|
NASAL IMPLANT LATERA ABSORBABLE SYSTEM LATSYS/LATDD24/LATAN124
|
Facility
|
OP
|
$9,088.00
|
|
|
Service Code
|
HCPCS C9749
|
| Hospital Charge Code |
5264751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,646.43 |
| Max. Negotiated Rate |
$8,695.40 |
| Rate for Payer: Aetna Commercial |
$8,506.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,128.31
|
| Rate for Payer: Aetna Managed Medicare |
$2,646.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,143.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,725.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,536.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,009.31
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cigna Commercial |
$8,695.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,289.22
|
| Rate for Payer: Health EOS Commercial |
$8,411.85
|
| Rate for Payer: HFN Commercial |
$8,695.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,088.64
|
| Rate for Payer: Multiplan Commercial |
$7,561.22
|
| Rate for Payer: NAPHCARE Commercial |
$5,670.91
|
| Rate for Payer: Preferred Network Access Commercial |
$8,695.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,631.24
|
| Rate for Payer: Quartz Commercial |
$6,143.49
|
| Rate for Payer: Quartz Medicare Advantage |
$5,670.91
|
| Rate for Payer: The Alliance Commercial |
$4,725.76
|
| Rate for Payer: WEA Trust Commercial |
$5,198.34
|
| Rate for Payer: WPS Commercial |
$7,000.49
|
|
|
NASAL IMPLANT LATERA ABSORBABLE SYSTEM LATSYS/LATDD24/LATAN124
|
Facility
|
IP
|
$9,088.00
|
|
|
Service Code
|
HCPCS C9749
|
| Hospital Charge Code |
5264751
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,631.24 |
| Max. Negotiated Rate |
$8,695.40 |
| Rate for Payer: Aetna Commercial |
$8,506.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,128.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,009.31
|
| Rate for Payer: Cash Price |
$2,726.40
|
| Rate for Payer: Cigna Commercial |
$8,695.40
|
| Rate for Payer: Health EOS Commercial |
$8,411.85
|
| Rate for Payer: HFN Commercial |
$8,695.40
|
| Rate for Payer: Multiplan Commercial |
$7,561.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,695.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,631.24
|
| Rate for Payer: Quartz Commercial |
$5,670.91
|
| Rate for Payer: WEA Trust Commercial |
$5,198.34
|
| Rate for Payer: WPS Commercial |
$7,000.49
|
|
|
Nasal Oxisensor Transducer R15
|
Facility
|
IP
|
$521.00
|
|
| Hospital Charge Code |
3101751
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$265.50 |
| Max. Negotiated Rate |
$498.49 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.18
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$498.49
|
| Rate for Payer: Health EOS Commercial |
$482.24
|
| Rate for Payer: HFN Commercial |
$498.49
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: Preferred Network Access Commercial |
$498.49
|
| Rate for Payer: Quartz Beloit One Network |
$265.50
|
| Rate for Payer: Quartz Commercial |
$325.10
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$401.33
|
|
|
Nasal Oxisensor Transducer R15
|
Facility
|
OP
|
$521.00
|
|
| Hospital Charge Code |
3101751
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$151.72 |
| Max. Negotiated Rate |
$498.49 |
| Rate for Payer: Aetna Commercial |
$487.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$465.98
|
| Rate for Payer: Aetna Managed Medicare |
$151.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$352.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$270.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$260.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$287.18
|
| Rate for Payer: Cash Price |
$156.30
|
| Rate for Payer: Cigna Commercial |
$498.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$303.22
|
| Rate for Payer: Health EOS Commercial |
$482.24
|
| Rate for Payer: HFN Commercial |
$498.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$406.38
|
| Rate for Payer: Multiplan Commercial |
$433.47
|
| Rate for Payer: NAPHCARE Commercial |
$325.10
|
| Rate for Payer: Preferred Network Access Commercial |
$498.49
|
| Rate for Payer: Quartz Beloit One Network |
$265.50
|
| Rate for Payer: Quartz Commercial |
$352.20
|
| Rate for Payer: Quartz Medicare Advantage |
$325.10
|
| Rate for Payer: The Alliance Commercial |
$270.92
|
| Rate for Payer: WEA Trust Commercial |
$298.01
|
