|
Specialty bed: Bariatric - Devices and Equipment
|
Facility
|
IP
|
$1,792.00
|
|
| Hospital Charge Code |
3031054
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$878.08 |
| Max. Negotiated Rate |
$1,648.64 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,075.20
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
|
Specialty bed: Bariatric - Devices and Equipment
|
Facility
|
OP
|
$1,792.00
|
|
| Hospital Charge Code |
3031054
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$501.76 |
| Max. Negotiated Rate |
$7,168.00 |
| Rate for Payer: Aetna Commercial |
$1,612.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.12
|
| Rate for Payer: Aetna Managed Medicare |
$501.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,164.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$896.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$949.76
|
| Rate for Payer: Cash Price |
$537.60
|
| Rate for Payer: Cigna Commercial |
$1,648.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,002.80
|
| Rate for Payer: Health EOS Commercial |
$1,594.88
|
| Rate for Payer: HFN Commercial |
$1,648.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,344.00
|
| Rate for Payer: Multiplan Commercial |
$1,433.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,648.64
|
| Rate for Payer: Quartz Beloit One Network |
$878.08
|
| Rate for Payer: Quartz Commercial |
$1,164.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.20
|
| Rate for Payer: The Alliance Commercial |
$7,168.00
|
| Rate for Payer: WEA Trust Commercial |
$985.60
|
| Rate for Payer: WPS Commercial |
$1,327.33
|
|
|
Specialty bed: Bariatric w/ Turn Assist - Devices and Equipment
|
Facility
|
OP
|
$1,164.00
|
|
| Hospital Charge Code |
3031053
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$325.92 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$1,047.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.04
|
| Rate for Payer: Aetna Managed Medicare |
$325.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$756.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$558.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.92
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,070.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.37
|
| Rate for Payer: Health EOS Commercial |
$1,035.96
|
| Rate for Payer: HFN Commercial |
$1,070.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$873.00
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: NAPHCARE Commercial |
$698.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.88
|
| Rate for Payer: Quartz Beloit One Network |
$570.36
|
| Rate for Payer: Quartz Commercial |
$756.60
|
| Rate for Payer: Quartz Medicare Advantage |
$698.40
|
| Rate for Payer: The Alliance Commercial |
$4,656.00
|
| Rate for Payer: WEA Trust Commercial |
$640.20
|
| Rate for Payer: WPS Commercial |
$862.17
|
|
|
Specialty bed: Bariatric w/ Turn Assist - Devices and Equipment
|
Facility
|
IP
|
$1,164.00
|
|
| Hospital Charge Code |
3031053
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$570.36 |
| Max. Negotiated Rate |
$1,070.88 |
| Rate for Payer: Aetna Commercial |
$1,047.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.92
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,070.88
|
| Rate for Payer: Health EOS Commercial |
$1,035.96
|
| Rate for Payer: HFN Commercial |
$1,070.88
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: NAPHCARE Commercial |
$698.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.88
|
| Rate for Payer: Quartz Beloit One Network |
$570.36
|
| Rate for Payer: Quartz Commercial |
$698.40
|
| Rate for Payer: WEA Trust Commercial |
$640.20
|
| Rate for Payer: WPS Commercial |
$862.17
|
|
|
Specialty bed: Critical Care - Devices and Equipment
|
Facility
|
OP
|
$2,478.00
|
|
| Hospital Charge Code |
3031052
|
| Min. Negotiated Rate |
$693.84 |
| Max. Negotiated Rate |
$9,912.00 |
| Rate for Payer: Aetna Commercial |
$2,230.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,131.08
|
| Rate for Payer: Aetna Managed Medicare |
$693.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,610.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,239.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,189.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.34
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$2,279.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,386.69
|
| Rate for Payer: Health EOS Commercial |
$2,205.42
|
| Rate for Payer: HFN Commercial |
$2,279.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,858.50
|
| Rate for Payer: Multiplan Commercial |
$1,982.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,279.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.22
|
| Rate for Payer: Quartz Commercial |
$1,610.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,486.80
|
| Rate for Payer: The Alliance Commercial |
$9,912.00
|
| Rate for Payer: WEA Trust Commercial |
$1,362.90
|
