|
Tympanometry Binaural
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$8.72
|
| Rate for Payer: Anthem Medicare Advantage |
$8.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.72
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.72
|
| Rate for Payer: Health EOS Commercial |
$98.43
|
| Rate for Payer: HFN Commercial |
$102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.72
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$13.07
|
| Rate for Payer: Preferred Network Access Commercial |
$102.75
|
| Rate for Payer: Quartz Beloit One Network |
$47.59
|
| Rate for Payer: Quartz Commercial |
$61.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8.72
|
| Rate for Payer: The Alliance Commercial |
$21.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.72
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$34.86
|
|
|
Tympanometry Binaural
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Tympanometry Binaural
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare PPO |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Tympanometry Monaural
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$53.00 |
| Max. Negotiated Rate |
$99.51 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$64.90
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Tympanometry Monaural
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.31 |
| Max. Negotiated Rate |
$157.25 |
| Rate for Payer: Aetna Commercial |
$97.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$39.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$70.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$54.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$51.92
|
| Rate for Payer: Anthem Medicare Advantage |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$57.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.31
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$99.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.31
|
| Rate for Payer: Health EOS Commercial |
$96.26
|
| Rate for Payer: HFN Commercial |
$99.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.31
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$58.97
|
| Rate for Payer: Preferred Network Access Commercial |
$99.51
|
| Rate for Payer: Quartz Beloit One Network |
$53.00
|
| Rate for Payer: Quartz Commercial |
$70.30
|
| Rate for Payer: Quartz Medicare Advantage |
$39.31
|
| Rate for Payer: The Alliance Commercial |
$157.25
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.31
|
| Rate for Payer: United Healthcare PPO |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: Wellcare Medicare |
$39.31
|
| Rate for Payer: WPS Commercial |
$80.11
|
|
|
Tympanometry Monaural
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$8.72 |
| Max. Negotiated Rate |
$102.75 |
| Rate for Payer: Aetna Commercial |
$102.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$93.02
|
| Rate for Payer: Aetna Managed Medicare |
$8.72
|
| Rate for Payer: Anthem Medicare Advantage |
$8.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.72
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$102.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.72
|
| Rate for Payer: Health EOS Commercial |
$98.43
|
| Rate for Payer: HFN Commercial |
$102.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.72
|
| Rate for Payer: Multiplan Commercial |
$86.53
|
| Rate for Payer: NAPHCARE Commercial |
$13.07
|
| Rate for Payer: Preferred Network Access Commercial |
$102.75
|
| Rate for Payer: Quartz Beloit One Network |
$47.59
|
| Rate for Payer: Quartz Commercial |
$61.65
|
| Rate for Payer: Quartz Medicare Advantage |
$8.72
|
| Rate for Payer: The Alliance Commercial |
$21.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.72
|
| Rate for Payer: WEA Trust Commercial |
$59.49
|
| Rate for Payer: WPS Commercial |
$34.86
|
|
|
TYMPANOPLASTY/TYMPANOMASTOIDECTOMY
|
Facility
|
IP
|
$5,417.00
|
|
| Hospital Charge Code |
2960463
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,760.50 |
| Max. Negotiated Rate |
$5,182.99 |
| Rate for Payer: Aetna Commercial |
$5,070.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,844.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,985.85
|
| Rate for Payer: Cash Price |
$1,625.10
|
| Rate for Payer: Cigna Commercial |
$5,182.99
|
| Rate for Payer: Health EOS Commercial |
$5,013.98
|
| Rate for Payer: HFN Commercial |
$5,182.99
|
| Rate for Payer: Multiplan Commercial |
$4,506.94
|
| Rate for Payer: Preferred Network Access Commercial |
$5,182.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,760.50
|
| Rate for Payer: Quartz Commercial |
$3,380.21
|
| Rate for Payer: WEA Trust Commercial |
$3,098.52
|
| Rate for Payer: WPS Commercial |
$4,172.72
|
|
|
TYMPANOPLASTY/TYMPANOMASTOIDECTOMY
|
Facility
|
OP
|
$5,417.00
|
|
| Hospital Charge Code |
2960463
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,577.43 |
| Max. Negotiated Rate |
$5,182.99 |
| Rate for Payer: Aetna Commercial |
$5,070.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,844.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,577.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,661.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,816.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,704.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,985.85
|
| Rate for Payer: Cash Price |
$1,625.10
|
| Rate for Payer: Cigna Commercial |
$5,182.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,152.69
|
| Rate for Payer: Health EOS Commercial |
$5,013.98
|
| Rate for Payer: HFN Commercial |
$5,182.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,225.26
|