| Rate for Payer: WPS Commercial |
$401.33
|
|
|
Nasal packing - Epistaxis Treatment
|
Facility
|
OP
|
$815.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
3025912
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$140.02 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$762.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.94
|
| Rate for Payer: Aetna Managed Medicare |
$140.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$550.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$423.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$406.85
|
| Rate for Payer: Anthem Medicare Advantage |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$140.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$140.02
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$779.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$140.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$140.02
|
| Rate for Payer: Health EOS Commercial |
$754.36
|
| Rate for Payer: HFN Commercial |
$779.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$520.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$140.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$140.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$140.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$140.02
|
| Rate for Payer: Multiplan Commercial |
$678.08
|
| Rate for Payer: NAPHCARE Commercial |
$210.02
|
| Rate for Payer: Preferred Network Access Commercial |
$779.79
|
| Rate for Payer: Quartz Beloit One Network |
$415.32
|
| Rate for Payer: Quartz Commercial |
$550.94
|
| Rate for Payer: Quartz Medicare Advantage |
$140.02
|
| Rate for Payer: The Alliance Commercial |
$560.06
|
| Rate for Payer: United Healthcare Medicare Advantage |
$140.02
|
| Rate for Payer: WEA Trust Commercial |
$466.18
|
| Rate for Payer: Wellcare Medicare |
$140.02
|
| Rate for Payer: WPS Commercial |
$627.79
|
|
|
Nasal packing - Epistaxis Treatment
|
Facility
|
IP
|
$815.00
|
|
|
Service Code
|
CPT 30901
|
| Hospital Charge Code |
3025912
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$415.32 |
| Max. Negotiated Rate |
$779.79 |
| Rate for Payer: Aetna Commercial |
$762.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$728.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$449.23
|
| Rate for Payer: Cash Price |
$244.50
|
| Rate for Payer: Cigna Commercial |
$779.79
|
| Rate for Payer: Health EOS Commercial |
$754.36
|
| Rate for Payer: HFN Commercial |
$779.79
|
| Rate for Payer: Multiplan Commercial |
$678.08
|
| Rate for Payer: Preferred Network Access Commercial |
$779.79
|
| Rate for Payer: Quartz Beloit One Network |
$415.32
|
| Rate for Payer: Quartz Commercial |
$508.56
|
| Rate for Payer: WEA Trust Commercial |
$466.18
|
| Rate for Payer: WPS Commercial |
$627.79
|
|
|
NASAL PACKING NOVAPAK CS3600-2
|
Facility
|
OP
|
$333.00
|
|
| Hospital Charge Code |
6049646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$96.97 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Aetna Managed Medicare |
$96.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$225.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$173.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$166.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.81
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.74
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: NAPHCARE Commercial |
$207.79
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$225.11
|
| Rate for Payer: Quartz Medicare Advantage |
$207.79
|
| Rate for Payer: The Alliance Commercial |
$173.16
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
NASAL PACKING NOVAPAK CS3600-2
|
Facility
|
IP
|
$333.00
|
|
| Hospital Charge Code |
6049646
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$169.70 |
| Max. Negotiated Rate |
$318.61 |
| Rate for Payer: Aetna Commercial |
$311.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$297.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$183.55
|
| Rate for Payer: Cash Price |
$99.90
|
| Rate for Payer: Cigna Commercial |
$318.61
|
| Rate for Payer: Health EOS Commercial |
$308.22
|
| Rate for Payer: HFN Commercial |
$318.61
|
| Rate for Payer: Multiplan Commercial |
$277.06
|
| Rate for Payer: Preferred Network Access Commercial |
$318.61
|
| Rate for Payer: Quartz Beloit One Network |
$169.70
|
| Rate for Payer: Quartz Commercial |
$207.79
|
| Rate for Payer: WEA Trust Commercial |