| Rate for Payer: WPS Commercial |
$1,835.45
|
|
|
Specialty bed: Critical Care - Devices and Equipment
|
Facility
|
IP
|
$2,478.00
|
|
| Hospital Charge Code |
3031052
|
| Min. Negotiated Rate |
$1,214.22 |
| Max. Negotiated Rate |
$2,279.76 |
| Rate for Payer: Aetna Commercial |
$2,230.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,131.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,313.34
|
| Rate for Payer: Cash Price |
$743.40
|
| Rate for Payer: Cigna Commercial |
$2,279.76
|
| Rate for Payer: Health EOS Commercial |
$2,205.42
|
| Rate for Payer: HFN Commercial |
$2,279.76
|
| Rate for Payer: Multiplan Commercial |
$1,982.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,486.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,279.76
|
| Rate for Payer: Quartz Beloit One Network |
$1,214.22
|
| Rate for Payer: Quartz Commercial |
$1,486.80
|
| Rate for Payer: WEA Trust Commercial |
$1,362.90
|
| Rate for Payer: WPS Commercial |
$1,835.45
|
|
|
Specialty bed: Fluid air bed - Devices and Equipment
|
Facility
|
IP
|
$1,793.00
|
|
| Hospital Charge Code |
3031051
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$878.57 |
| Max. Negotiated Rate |
$1,649.56 |
| Rate for Payer: Aetna Commercial |
$1,613.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$950.29
|
| Rate for Payer: Cash Price |
$537.90
|
| Rate for Payer: Cigna Commercial |
$1,649.56
|
| Rate for Payer: Health EOS Commercial |
$1,595.77
|
| Rate for Payer: HFN Commercial |
$1,649.56
|
| Rate for Payer: Multiplan Commercial |
$1,434.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,649.56
|
| Rate for Payer: Quartz Beloit One Network |
$878.57
|
| Rate for Payer: Quartz Commercial |
$1,075.80
|
| Rate for Payer: WEA Trust Commercial |
$986.15
|
| Rate for Payer: WPS Commercial |
$1,328.08
|
|
|
Specialty bed: Fluid air bed - Devices and Equipment
|
Facility
|
OP
|
$1,793.00
|
|
| Hospital Charge Code |
3031051
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$502.04 |
| Max. Negotiated Rate |
$7,172.00 |
| Rate for Payer: Aetna Commercial |
$1,613.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.98
|
| Rate for Payer: Aetna Managed Medicare |
$502.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,165.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$896.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$860.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$950.29
|
| Rate for Payer: Cash Price |
$537.90
|
| Rate for Payer: Cigna Commercial |
$1,649.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,003.36
|
| Rate for Payer: Health EOS Commercial |
$1,595.77
|
| Rate for Payer: HFN Commercial |
$1,649.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,344.75
|
| Rate for Payer: Multiplan Commercial |
$1,434.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,075.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,649.56
|
| Rate for Payer: Quartz Beloit One Network |
$878.57
|
| Rate for Payer: Quartz Commercial |
$1,165.45
|
| Rate for Payer: Quartz Medicare Advantage |
$1,075.80
|
| Rate for Payer: The Alliance Commercial |
$7,172.00
|
| Rate for Payer: WEA Trust Commercial |
$986.15
|
| Rate for Payer: WPS Commercial |
$1,328.08
|
|
|
Specialty bed: MedSurg - Devices and Equipment
|
Facility
|
IP
|
$1,164.00
|
|
| Hospital Charge Code |
3031050
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$570.36 |
| Max. Negotiated Rate |
$1,070.88 |
| Rate for Payer: Aetna Commercial |
$1,047.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.92
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,070.88
|
| Rate for Payer: Health EOS Commercial |
$1,035.96
|
| Rate for Payer: HFN Commercial |
$1,070.88
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: NAPHCARE Commercial |
$698.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.88
|
| Rate for Payer: Quartz Beloit One Network |
$570.36
|
| Rate for Payer: Quartz Commercial |
$698.40
|
| Rate for Payer: WEA Trust Commercial |
$640.20
|
| Rate for Payer: WPS Commercial |
$862.17
|
|
|
Specialty bed: MedSurg - Devices and Equipment
|
Facility
|
OP
|
$1,164.00
|
|
| Hospital Charge Code |
3031050
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$325.92 |
| Max. Negotiated Rate |
$4,656.00 |
| Rate for Payer: Aetna Commercial |
$1,047.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,001.04
|
| Rate for Payer: Aetna Managed Medicare |
$325.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$756.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$582.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$558.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$616.92
|
| Rate for Payer: Cash Price |
$349.20
|
| Rate for Payer: Cigna Commercial |
$1,070.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$651.37
|
| Rate for Payer: Health EOS Commercial |
$1,035.96
|
| Rate for Payer: HFN Commercial |
$1,070.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$873.00
|
