|
TUNNELER #402
|
Facility
OP
|
$4,600.00
|
|
| Hospital Charge Code |
2965003
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,288.00 |
| Max. Negotiated Rate |
$18,400.00 |
| Rate for Payer: Aetna Commercial |
$4,140.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,956.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,288.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,990.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,300.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,208.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,438.00
|
| Rate for Payer: Cash Price |
$1,380.00
|
| Rate for Payer: Cigna Commercial |
$4,232.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,574.16
|
| Rate for Payer: Health EOS Commercial |
$4,094.00
|
| Rate for Payer: HFN Commercial |
$4,232.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,450.00
|
| Rate for Payer: Multiplan Commercial |
$3,680.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,760.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,232.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,254.00
|
| Rate for Payer: Quartz Commercial |
$2,990.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,760.00
|
| Rate for Payer: The Alliance Commercial |
$18,400.00
|
| Rate for Payer: WEA Trust Commercial |
$2,530.00
|
| Rate for Payer: WPS Commercial |
$3,407.22
|
|
|
TUNNELER HICKMAN 0601930
|
Facility
IP
|
$566.00
|
|
| Hospital Charge Code |
2964763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$277.34 |
| Max. Negotiated Rate |
$520.72 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$339.60
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$339.60
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
TUNNELER HICKMAN 0601930
|
Facility
OP
|
$566.00
|
|
| Hospital Charge Code |
2964763
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$158.48 |
| Max. Negotiated Rate |
$2,264.00 |
| Rate for Payer: Aetna Commercial |
$509.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$486.76
|
| Rate for Payer: Aetna Managed Medicare |
$158.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$367.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$283.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$271.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$299.98
|
| Rate for Payer: Cash Price |
$169.80
|
| Rate for Payer: Cigna Commercial |
$520.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$316.73
|
| Rate for Payer: Health EOS Commercial |
$503.74
|
| Rate for Payer: HFN Commercial |
$520.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$424.50
|
| Rate for Payer: Multiplan Commercial |
$452.80
|
| Rate for Payer: NAPHCARE Commercial |
$339.60
|
| Rate for Payer: Preferred Network Access Commercial |
$520.72
|
| Rate for Payer: Quartz Beloit One Network |
$277.34
|
| Rate for Payer: Quartz Commercial |
$367.90
|
| Rate for Payer: Quartz Medicare Advantage |
$339.60
|
| Rate for Payer: The Alliance Commercial |
$2,264.00
|
| Rate for Payer: WEA Trust Commercial |
$311.30
|
| Rate for Payer: WPS Commercial |
$419.24
|
|
|
TURBINOPLASTY/SUBMUCOUS TURBINECTOMY
|
Facility
IP
|
$5,934.00
|
|
| Hospital Charge Code |
2960457
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,907.66 |
| Max. Negotiated Rate |
$5,459.28 |
| Rate for Payer: Aetna Commercial |
$5,340.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,145.02
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cigna Commercial |
$5,459.28
|
| Rate for Payer: Health EOS Commercial |
$5,281.26
|
| Rate for Payer: HFN Commercial |
$5,459.28
|
| Rate for Payer: Multiplan Commercial |
$4,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,560.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,459.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,907.66
|
| Rate for Payer: Quartz Commercial |
$3,560.40
|
| Rate for Payer: WEA Trust Commercial |
$3,263.70
|
| Rate for Payer: WPS Commercial |
$4,395.31
|
|
|
TURBINOPLASTY/SUBMUCOUS TURBINECTOMY
|
Facility
OP
|
$5,934.00
|
|
| Hospital Charge Code |
2960457
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,661.52 |
| Max. Negotiated Rate |
$23,736.00 |
| Rate for Payer: Aetna Commercial |
$5,340.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,103.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,661.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,857.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,967.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,848.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,145.02
|
| Rate for Payer: Cash Price |
$1,780.20
|
| Rate for Payer: Cigna Commercial |
$5,459.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,320.67
|
| Rate for Payer: Health EOS Commercial |
$5,281.26
|
| Rate for Payer: HFN Commercial |
$5,459.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,450.50
|
| Rate for Payer: Multiplan Commercial |
$4,747.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,560.40
|
| Rate for Payer: Preferred Network Access Commercial |
$5,459.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,907.66
|
| Rate for Payer: Quartz Commercial |
$3,857.10
|
| Rate for Payer: Quartz Medicare Advantage |
$3,560.40
