|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR)
|
Facility
|
OP
|
$29,708.76
|
|
|
Service Code
|
CPT 31255
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,400.16 |
| Max. Negotiated Rate |
$29,708.76 |
| Rate for Payer: Aetna Managed Medicare |
$7,427.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$7,427.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,427.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,427.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,427.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,427.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,629.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,427.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,427.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,427.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,427.19
|
| Rate for Payer: NAPHCARE Commercial |
$11,140.79
|
| Rate for Payer: Quartz Medicare Advantage |
$7,427.19
|
| Rate for Payer: The Alliance Commercial |
$29,708.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,427.19
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: Wellcare Medicare |
$7,427.19
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL WITH ETHMOIDECTOMY; TOTAL (ANTERIOR AND POSTERIOR), INCLUDING SPHENOIDOTOMY, WITH REMOVAL OF TISSUE FROM THE SPHENOID SINUS
|
Facility
|
OP
|
$29,708.76
|
|
|
Service Code
|
CPT 31259
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,400.16 |
| Max. Negotiated Rate |
$29,708.76 |
| Rate for Payer: Aetna Managed Medicare |
$7,427.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$7,427.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,427.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,427.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,427.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,427.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,629.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,427.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,427.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,427.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,427.19
|
| Rate for Payer: NAPHCARE Commercial |
$11,140.79
|
| Rate for Payer: Quartz Medicare Advantage |
$7,427.19
|
| Rate for Payer: The Alliance Commercial |
$29,708.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,427.19
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: Wellcare Medicare |
$7,427.19
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH FRONTAL SINUS EXPLORATION, INCLUDING REMOVAL OF TISSUE FROM FRONTAL SINUS, WHEN PERFORMED
|
Facility
|
OP
|
$29,708.76
|
|
|
Service Code
|
CPT 31276
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,400.16 |
| Max. Negotiated Rate |
$29,708.76 |
| Rate for Payer: Aetna Managed Medicare |
$7,427.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$7,427.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,427.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,427.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,427.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,427.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,629.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,427.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,427.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,427.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,427.19
|
| Rate for Payer: NAPHCARE Commercial |
$11,140.79
|
| Rate for Payer: Quartz Medicare Advantage |
$7,427.19
|
| Rate for Payer: The Alliance Commercial |
$29,708.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,427.19
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: Wellcare Medicare |
$7,427.19
|
|
|
NASAL/SINUS ENDOSCOPY, SURGICAL, WITH MAXILLARY ANTROSTOMY; WITH REMOVAL OF TISSUE FROM MAXILLARY SINUS
|
Facility
|
OP
|
$29,708.76
|
|
|
Service Code
|
CPT 31267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,400.16 |
| Max. Negotiated Rate |
$29,708.76 |
| Rate for Payer: Aetna Managed Medicare |
$7,427.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$7,427.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,427.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,427.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,427.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,427.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,629.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,427.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,427.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,427.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,427.19