| Rate for Payer: Multiplan Commercial |
$931.20
|
| Rate for Payer: NAPHCARE Commercial |
$698.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,070.88
|
| Rate for Payer: Quartz Beloit One Network |
$570.36
|
| Rate for Payer: Quartz Commercial |
$756.60
|
| Rate for Payer: Quartz Medicare Advantage |
$698.40
|
| Rate for Payer: The Alliance Commercial |
$4,656.00
|
| Rate for Payer: WEA Trust Commercial |
$640.20
|
| Rate for Payer: WPS Commercial |
$862.17
|
|
|
SPECIMEN TRAP STERILE 40cc
|
Facility
|
IP
|
$69.00
|
|
| Hospital Charge Code |
2974707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.81 |
| Max. Negotiated Rate |
$63.48 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$41.40
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
SPECIMEN TRAP STERILE 40cc
|
Facility
|
OP
|
$69.00
|
|
| Hospital Charge Code |
2974707
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.32 |
| Max. Negotiated Rate |
$276.00 |
| Rate for Payer: Aetna Commercial |
$62.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.34
|
| Rate for Payer: Aetna Managed Medicare |
$19.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.57
|
| Rate for Payer: Cash Price |
$20.70
|
| Rate for Payer: Cigna Commercial |
$63.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.61
|
| Rate for Payer: Health EOS Commercial |
$61.41
|
| Rate for Payer: HFN Commercial |
$63.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.75
|
| Rate for Payer: Multiplan Commercial |
$55.20
|
| Rate for Payer: NAPHCARE Commercial |
$41.40
|
| Rate for Payer: Preferred Network Access Commercial |
$63.48
|
| Rate for Payer: Quartz Beloit One Network |
$33.81
|
| Rate for Payer: Quartz Commercial |
$44.85
|
| Rate for Payer: Quartz Medicare Advantage |
$41.40
|
| Rate for Payer: The Alliance Commercial |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$37.95
|
| Rate for Payer: WPS Commercial |
$51.11
|
|
|
Spec RT Port Plan Particles
|
Facility
|
OP
|
$1,622.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
3040384
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$365.21 |
| Max. Negotiated Rate |
$1,492.24 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.92
|
| Rate for Payer: Aetna Managed Medicare |
$365.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,369.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,095.63
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,040.85
|
| Rate for Payer: Anthem Medicare Advantage |
$365.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$365.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$365.21
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,492.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$365.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$907.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$365.21
|
| Rate for Payer: Health EOS Commercial |
$1,443.58
|
| Rate for Payer: HFN Commercial |
$1,492.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,358.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$365.21
|
| Rate for Payer: Independent Care Health Plan Medicare |
$365.21
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$365.21
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$365.21
|
| Rate for Payer: Multiplan Commercial |
$1,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$547.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,492.24
|
| Rate for Payer: Quartz Beloit One Network |
$794.78
|
| Rate for Payer: Quartz Commercial |
$1,054.30
|
| Rate for Payer: Quartz Medicare Advantage |
$365.21
|
| Rate for Payer: The Alliance Commercial |
$1,460.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$365.21
|
| Rate for Payer: United Healthcare PPO |
$1,216.50
|
| Rate for Payer: WEA Trust Commercial |
$892.10
|
| Rate for Payer: Wellcare Medicare |
$365.21
|
| Rate for Payer: WPS Commercial |
$1,201.42
|
|
|
Spec RT Port Plan Particles
|
Facility
|
IP
|
$1,622.00
|
|
|
Service Code
|
CPT 77321
|
| Hospital Charge Code |
3040384
|
|
Hospital Revenue Code
|
333
|
| Min. Negotiated Rate |
$794.78 |
| Max. Negotiated Rate |
$1,492.24 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.66
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,492.24
|
| Rate for Payer: Health EOS Commercial |
$1,443.58
|
| Rate for Payer: HFN Commercial |
$1,492.24
|
| Rate for Payer: Multiplan Commercial |
$1,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$973.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,492.24
|
| Rate for Payer: Quartz Beloit One Network |
$794.78
|
| Rate for Payer: Quartz Commercial |
$973.20
|
| Rate for Payer: WEA Trust Commercial |
$892.10
|
| Rate for Payer: WPS Commercial |
$1,201.42
|
|
|
Spectral Doppler Complete 93320
|
Facility
|
IP
|
$1,132.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
5381789
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$554.68 |
| Max. Negotiated Rate |
$1,041.44 |
| Rate for Payer: Aetna Commercial |