| Rate for Payer: Multiplan Commercial |
$4,506.94
|
| Rate for Payer: NAPHCARE Commercial |
$3,380.21
|
| Rate for Payer: Preferred Network Access Commercial |
$5,182.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,760.50
|
| Rate for Payer: Quartz Commercial |
$3,661.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,380.21
|
| Rate for Payer: The Alliance Commercial |
$2,816.84
|
| Rate for Payer: WEA Trust Commercial |
$3,098.52
|
| Rate for Payer: WPS Commercial |
$4,172.72
|
|
|
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
|
Facility
|
OP
|
$6,807.99
|
|
|
Service Code
|
CPT 69436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,632.87 |
| Max. Negotiated Rate |
$6,807.99 |
| Rate for Payer: Aetna Managed Medicare |
$1,632.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,632.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,632.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,632.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,632.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,074.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,632.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,632.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,632.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,632.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,449.31
|
| Rate for Payer: Quartz Medicare Advantage |
$1,632.87
|
| Rate for Payer: The Alliance Commercial |
$6,531.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,632.87
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$1,632.87
|
|
|
Tympanostomy With Tube
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
1152801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.63 |
| Max. Negotiated Rate |
$524.82 |
| Rate for Payer: Aetna Commercial |
$512.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$464.19
|
| Rate for Payer: Aetna Managed Medicare |
$116.63
|
| Rate for Payer: Anthem Medicare Advantage |
$116.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$116.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$116.63
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$512.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$171.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$116.63
|
| Rate for Payer: Health EOS Commercial |
$491.18
|
| Rate for Payer: HFN Commercial |
$512.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$454.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$454.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$116.63
|
| Rate for Payer: Multiplan Commercial |
$431.81
|
| Rate for Payer: NAPHCARE Commercial |
$174.94
|
| Rate for Payer: Preferred Network Access Commercial |
$512.77
|
| Rate for Payer: Quartz Beloit One Network |
$237.49
|
| Rate for Payer: Quartz Commercial |
$307.66
|
| Rate for Payer: Quartz Medicare Advantage |
$116.63
|
| Rate for Payer: The Alliance Commercial |
$495.66
|
| Rate for Payer: United Healthcare Medicaid |
$171.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$116.63
|
| Rate for Payer: WEA Trust Commercial |
$296.87
|
| Rate for Payer: WPS Commercial |
$524.82
|
|
|
TYMPANOSTOMY WITH TUBES, BILATERAL
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959854
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
TYMPANOSTOMY WITH TUBES, BILATERAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959854
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
TYMPANOTOMY, EXPLORATORY
|
Facility
|
OP
|
$4,643.00
|
|
| Hospital Charge Code |
2960464
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,352.04 |
| Max. Negotiated Rate |
$4,442.42 |
| Rate for Payer: Aetna Commercial |
$4,345.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Aetna Managed Medicare |
$1,352.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,138.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,414.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,317.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,559.22
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,442.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,702.23
|
| Rate for Payer: Health EOS Commercial |
$4,297.56
|
| Rate for Payer: HFN Commercial |
$4,442.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,621.54
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: NAPHCARE Commercial |
$2,897.23
|
| Rate for Payer: Preferred Network Access Commercial |
$4,442.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.07
|
| Rate for Payer: Quartz Commercial |
$3,138.67
|
| Rate for Payer: Quartz Medicare Advantage |
$2,897.23
|
| Rate for Payer: The Alliance Commercial |
$2,414.36
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: WPS Commercial |
$3,576.50
|
|
|
TYMPANOTOMY, EXPLORATORY
|
Facility
|
IP
|
$4,643.00
|
|
| Hospital Charge Code |
2960464
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,366.07 |
| Max. Negotiated Rate |
$4,442.42 |
| Rate for Payer: Aetna Commercial |
$4,345.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,152.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,559.22
|
| Rate for Payer: Cash Price |
$1,392.90
|
| Rate for Payer: Cigna Commercial |
$4,442.42
|
| Rate for Payer: Health EOS Commercial |
$4,297.56
|
| Rate for Payer: HFN Commercial |
$4,442.42
|
| Rate for Payer: Multiplan Commercial |
$3,862.98
|
| Rate for Payer: Preferred Network Access Commercial |
$4,442.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,366.07
|
| Rate for Payer: Quartz Commercial |
$2,897.23
|
| Rate for Payer: WEA Trust Commercial |
$2,655.80
|
| Rate for Payer: WPS Commercial |
$3,576.50
|
|
|
Tymp Art Ard
|
Facility
|
IP
|
$363.00