|
| Rate for Payer: The Alliance Commercial |
$23,736.00
|
| Rate for Payer: WEA Trust Commercial |
$3,263.70
|
| Rate for Payer: WPS Commercial |
$4,395.31
|
|
|
TURBOHAWK DEVICE LS-M
|
Facility
OP
|
$18,884.00
|
|
| Hospital Charge Code |
2973923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$5,287.52 |
| Max. Negotiated Rate |
$75,536.00 |
| Rate for Payer: Aetna Commercial |
$16,995.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,240.24
|
| Rate for Payer: Aetna Managed Medicare |
$5,287.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,274.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,442.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,064.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,008.52
|
| Rate for Payer: Cash Price |
$5,665.20
|
| Rate for Payer: Cigna Commercial |
$17,373.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,567.49
|
| Rate for Payer: Health EOS Commercial |
$16,806.76
|
| Rate for Payer: HFN Commercial |
$17,373.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,163.00
|
| Rate for Payer: Multiplan Commercial |
$15,107.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,330.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,373.28
|
| Rate for Payer: Quartz Beloit One Network |
$9,253.16
|
| Rate for Payer: Quartz Commercial |
$12,274.60
|
| Rate for Payer: Quartz Medicare Advantage |
$11,330.40
|
| Rate for Payer: The Alliance Commercial |
$75,536.00
|
| Rate for Payer: WEA Trust Commercial |
$10,386.20
|
| Rate for Payer: WPS Commercial |
$13,987.38
|
|
|
TURBOHAWK DEVICE LS-M
|
Facility
IP
|
$18,884.00
|
|
| Hospital Charge Code |
2973923
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$9,253.16 |
| Max. Negotiated Rate |
$17,373.28 |
| Rate for Payer: Aetna Commercial |
$16,995.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,008.52
|
| Rate for Payer: Cash Price |
$5,665.20
|
| Rate for Payer: Cigna Commercial |
$17,373.28
|
| Rate for Payer: Health EOS Commercial |
$16,806.76
|
| Rate for Payer: HFN Commercial |
$17,373.28
|
| Rate for Payer: Multiplan Commercial |
$15,107.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,330.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,373.28
|
| Rate for Payer: Quartz Beloit One Network |
$9,253.16
|
| Rate for Payer: Quartz Commercial |
$11,330.40
|
| Rate for Payer: WEA Trust Commercial |
$10,386.20
|
| Rate for Payer: WPS Commercial |
$13,987.38
|
|
|
TURBOHAWK PLAQUE EXCISION
|
Facility
OP
|
$12,963.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,629.64 |
| Max. Negotiated Rate |
$11,925.96 |
| Rate for Payer: Aetna Commercial |
$11,666.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$11,148.18
|
| Rate for Payer: Aetna Managed Medicare |
$3,629.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,425.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,481.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,222.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,870.39
|
| Rate for Payer: Cash Price |
$3,888.90
|
| Rate for Payer: Cigna Commercial |
$11,925.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,254.09
|
| Rate for Payer: Health EOS Commercial |
$11,537.07
|
| Rate for Payer: HFN Commercial |
$11,925.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,722.25
|
| Rate for Payer: Multiplan Commercial |
$10,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$7,777.80
|
| Rate for Payer: Preferred Network Access Commercial |
$11,925.96
|
| Rate for Payer: Quartz Beloit One Network |
$6,351.87
|
| Rate for Payer: Quartz Commercial |
$8,425.95
|
| Rate for Payer: Quartz Medicare Advantage |
$7,777.80
|
| Rate for Payer: WEA Trust Commercial |
$7,129.65
|
| Rate for Payer: WPS Commercial |
$9,601.69
|
|
|
TURBOHAWK PLAQUE EXCISION
|
Facility
IP
|
$12,963.00
|
|
|
Service Code
|
HCPCS C1724
|
| Hospital Charge Code |
2973924
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6,351.87 |
| Max. Negotiated Rate |
$11,925.96 |
| Rate for Payer: Aetna Commercial |
$11,666.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,870.39
|
| Rate for Payer: Cash Price |
$3,888.90
|
| Rate for Payer: Cigna Commercial |
$11,925.96
|
| Rate for Payer: Health EOS Commercial |
$11,537.07
|
| Rate for Payer: HFN Commercial |
$11,925.96
|
| Rate for Payer: Multiplan Commercial |
$10,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$7,777.80
|
| Rate for Payer: Preferred Network Access Commercial |
$11,925.96
|
| Rate for Payer: Quartz Beloit One Network |
$6,351.87
|
| Rate for Payer: Quartz Commercial |
$7,777.80
|
| Rate for Payer: WEA Trust Commercial |
$7,129.65
|
| Rate for Payer: WPS Commercial |
$9,601.69
|
|
|
T vulgaris
|
Facility
OP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.17 |
| Max. Negotiated Rate |
$420.00 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.54
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21.38
|
| Rate for Payer: Anthem Medicaid |
$8.17
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicaid |
$8.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.88
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Managed Health Services Medicaid |
$8.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$19.32