$190.48
|
| Rate for Payer: WPS Commercial |
$256.51
|
|
|
NASAL PACKING NOVASHIELD CG 1000
|
Facility
|
IP
|
$1,529.00
|
|
| Hospital Charge Code |
4493730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$779.18 |
| Max. Negotiated Rate |
$1,462.95 |
| Rate for Payer: Aetna Commercial |
$1,431.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,367.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$842.78
|
| Rate for Payer: Cash Price |
$458.70
|
| Rate for Payer: Cigna Commercial |
$1,462.95
|
| Rate for Payer: Health EOS Commercial |
$1,415.24
|
| Rate for Payer: HFN Commercial |
$1,462.95
|
| Rate for Payer: Multiplan Commercial |
$1,272.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,462.95
|
| Rate for Payer: Quartz Beloit One Network |
$779.18
|
| Rate for Payer: Quartz Commercial |
$954.10
|
| Rate for Payer: WEA Trust Commercial |
$874.59
|
| Rate for Payer: WPS Commercial |
$1,177.79
|
|
|
NASAL PACKING NOVASHIELD CG 1000
|
Facility
|
OP
|
$1,529.00
|
|
| Hospital Charge Code |
4493730
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$445.24 |
| Max. Negotiated Rate |
$1,462.95 |
| Rate for Payer: Aetna Commercial |
$1,431.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,367.54
|
| Rate for Payer: Aetna Managed Medicare |
$445.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,033.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$795.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$763.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$842.78
|
| Rate for Payer: Cash Price |
$458.70
|
| Rate for Payer: Cigna Commercial |
$1,462.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$889.88
|
| Rate for Payer: Health EOS Commercial |
$1,415.24
|
| Rate for Payer: HFN Commercial |
$1,462.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,192.62
|
| Rate for Payer: Multiplan Commercial |
$1,272.13
|
| Rate for Payer: NAPHCARE Commercial |
$954.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,462.95
|
| Rate for Payer: Quartz Beloit One Network |
$779.18
|
| Rate for Payer: Quartz Commercial |
$1,033.60
|
| Rate for Payer: Quartz Medicare Advantage |
$954.10
|
| Rate for Payer: The Alliance Commercial |
$795.08
|
| Rate for Payer: WEA Trust Commercial |
$874.59
|
| Rate for Payer: WPS Commercial |
$1,177.79
|
|
|
NASAL PILLOW MIRAGE SWIFT LRG
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
2970384
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
NASAL PILLOW MIRAGE SWIFT LRG
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
2970384
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$14.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.20
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
NASAL PILLOW MIRAGE SWIFT MED
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
2970383
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Aetna Managed Medicare |
$14.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.68
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.78
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$31.82
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$34.48
|
| Rate for Payer: Quartz Medicare Advantage |
$31.82
|
| Rate for Payer: The Alliance Commercial |
$26.52
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
NASAL PILLOW MIRAGE SWIFT MED
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
2970383
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$31.82
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
NASAL PILLOW MIRAGE SWIFT SMAL
|
Facility
|
OP
|
$50.00
|
|
| Hospital Charge Code |
2970382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.56 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Aetna Managed Medicare |
$14.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.10
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.00
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: NAPHCARE Commercial |
$31.20
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$33.80
|
| Rate for Payer: Quartz Medicare Advantage |
$31.20
|
| Rate for Payer: The Alliance Commercial |
$26.00
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
NASAL PILLOW MIRAGE SWIFT SMAL
|
Facility
|
IP
|
$50.00
|
|
| Hospital Charge Code |
2970382
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.48 |
| Max. Negotiated Rate |
$47.84 |
| Rate for Payer: Aetna Commercial |