$1,018.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$973.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$599.96
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$1,041.44
|
| Rate for Payer: Health EOS Commercial |
$1,007.48
|
| Rate for Payer: HFN Commercial |
$1,041.44
|
| Rate for Payer: Multiplan Commercial |
$905.60
|
| Rate for Payer: NAPHCARE Commercial |
$679.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,041.44
|
| Rate for Payer: Quartz Beloit One Network |
$554.68
|
| Rate for Payer: Quartz Commercial |
$679.20
|
| Rate for Payer: WEA Trust Commercial |
$622.60
|
| Rate for Payer: WPS Commercial |
$838.47
|
|
|
Spectral Doppler Complete 93320
|
Facility
|
OP
|
$1,132.00
|
|
|
Service Code
|
CPT 93320
|
| Hospital Charge Code |
5381789
|
|
Hospital Revenue Code
|
483
|
| Min. Negotiated Rate |
$316.96 |
| Max. Negotiated Rate |
$4,528.00 |
| Rate for Payer: Aetna Commercial |
$1,018.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$973.52
|
| Rate for Payer: Aetna Managed Medicare |
$316.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$735.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$543.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$599.96
|
| Rate for Payer: Cash Price |
$339.60
|
| Rate for Payer: Cigna Commercial |
$1,041.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$633.47
|
| Rate for Payer: Health EOS Commercial |
$1,007.48
|
| Rate for Payer: HFN Commercial |
$1,041.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$849.00
|
| Rate for Payer: Multiplan Commercial |
$905.60
|
| Rate for Payer: NAPHCARE Commercial |
$679.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,041.44
|
| Rate for Payer: Quartz Beloit One Network |
$554.68
|
| Rate for Payer: Quartz Commercial |
$735.80
|
| Rate for Payer: Quartz Medicare Advantage |
$679.20
|
| Rate for Payer: The Alliance Commercial |
$4,528.00
|
| Rate for Payer: United Healthcare PPO |
$849.00
|
| Rate for Payer: WEA Trust Commercial |
$622.60
|
| Rate for Payer: WPS Commercial |
$838.47
|
|
|
Spectral Doppler Limited 93321
|
Facility
|
IP
|
$742.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
5381790
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$363.58 |
| Max. Negotiated Rate |
$682.64 |
| Rate for Payer: Aetna Commercial |
$667.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.26
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$682.64
|
| Rate for Payer: Health EOS Commercial |
$660.38
|
| Rate for Payer: HFN Commercial |
$682.64
|
| Rate for Payer: Multiplan Commercial |
$593.60
|
| Rate for Payer: NAPHCARE Commercial |
$445.20
|
| Rate for Payer: Preferred Network Access Commercial |
$682.64
|
| Rate for Payer: Quartz Beloit One Network |
$363.58
|
| Rate for Payer: Quartz Commercial |
$445.20
|
| Rate for Payer: WEA Trust Commercial |
$408.10
|
| Rate for Payer: WPS Commercial |
$549.60
|
|
|
Spectral Doppler Limited 93321
|
Facility
|
OP
|
$742.00
|
|
|
Service Code
|
CPT 93321
|
| Hospital Charge Code |
5381790
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$207.76 |
| Max. Negotiated Rate |
$2,968.00 |
| Rate for Payer: Aetna Commercial |
$667.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$638.12
|
| Rate for Payer: Aetna Managed Medicare |
$207.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$482.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$371.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$356.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$393.26
|
| Rate for Payer: Cash Price |
$222.60
|
| Rate for Payer: Cigna Commercial |
$682.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$415.22
|
| Rate for Payer: Health EOS Commercial |
$660.38
|
| Rate for Payer: HFN Commercial |
$682.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$556.50
|
| Rate for Payer: Multiplan Commercial |
$593.60
|
| Rate for Payer: NAPHCARE Commercial |
$445.20
|
| Rate for Payer: Preferred Network Access Commercial |
$682.64
|
| Rate for Payer: Quartz Beloit One Network |
$363.58
|
| Rate for Payer: Quartz Commercial |
$482.30
|
| Rate for Payer: Quartz Medicare Advantage |
$445.20
|
| Rate for Payer: The Alliance Commercial |
$2,968.00
|
| Rate for Payer: United Healthcare PPO |
$556.50
|
| Rate for Payer: WEA Trust Commercial |
$408.10
|
| Rate for Payer: WPS Commercial |
$549.60
|
|
|
SPEECH AUDIOMETRY, COMPLETE 92556
|
Facility
|
IP
|
$134.00
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
3015336
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$65.66 |
| Max. Negotiated Rate |
$123.28 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$80.40
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$80.40
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
SPEECH AUDIOMETRY, COMPLETE 92556
|
Professional
|
Both
|
$134.00
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
3015336
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.96 |
| Max. Negotiated Rate |
$131.49 |
| Rate for Payer: Aetna Commercial |