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$8.17
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$68.25
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$420.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: United Healthcare PPO |
$78.75
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: Wellcare Medicare |
$12.88
|
| Rate for Payer: WMAP Medicaid |
$8.17
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
T vulgaris
|
Professional
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.88 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| Rate for Payer: Aetna Managed Medicare |
$12.88
|
| Rate for Payer: Anthem Medicare Advantage |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.88
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$99.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.88
|
| Rate for Payer: Health EOS Commercial |
$95.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.88
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: Preferred Network Access Commercial |
$99.75
|
| Rate for Payer: Quartz Beloit One Network |
$46.20
|
| Rate for Payer: Quartz Commercial |
$59.85
|
| Rate for Payer: Quartz Medicare Advantage |
$12.88
|
| Rate for Payer: The Alliance Commercial |
$50.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.88
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$56.67
|
|
|
T vulgaris
|
Facility
IP
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$51.45 |
| Max. Negotiated Rate |
$96.60 |
| Rate for Payer: Aetna Commercial |
$94.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.65
|
| Rate for Payer: Cash Price |
$31.50
|
| Rate for Payer: Cigna Commercial |
$96.60
|
| Rate for Payer: Health EOS Commercial |
$93.45
|
| Rate for Payer: HFN Commercial |
$96.60
|
| Rate for Payer: Multiplan Commercial |
$84.00
|
| Rate for Payer: NAPHCARE Commercial |
$63.00
|
| Rate for Payer: Preferred Network Access Commercial |
$96.60
|
| Rate for Payer: Quartz Beloit One Network |
$51.45
|
| Rate for Payer: Quartz Commercial |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
TWIST LOCK CABLE EXTERNAL INTERSTIM 357625
|
Facility
OP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5384684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$409.36 |
| Max. Negotiated Rate |
$1,345.04 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,257.32
|
| Rate for Payer: Aetna Managed Medicare |
$409.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$950.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$731.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$701.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.86
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,345.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$818.14
|
| Rate for Payer: Health EOS Commercial |
$1,301.18
|
| Rate for Payer: HFN Commercial |
$1,345.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,096.50
|
| Rate for Payer: Multiplan Commercial |
$1,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$877.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.04
|
| Rate for Payer: Quartz Beloit One Network |
$716.38
|
| Rate for Payer: Quartz Commercial |
$950.30
|
| Rate for Payer: Quartz Medicare Advantage |
$877.20
|
| Rate for Payer: WEA Trust Commercial |
$804.10
|
| Rate for Payer: WPS Commercial |
$1,082.90
|
|
|
TWIST LOCK CABLE EXTERNAL INTERSTIM 357625
|
Facility
IP
|
$1,462.00
|
|
|
Service Code
|
HCPCS C1894
|
| Hospital Charge Code |
5384684
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$716.38 |
| Max. Negotiated Rate |
$1,345.04 |
| Rate for Payer: Aetna Commercial |
$1,315.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.86
|
| Rate for Payer: Cash Price |
$438.60
|
| Rate for Payer: Cigna Commercial |
$1,345.04
|
| Rate for Payer: Health EOS Commercial |
$1,301.18
|
| Rate for Payer: HFN Commercial |
$1,345.04
|
| Rate for Payer: Multiplan Commercial |
$1,169.60
|
| Rate for Payer: NAPHCARE Commercial |
$877.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,345.04
|
| Rate for Payer: Quartz Beloit One Network |
$716.38
|
| Rate for Payer: Quartz Commercial |
$877.20
|
| Rate for Payer: WEA Trust Commercial |
$804.10
|
| Rate for Payer: WPS Commercial |
$1,082.90
|
|
|
Tx Devices Design-Complex 7733426
|
Professional
|
$451.00
|
|
|
Service Code
|
CPT 77334 26
|
| Hospital Charge Code |
5258640
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$58.71 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$428.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.86
|
| Rate for Payer: Aetna Managed Medicare |
$58.71
|
| Rate for Payer: Anthem Medicare Advantage |
$58.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$58.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$58.71
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cash Price |
$135.30
|
| Rate for Payer: Cigna Commercial |
$428.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$225.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.71
|
| Rate for Payer: Health EOS Commercial |
$410.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$206.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$206.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$58.71