$46.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27.56
|
| Rate for Payer: Cash Price |
$15.00
|
| Rate for Payer: Cigna Commercial |
$47.84
|
| Rate for Payer: Health EOS Commercial |
$46.28
|
| Rate for Payer: HFN Commercial |
$47.84
|
| Rate for Payer: Multiplan Commercial |
$41.60
|
| Rate for Payer: Preferred Network Access Commercial |
$47.84
|
| Rate for Payer: Quartz Beloit One Network |
$25.48
|
| Rate for Payer: Quartz Commercial |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$28.60
|
| Rate for Payer: WPS Commercial |
$38.52
|
|
|
NASAL SEPTAL SPLINT DOYLE II 1524050
|
Facility
|
IP
|
$623.00
|
|
| Hospital Charge Code |
2965315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$317.48 |
| Max. Negotiated Rate |
$596.09 |
| Rate for Payer: Aetna Commercial |
$583.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$557.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.40
|
| Rate for Payer: Cash Price |
$186.90
|
| Rate for Payer: Cigna Commercial |
$596.09
|
| Rate for Payer: Health EOS Commercial |
$576.65
|
| Rate for Payer: HFN Commercial |
$596.09
|
| Rate for Payer: Multiplan Commercial |
$518.34
|
| Rate for Payer: Preferred Network Access Commercial |
$596.09
|
| Rate for Payer: Quartz Beloit One Network |
$317.48
|
| Rate for Payer: Quartz Commercial |
$388.75
|
| Rate for Payer: WEA Trust Commercial |
$356.36
|
| Rate for Payer: WPS Commercial |
$479.90
|
|
|
NASAL SEPTAL SPLINT DOYLE II 1524050
|
Facility
|
OP
|
$623.00
|
|
| Hospital Charge Code |
2965315
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$181.42 |
| Max. Negotiated Rate |
$596.09 |
| Rate for Payer: Aetna Commercial |
$583.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$557.21
|
| Rate for Payer: Aetna Managed Medicare |
$181.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$421.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$311.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$343.40
|
| Rate for Payer: Cash Price |
$186.90
|
| Rate for Payer: Cigna Commercial |
$596.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$362.59
|
| Rate for Payer: Health EOS Commercial |
$576.65
|
| Rate for Payer: HFN Commercial |
$596.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$485.94
|
| Rate for Payer: Multiplan Commercial |
$518.34
|
| Rate for Payer: NAPHCARE Commercial |
$388.75
|
| Rate for Payer: Preferred Network Access Commercial |
$596.09
|
| Rate for Payer: Quartz Beloit One Network |
$317.48
|
| Rate for Payer: Quartz Commercial |
$421.15
|
| Rate for Payer: Quartz Medicare Advantage |
$388.75
|
| Rate for Payer: The Alliance Commercial |
$323.96
|
| Rate for Payer: WEA Trust Commercial |
$356.36
|
| Rate for Payer: WPS Commercial |
$479.90
|
|
|
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 |
$182.02 |
| Max. Negotiated Rate |
$2,445.30 |
| Rate for Payer: Aetna Commercial |
$2,445.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,213.64
|
| 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 |
$2,445.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,544.40
|
| Rate for Payer: Health EOS Commercial |
$2,342.34
|
| Rate for Payer: HFN Commercial |
$2,445.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$545.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.80
|
| Rate for Payer: Multiplan Commercial |
$2,059.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,445.30
|
| Rate for Payer: Quartz Beloit One Network |
$1,132.56
|
| Rate for Payer: Quartz Commercial |
$1,467.18
|
| Rate for Payer: The Alliance Commercial |
$1,287.00
|
| Rate for Payer: United Healthcare Medicaid |
$182.02
|
| Rate for Payer: WEA Trust Commercial |
$1,415.70
|
| Rate for Payer: WPS Commercial |
$1,906.49
|
|
|
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 |
$133.12 |
| Max. Negotiated Rate |
$1,223.14 |
| Rate for Payer: Aetna Commercial |
$1,223.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,107.27
|
| Rate for Payer: Aetna Managed Medicare |
$133.12
|
| Rate for Payer: Anthem Medicare Advantage |
$133.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$133.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$133.12
|
| 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 |
$1,223.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$182.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$133.12
|
| Rate for Payer: Health EOS Commercial |
$1,171.64
|
| Rate for Payer: HFN Commercial |