|
| Rate for Payer: NAPHCARE Commercial |
$11,140.79
|
| Rate for Payer: Quartz Medicare Advantage |
$7,427.19
|
| Rate for Payer: The Alliance Commercial |
$29,708.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,427.19
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: Wellcare Medicare |
$7,427.19
|
|
|
Nasal/Sinus Endoscopy With Debridement
|
Professional
|
Both
|
$1,238.00
|
|
|
Service Code
|
CPT 31237
|
| Hospital Charge Code |
1152807
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$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 NDSC SURG W/DILATION FRNT&SPHN SINUS 31298
|
Professional
|
Both
|
$7,723.00
|
|
|
Service Code
|
CPT 31298
|
| Hospital Charge Code |
6149817
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$207.39 |
| Max. Negotiated Rate |
$7,630.32 |
| Rate for Payer: Aetna Commercial |
$7,630.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,907.45
|
| Rate for Payer: Aetna Managed Medicare |
$207.39
|
| Rate for Payer: Anthem Medicare Advantage |
$207.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$207.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$207.39
|
| Rate for Payer: Cash Price |
$2,316.90
|
| Rate for Payer: Cash Price |
$2,316.90
|
| Rate for Payer: Cash Price |
$2,316.90
|
| Rate for Payer: Cigna Commercial |
$7,630.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,140.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.39
|
| Rate for Payer: Health EOS Commercial |
$7,309.05
|
| Rate for Payer: HFN Commercial |
$7,630.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$875.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$875.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$207.39
|
| Rate for Payer: Multiplan Commercial |
$6,425.54
|
| Rate for Payer: NAPHCARE Commercial |
$311.08
|
| Rate for Payer: Preferred Network Access Commercial |
$7,630.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,534.04
|
| Rate for Payer: Quartz Commercial |
$4,578.19
|
| Rate for Payer: Quartz Medicare Advantage |
$207.39
|
| Rate for Payer: The Alliance Commercial |
$881.39
|
| Rate for Payer: United Healthcare Medicaid |
$3,140.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$207.39
|
| Rate for Payer: WEA Trust Commercial |
$4,417.56
|
| Rate for Payer: WPS Commercial |
$933.24
|
|
|
NASAL SPLINT AQUAPLAST
|
Facility
|
IP
|
$33.00
|
|
| Hospital Charge Code |
5264938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$16.82 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.19
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.57
|
| Rate for Payer: Health EOS Commercial |
$30.54
|
| Rate for Payer: HFN Commercial |
$31.57
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: Preferred Network Access Commercial |
$31.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.82
|
| Rate for Payer: Quartz Commercial |
$20.59
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$25.42
|
|
|
NASAL SPLINT AQUAPLAST
|
Facility
|
OP
|
$33.00
|
|
| Hospital Charge Code |
5264938
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9.61 |
| Max. Negotiated Rate |
$31.57 |
| Rate for Payer: Aetna Commercial |
$30.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29.52
|
| Rate for Payer: Aetna Managed Medicare |
$9.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18.19
|
| Rate for Payer: Cash Price |
$9.90
|
| Rate for Payer: Cigna Commercial |
$31.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.21
|
| Rate for Payer: Health EOS Commercial |
$30.54
|
| Rate for Payer: HFN Commercial |
$31.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25.74
|
| Rate for Payer: Multiplan Commercial |
$27.46
|
| Rate for Payer: NAPHCARE Commercial |
$20.59
|
| Rate for Payer: Preferred Network Access Commercial |
$31.57
|
| Rate for Payer: Quartz Beloit One Network |
$16.82
|
| Rate for Payer: Quartz Commercial |
$22.31
|
| Rate for Payer: Quartz Medicare Advantage |
$20.59
|
| Rate for Payer: The Alliance Commercial |
$17.16
|
| Rate for Payer: WEA Trust Commercial |
$18.88
|
| Rate for Payer: WPS Commercial |
$25.42
|
|
|
NASAL SPLINT AQUAPLAST EXTERNAL PERFORATED 3 X 3 IN (7.6 X 7.6 CM) IVORY SGYAQF0521
|
Facility
|
OP
|
$201.00
|
|
| Hospital Charge Code |
5937637
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$58.53 |
| Max. Negotiated Rate |
$192.32 |
| Rate for Payer: Aetna Commercial |
$188.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Aetna Managed Medicare |