$127.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$127.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.40
|
| Rate for Payer: Health EOS Commercial |
$121.94
|
| Rate for Payer: HFN Commercial |
$127.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$131.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$131.49
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: Preferred Network Access Commercial |
$127.30
|
| Rate for Payer: Quartz Beloit One Network |
$58.96
|
| Rate for Payer: Quartz Commercial |
$76.38
|
| Rate for Payer: The Alliance Commercial |
$67.00
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
SPEECH AUDIOMETRY, COMPLETE 92556
|
Facility
|
OP
|
$134.00
|
|
|
Service Code
|
CPT 92556
|
| Hospital Charge Code |
3015336
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$241.84 |
| Rate for Payer: Aetna Commercial |
$120.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.24
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$67.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$64.32
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cash Price |
$40.20
|
| Rate for Payer: Cigna Commercial |
$123.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$74.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$119.26
|
| Rate for Payer: HFN Commercial |
$123.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$107.20
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$123.28
|
| Rate for Payer: Quartz Beloit One Network |
$65.66
|
| Rate for Payer: Quartz Commercial |
$87.10
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: WEA Trust Commercial |
$73.70
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$99.25
|
|
|
Speech Audiometry Threshold
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
1152818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Speech Audiometry Threshold
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
1152818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.32 |
| Max. Negotiated Rate |
$121.60 |
| Rate for Payer: Aetna Commercial |
$121.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$121.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$64.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.80
|
| Rate for Payer: Health EOS Commercial |
$116.48
|
| Rate for Payer: HFN Commercial |
$121.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$82.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$82.74
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: Preferred Network Access Commercial |
$121.60
|
| Rate for Payer: Quartz Beloit One Network |
$56.32
|
| Rate for Payer: Quartz Commercial |
$72.96
|
| Rate for Payer: The Alliance Commercial |
$64.00
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Speech Audiometry Threshold
|
Facility
|
OP
|
$128.00
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
1152818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$60.46 |
| Max. Negotiated Rate |
$241.84 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Aetna Managed Medicare |
$60.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$83.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61.44
|
| Rate for Payer: Anthem Medicare Advantage |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$60.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$60.46
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$60.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$60.46
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$60.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$60.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$60.46
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$90.69
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$83.20
|
| Rate for Payer: Quartz Medicare Advantage |
$60.46
|
| Rate for Payer: The Alliance Commercial |
$241.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$60.46
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: Wellcare Medicare |
$60.46
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
|
Speech Audiometry Threshold
|
Facility
|
IP
|
$128.00
|
|
|
Service Code
|
CPT 92555
|
| Hospital Charge Code |
1230803
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$62.72 |
| Max. Negotiated Rate |
$117.76 |
| Rate for Payer: Aetna Commercial |
$115.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$110.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$67.84
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$117.76
|
| Rate for Payer: Health EOS Commercial |
$113.92
|
| Rate for Payer: HFN Commercial |
$117.76
|
| Rate for Payer: Multiplan Commercial |
$102.40
|
| Rate for Payer: NAPHCARE Commercial |
$76.80
|
| Rate for Payer: Preferred Network Access Commercial |
$117.76
|
| Rate for Payer: Quartz Beloit One Network |
$62.72
|
| Rate for Payer: Quartz Commercial |
$76.80
|
| Rate for Payer: WEA Trust Commercial |
$70.40
|
| Rate for Payer: WPS Commercial |
$94.81
|
|
