563.36
|
| Rate for Payer: Health EOS Commercial |
$8,284.12
|
| Rate for Payer: HFN Commercial |
$8,563.36
|
| Rate for Payer: Multiplan Commercial |
$7,446.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,563.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,560.92
|
| Rate for Payer: Quartz Commercial |
$5,584.80
|
| Rate for Payer: WEA Trust Commercial |
$5,119.40
|
| Rate for Payer: WPS Commercial |
$6,894.19
|
|