$58.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$104.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$100.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.79
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$192.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.98
|
| Rate for Payer: Health EOS Commercial |
$186.05
|
| Rate for Payer: HFN Commercial |
$192.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$156.78
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: NAPHCARE Commercial |
$125.42
|
| Rate for Payer: Preferred Network Access Commercial |
$192.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.43
|
| Rate for Payer: Quartz Commercial |
$135.88
|
| Rate for Payer: Quartz Medicare Advantage |
$125.42
|
| Rate for Payer: The Alliance Commercial |
$104.52
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: WPS Commercial |
$154.83
|
|
|
NASAL SPLINT AQUAPLAST EXTERNAL PERFORATED 3 X 3 IN (7.6 X 7.6 CM) IVORY SGYAQF0521
|
Facility
|
IP
|
$201.00
|
|
| Hospital Charge Code |
5937637
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$102.43 |
| Max. Negotiated Rate |
$192.32 |
| Rate for Payer: Aetna Commercial |
$188.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$110.79
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$192.32
|
| Rate for Payer: Health EOS Commercial |
$186.05
|
| Rate for Payer: HFN Commercial |
$192.32
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: Preferred Network Access Commercial |
$192.32
|
| Rate for Payer: Quartz Beloit One Network |
$102.43
|
| Rate for Payer: Quartz Commercial |
$125.42
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: WPS Commercial |
$154.83
|
|
|
NASAL SPLINT DENVER SM/MED 150010NKS
|
Facility
|
IP
|
$430.00
|
|
| Hospital Charge Code |
2965530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$219.13 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$268.32
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
NASAL SPLINT DENVER SM/MED 150010NKS
|
Facility
|
OP
|
$430.00
|
|
| Hospital Charge Code |
2965530
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.22 |
| Max. Negotiated Rate |
$411.42 |
| Rate for Payer: Aetna Commercial |
$402.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.59
|
| Rate for Payer: Aetna Managed Medicare |
$125.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.02
|
| Rate for Payer: Cash Price |
$129.00
|
| Rate for Payer: Cigna Commercial |
$411.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.26
|
| Rate for Payer: Health EOS Commercial |
$398.01
|
| Rate for Payer: HFN Commercial |
$411.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.40
|
| Rate for Payer: Multiplan Commercial |
$357.76
|
| Rate for Payer: NAPHCARE Commercial |
$268.32
|
| Rate for Payer: Preferred Network Access Commercial |
$411.42
|
| Rate for Payer: Quartz Beloit One Network |
$219.13
|
| Rate for Payer: Quartz Commercial |
$290.68
|
| Rate for Payer: Quartz Medicare Advantage |
$268.32
|
| Rate for Payer: The Alliance Commercial |
$223.60
|
| Rate for Payer: WEA Trust Commercial |
$245.96
|
| Rate for Payer: WPS Commercial |
$331.23
|
|
|
NASAL SPLINT MEROCEL SILICONE 400561
|
Facility
|
IP
|
$1,025.00
|
|
| Hospital Charge Code |
3157464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$522.34 |
| Max. Negotiated Rate |
$980.72 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$639.60
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.56
|
|
|
NASAL SPLINT MEROCEL SILICONE 400561
|
Facility
|
OP
|
$1,025.00
|
|
| Hospital Charge Code |
3157464
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$298.48 |
| Max. Negotiated Rate |
$980.72 |
| Rate for Payer: Aetna Commercial |
$959.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$916.76
|
| Rate for Payer: Aetna Managed Medicare |
$298.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$692.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$533.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$511.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$564.98
|
| Rate for Payer: Cash Price |
$307.50
|
| Rate for Payer: Cigna Commercial |
$980.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$596.55
|
| Rate for Payer: Health EOS Commercial |
$948.74
|
| Rate for Payer: HFN Commercial |
$980.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$799.50
|
| Rate for Payer: Multiplan Commercial |
$852.80
|
| Rate for Payer: NAPHCARE Commercial |
$639.60
|
| Rate for Payer: Preferred Network Access Commercial |
$980.72
|
| Rate for Payer: Quartz Beloit One Network |
$522.34
|