|
| Rate for Payer: Multiplan Commercial |
$360.80
|
| Rate for Payer: Preferred Network Access Commercial |
$428.45
|
| Rate for Payer: Quartz Beloit One Network |
$198.44
|
| Rate for Payer: Quartz Commercial |
$257.07
|
| Rate for Payer: Quartz Medicare Advantage |
$58.71
|
| Rate for Payer: The Alliance Commercial |
$223.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$58.71
|
| Rate for Payer: WEA Trust Commercial |
$248.05
|
| Rate for Payer: WPS Commercial |
$293.55
|
|
|
Tx Devices Design-Intermediate 7733326
|
Professional
|
$472.00
|
|
|
Service Code
|
CPT 77333 26
|
| Hospital Charge Code |
5258639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$38.40 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Aetna Commercial |
$448.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| Rate for Payer: Aetna Managed Medicare |
$38.40
|
| Rate for Payer: Anthem Medicare Advantage |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38.40
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cash Price |
$141.60
|
| Rate for Payer: Cigna Commercial |
$448.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$236.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.40
|
| Rate for Payer: Health EOS Commercial |
$429.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38.40
|
| Rate for Payer: Multiplan Commercial |
$377.60
|
| Rate for Payer: Preferred Network Access Commercial |
$448.40
|
| Rate for Payer: Quartz Beloit One Network |
$207.68
|
| Rate for Payer: Quartz Commercial |
$269.04
|
| Rate for Payer: Quartz Medicare Advantage |
$38.40
|
| Rate for Payer: The Alliance Commercial |
$145.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38.40
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$192.00
|
|
|
Tx Devices Design-Simple 7733226
|
Professional
|
$328.00
|
|
|
Service Code
|
CPT 77332 26
|
| Hospital Charge Code |
5258634
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.19 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Aetna Managed Medicare |
$23.19
|
| Rate for Payer: Anthem Medicare Advantage |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23.19
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$311.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$164.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.19
|
| Rate for Payer: Health EOS Commercial |
$298.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$81.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23.19
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.60
|
| Rate for Payer: Quartz Beloit One Network |
$144.32
|
| Rate for Payer: Quartz Commercial |
$186.96
|
| Rate for Payer: Quartz Medicare Advantage |
$23.19
|
| Rate for Payer: The Alliance Commercial |
$88.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23.19
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$115.95
|
|
|
Tymp And Art
|
Professional
|
$263.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
3203502
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$21.62 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna Commercial |
$249.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Aetna Managed Medicare |
$21.62
|
| Rate for Payer: Anthem Medicare Advantage |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.62
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$249.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$131.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.62
|
| Rate for Payer: Health EOS Commercial |
$239.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.62
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: Preferred Network Access Commercial |
$249.85
|
| Rate for Payer: Quartz Beloit One Network |
$115.72
|
| Rate for Payer: Quartz Commercial |
$149.91
|
| Rate for Payer: Quartz Medicare Advantage |
$21.62
|
| Rate for Payer: The Alliance Commercial |
$54.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.62
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$86.48
|
|
|
Tymp And Art
|
Facility
IP
|
$263.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
3203502
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$128.87 |
| Max. Negotiated Rate |
$241.96 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.39
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$241.96
|
| Rate for Payer: Health EOS Commercial |
$234.07
|
| Rate for Payer: HFN Commercial |
$241.96
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: NAPHCARE Commercial |
$157.80
|
| Rate for Payer: Preferred Network Access Commercial |
$241.96
|
| Rate for Payer: Quartz Beloit One Network |
$128.87
|
| Rate for Payer: Quartz Commercial |
$157.80
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
Tymp And Art
|
Facility
OP
|
$263.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
3203502
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$126.24 |
| Max. Negotiated Rate |
$574.33 |
| Rate for Payer: Aetna Commercial |
$236.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$131.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$126.24
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$139.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$154.39