$1,223.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$545.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$545.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$133.12
|
| Rate for Payer: Multiplan Commercial |
$1,030.02
|
| Rate for Payer: NAPHCARE Commercial |
$199.68
|
| Rate for Payer: Preferred Network Access Commercial |
$1,223.14
|
| Rate for Payer: Quartz Beloit One Network |
$566.51
|
| Rate for Payer: Quartz Commercial |
$733.89
|
| Rate for Payer: Quartz Medicare Advantage |
$133.12
|
| Rate for Payer: The Alliance Commercial |
$565.76
|
| Rate for Payer: United Healthcare Medicaid |
$182.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$133.12
|
| Rate for Payer: WEA Trust Commercial |
$708.14
|
| Rate for Payer: WPS Commercial |
$599.04
|
|
|
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 |
$138.85 |
| Max. Negotiated Rate |
$2,425.54 |
| Rate for Payer: Aetna Commercial |
$2,425.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,195.75
|
| 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 |
$736.50
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cigna Commercial |
$2,425.54
|
| 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 |
$2,323.41
|
| Rate for Payer: HFN Commercial |
$2,425.54
|
| 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 |
$2,042.56
|
| Rate for Payer: NAPHCARE Commercial |
$208.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,425.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.41
|
| Rate for Payer: Quartz Commercial |
$1,455.32
|
| 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 |
$1,404.26
|
| Rate for Payer: WPS Commercial |
$624.83
|
|
|
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 |
$307.15 |
| Max. Negotiated Rate |
$4,851.08 |
| Rate for Payer: Aetna Commercial |
$4,851.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,391.50
|
| 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 |
$4,851.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$307.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,063.84
|
| Rate for Payer: Health EOS Commercial |
$4,646.82
|
| Rate for Payer: HFN Commercial |
$4,851.08
|
| 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: Multiplan Commercial |
$4,085.12
|
| Rate for Payer: Preferred Network Access Commercial |
$4,851.08
|
| Rate for Payer: Quartz Beloit One Network |
$2,246.82
|
| Rate for Payer: Quartz Commercial |
$2,910.65
|
| Rate for Payer: The Alliance Commercial |
$2,553.20
|
| Rate for Payer: United Healthcare Medicaid |
$307.15
|
| Rate for Payer: WEA Trust Commercial |
$2,808.52
|
| Rate for Payer: WPS Commercial |
$3,782.17
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH BIOPSY, POLYPECTOMY OR DEBRIDEMENT (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$7,492.58
|
|
|
Service Code
|
CPT 31237
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.14 |
| Max. Negotiated Rate |
$7,492.58 |
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$7,492.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONCHA BULLOSA RESECTION
|
Facility
|
OP
|
$7,492.58
|
|
|
Service Code
|
CPT 31240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.14 |
| Max. Negotiated Rate |
$7,492.58 |
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$7,492.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL; WITH CONTROL OF NASAL HEMORRHAGE
|
Facility
|
OP
|
$7,492.58
|
|
|
Service Code
|
CPT 31238
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,873.14 |
| Max. Negotiated Rate |
$7,492.58 |
| Rate for Payer: Aetna Managed Medicare |
$1,873.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,873.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,873.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,873.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,873.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,968.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,873.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,873.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,873.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,873.14
|
| Rate for Payer: NAPHCARE Commercial |
$2,809.72
|
| Rate for Payer: Quartz Medicare Advantage |
$1,873.14
|
| Rate for Payer: The Alliance Commercial |
$7,492.58
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,873.14
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,873.14
|
|