| Rate for Payer: Quartz Commercial |
$692.90
|
| Rate for Payer: Quartz Medicare Advantage |
$639.60
|
| Rate for Payer: The Alliance Commercial |
$533.00
|
| Rate for Payer: WEA Trust Commercial |
$586.30
|
| Rate for Payer: WPS Commercial |
$789.56
|
|
|
NASAL SPLINT REUTER LARGE PAIR 1527010
|
Facility
|
IP
|
$553.00
|
|
| Hospital Charge Code |
5415537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.81 |
| Max. Negotiated Rate |
$529.11 |
| Rate for Payer: Aetna Commercial |
$517.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.81
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$529.11
|
| Rate for Payer: Health EOS Commercial |
$511.86
|
| Rate for Payer: HFN Commercial |
$529.11
|
| Rate for Payer: Multiplan Commercial |
$460.10
|
| Rate for Payer: Preferred Network Access Commercial |
$529.11
|
| Rate for Payer: Quartz Beloit One Network |
$281.81
|
| Rate for Payer: Quartz Commercial |
$345.07
|
| Rate for Payer: WEA Trust Commercial |
$316.32
|
| Rate for Payer: WPS Commercial |
$425.98
|
|
|
NASAL SPLINT REUTER LARGE PAIR 1527010
|
Facility
|
OP
|
$553.00
|
|
| Hospital Charge Code |
5415537
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$161.03 |
| Max. Negotiated Rate |
$529.11 |
| Rate for Payer: Aetna Commercial |
$517.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$494.60
|
| Rate for Payer: Aetna Managed Medicare |
$161.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$373.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$287.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$276.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$304.81
|
| Rate for Payer: Cash Price |
$165.90
|
| Rate for Payer: Cigna Commercial |
$529.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.85
|
| Rate for Payer: Health EOS Commercial |
$511.86
|
| Rate for Payer: HFN Commercial |
$529.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$431.34
|
| Rate for Payer: Multiplan Commercial |
$460.10
|
| Rate for Payer: NAPHCARE Commercial |
$345.07
|
| Rate for Payer: Preferred Network Access Commercial |
$529.11
|
| Rate for Payer: Quartz Beloit One Network |
$281.81
|
| Rate for Payer: Quartz Commercial |
$373.83
|
| Rate for Payer: Quartz Medicare Advantage |
$345.07
|
| Rate for Payer: The Alliance Commercial |
$287.56
|
| Rate for Payer: WEA Trust Commercial |
$316.32
|
| Rate for Payer: WPS Commercial |
$425.98
|
|
|
NASAL SPLINT SILICONE STERILE 20-10680S
|
Facility
|
IP
|
$186.00
|
|
| Hospital Charge Code |
5787669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.79 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$116.06
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
NASAL SPLINT SILICONE STERILE 20-10680S
|
Facility
|
OP
|
$186.00
|
|
| Hospital Charge Code |
5787669
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$54.16 |
| Max. Negotiated Rate |
$177.96 |
| Rate for Payer: Aetna Commercial |
$174.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$54.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$125.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$96.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$92.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$102.52
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$177.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$108.25
|
| Rate for Payer: Health EOS Commercial |
$172.16
|
| Rate for Payer: HFN Commercial |
$177.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$145.08
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$116.06
|
| Rate for Payer: Preferred Network Access Commercial |
$177.96
|
| Rate for Payer: Quartz Beloit One Network |
$94.79
|
| Rate for Payer: Quartz Commercial |
$125.74
|
| Rate for Payer: Quartz Medicare Advantage |
$116.06
|
| Rate for Payer: The Alliance Commercial |
$96.72
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$143.28
|
|
|
NASAL TAMPON 5.5cm #440412
|
Facility
|
OP
|
$513.00
|
|
| Hospital Charge Code |
2969535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$149.39 |
| Max. Negotiated Rate |
$490.84 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.83
|
| Rate for Payer: Aetna Managed Medicare |
$149.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$346.79
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$266.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$256.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$282.77
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$490.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$298.57
|
| Rate for Payer: Health EOS Commercial |