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cash Price |
$78.90
|
| Rate for Payer: Cigna Commercial |
$241.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$147.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$234.07
|
| Rate for Payer: HFN Commercial |
$241.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$574.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$154.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$154.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$154.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$154.39
|
| Rate for Payer: Multiplan Commercial |
$210.40
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$241.96
|
| Rate for Payer: Quartz Beloit One Network |
$128.87
|
| Rate for Payer: Quartz Commercial |
$170.95
|
| Rate for Payer: Quartz Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare Medicare Advantage |
$154.39
|
| Rate for Payer: United Healthcare PPO |
$197.25
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
Tympanic Membrane Repair
|
Professional
|
$673.00
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
1152802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$1,221.26 |
| Rate for Payer: Aetna Commercial |
$639.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.78
|
| Rate for Payer: Aetna Managed Medicare |
$271.39
|
| Rate for Payer: Anthem Medicare Advantage |
$271.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$271.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$271.39
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$639.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$336.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$271.39
|
| Rate for Payer: Health EOS Commercial |
$612.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$952.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$952.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$271.39
|
| Rate for Payer: Multiplan Commercial |
$538.40
|
| Rate for Payer: Preferred Network Access Commercial |
$639.35
|
| Rate for Payer: Quartz Beloit One Network |
$296.12
|
| Rate for Payer: Quartz Commercial |
$383.61
|
| Rate for Payer: Quartz Medicare Advantage |
$271.39
|
| Rate for Payer: The Alliance Commercial |
$1,153.41
|
| Rate for Payer: United Healthcare Medicaid |
$47.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$271.39
|
| Rate for Payer: WEA Trust Commercial |
$370.15
|
| Rate for Payer: WPS Commercial |
$1,221.26
|
|
|
Tympanometry
|
Facility
OP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
1152820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$147.46 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$39.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$67.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49.92
|
| Rate for Payer: Anthem Medicare Advantage |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.64
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.64
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.64
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$59.46
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$67.60
|
| Rate for Payer: Quartz Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.64
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$39.64
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Tympanometry
|
Facility
IP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
1152820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Tympanometry
|
Professional
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
1152820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$10.43 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Aetna Managed Medicare |
$10.43
|
| Rate for Payer: Anthem Medicare Advantage |
$10.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.43
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$98.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$52.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.43
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$56.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.43
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.80
|
| Rate for Payer: Quartz Beloit One Network |
$45.76
|
| Rate for Payer: Quartz Commercial |
$59.28
|
| Rate for Payer: Quartz Medicare Advantage |
$10.43
|
| Rate for Payer: The Alliance Commercial |
$26.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.43
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$41.72
|
|
|
Tympanometry 9256750
|
Professional
|
$130.00
|
|
|
Service Code
|
CPT 92567 50
|
| Hospital Charge Code |
3301638
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.20 |
| Max. Negotiated Rate |
$123.50 |
| Rate for Payer: Aetna Commercial |
$123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Cash Price |
$39.00
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$65.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.00
|
| Rate for Payer: Health EOS Commercial |
$118.30
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$123.50
|
| Rate for Payer: Quartz Beloit One Network |
$57.20
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: The Alliance Commercial |
$65.00
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$96.29
|
|