$474.83
|
| Rate for Payer: HFN Commercial |
$490.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$400.14
|
| Rate for Payer: Multiplan Commercial |
$426.82
|
| Rate for Payer: NAPHCARE Commercial |
$320.11
|
| Rate for Payer: Preferred Network Access Commercial |
$490.84
|
| Rate for Payer: Quartz Beloit One Network |
$261.42
|
| Rate for Payer: Quartz Commercial |
$346.79
|
| Rate for Payer: Quartz Medicare Advantage |
$320.11
|
| Rate for Payer: The Alliance Commercial |
$266.76
|
| Rate for Payer: WEA Trust Commercial |
$293.44
|
| Rate for Payer: WPS Commercial |
$395.16
|
|
|
NASAL TAMPON 5.5cm #440412
|
Facility
|
IP
|
$513.00
|
|
| Hospital Charge Code |
2969535
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$261.42 |
| Max. Negotiated Rate |
$490.84 |
| Rate for Payer: Aetna Commercial |
$480.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$282.77
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$490.84
|
| Rate for Payer: Health EOS Commercial |
$474.83
|
| Rate for Payer: HFN Commercial |
$490.84
|
| Rate for Payer: Multiplan Commercial |
$426.82
|
| Rate for Payer: Preferred Network Access Commercial |
$490.84
|
| Rate for Payer: Quartz Beloit One Network |
$261.42
|
| Rate for Payer: Quartz Commercial |
$320.11
|
| Rate for Payer: WEA Trust Commercial |
$293.44
|
| Rate for Payer: WPS Commercial |
$395.16
|
|
|
NASAL TAMPON,8.0cm #400411
|
Facility
|
IP
|
$511.00
|
|
| Hospital Charge Code |
2969534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.41 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$318.86
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
NASAL TAMPON,8.0cm #400411
|
Facility
|
OP
|
$511.00
|
|
| Hospital Charge Code |
2969534
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$148.80 |
| Max. Negotiated Rate |
$488.92 |
| Rate for Payer: Aetna Commercial |
$478.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.04
|
| Rate for Payer: Aetna Managed Medicare |
$148.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$345.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$265.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$255.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$281.66
|
| Rate for Payer: Cash Price |
$153.30
|
| Rate for Payer: Cigna Commercial |
$488.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$297.40
|
| Rate for Payer: Health EOS Commercial |
$472.98
|
| Rate for Payer: HFN Commercial |
$488.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$398.58
|
| Rate for Payer: Multiplan Commercial |
$425.15
|
| Rate for Payer: NAPHCARE Commercial |
$318.86
|
| Rate for Payer: Preferred Network Access Commercial |
$488.92
|
| Rate for Payer: Quartz Beloit One Network |
$260.41
|
| Rate for Payer: Quartz Commercial |
$345.44
|
| Rate for Payer: Quartz Medicare Advantage |
$318.86
|
| Rate for Payer: The Alliance Commercial |
$265.72
|
| Rate for Payer: WEA Trust Commercial |
$292.29
|
| Rate for Payer: WPS Commercial |
$393.62
|
|
|
NASAL TUMOR RESECTION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960347
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
NASAL TUMOR RESECTION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960347
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
Nasogastric - Tube Type
|
Facility
|
OP
|
$180.00
|
|
| Hospital Charge Code |
3025913
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$52.42 |
| Max. Negotiated Rate |
$172.22 |
| Rate for Payer: Aetna Commercial |
$168.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.99
|
| Rate for Payer: Aetna Managed Medicare |
$52.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$121.68
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$93.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$99.22
|
| Rate for Payer: Cash Price |
$54.00
|
| Rate for Payer: Cigna Commercial |
$172.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.76
|
| Rate for Payer: Health EOS Commercial |
$166.61
|
| Rate for Payer: HFN Commercial |
$172.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$140.40
|
| Rate for Payer: Multiplan Commercial |
$149.76
|
| Rate for Payer: NAPHCARE Commercial |
$112.32
|
| Rate for Payer: Preferred Network Access Commercial |
$172.22
|
| Rate for Payer: Quartz Beloit One Network |
$91.73
|
| Rate for Payer: Quartz Commercial |
$121.68
|
| Rate for Payer: Quartz Medicare Advantage |
$112.32
|
| Rate for Payer: The Alliance Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$102.96
|
| Rate for Payer: WPS Commercial |
$138.65
|
|