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
3203503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$184.98 |
| Max. Negotiated Rate |
$347.32 |
| Rate for Payer: Aetna Commercial |
$339.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.09
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$347.32
|
| Rate for Payer: Health EOS Commercial |
$335.99
|
| Rate for Payer: HFN Commercial |
$347.32
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: Preferred Network Access Commercial |
$347.32
|
| Rate for Payer: Quartz Beloit One Network |
$184.98
|
| Rate for Payer: Quartz Commercial |
$226.51
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$279.62
|
|
|
Tymp Art Ard
|
Facility
|
OP
|
$363.00
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
3203503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$135.42 |
| Max. Negotiated Rate |
$541.67 |
| Rate for Payer: Aetna Commercial |
$339.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Aetna Managed Medicare |
$135.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$245.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$188.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$181.21
|
| Rate for Payer: Anthem Medicare Advantage |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$200.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$135.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$135.42
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$347.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$135.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$211.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$135.42
|
| Rate for Payer: Health EOS Commercial |
$335.99
|
| Rate for Payer: HFN Commercial |
$347.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$503.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$135.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$135.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$135.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$135.42
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: NAPHCARE Commercial |
$203.13
|
| Rate for Payer: Preferred Network Access Commercial |
$347.32
|
| Rate for Payer: Quartz Beloit One Network |
$184.98
|
| Rate for Payer: Quartz Commercial |
$245.39
|
| Rate for Payer: Quartz Medicare Advantage |
$135.42
|
| Rate for Payer: The Alliance Commercial |
$541.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$135.42
|
| Rate for Payer: United Healthcare PPO |
$283.14
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: Wellcare Medicare |
$135.42
|
| Rate for Payer: WPS Commercial |
$279.62
|
|
|
Tymp Art Ard
|
Professional
|
Both
|
$363.00
|
|
|
Service Code
|
CPT 92570
|
| Hospital Charge Code |
3203503
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$24.20 |
| Max. Negotiated Rate |
$358.64 |
| Rate for Payer: Aetna Commercial |
$358.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$324.67
|
| Rate for Payer: Aetna Managed Medicare |
$24.20
|
| Rate for Payer: Anthem Medicare Advantage |
$24.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24.20
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cash Price |
$108.90
|
| Rate for Payer: Cigna Commercial |
$358.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$188.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24.20
|
| Rate for Payer: Health EOS Commercial |
$343.54
|
| Rate for Payer: HFN Commercial |
$358.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24.20
|
| Rate for Payer: Multiplan Commercial |
$302.02
|
| Rate for Payer: NAPHCARE Commercial |
$36.30
|
| Rate for Payer: Preferred Network Access Commercial |
$358.64
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$215.19
|
| Rate for Payer: Quartz Medicare Advantage |
$24.20
|
| Rate for Payer: The Alliance Commercial |
$60.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24.20
|
| Rate for Payer: WEA Trust Commercial |
$207.64
|
| Rate for Payer: WPS Commercial |
$96.80
|
|
|
U24 5 HIAA / 523
|
Professional
|
Both
|
$389.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
977767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$384.33 |
| Rate for Payer: Aetna Commercial |
$384.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$384.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$202.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$368.15
|
| Rate for Payer: HFN Commercial |
$384.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$323.65
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$384.33
|
| Rate for Payer: Quartz Beloit One Network |
$178.01
|
| Rate for Payer: Quartz Commercial |
$230.60
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$52.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: WPS Commercial |
$59.03
|
|
|
U24 5 HIAA / 523
|
Facility
|
IP
|
$389.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
977767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$198.23 |
| Max. Negotiated Rate |
$372.20 |
| Rate for Payer: Aetna Commercial |
$364.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.42
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$372.20
|
| Rate for Payer: Health EOS Commercial |
$360.06
|
| Rate for Payer: HFN Commercial |
$372.20
|
| Rate for Payer: Multiplan Commercial |
$323.65
|
| Rate for Payer: Preferred Network Access Commercial |
$372.20
|
| Rate for Payer: Quartz Beloit One Network |
$198.23
|
| Rate for Payer: Quartz Commercial |
$242.74
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: WPS Commercial |
$299.65
|
|
|
U24 5 HIAA / 523
|
Facility
|
OP
|
$389.00
|
|
|
Service Code
|
CPT 83497
|
| Hospital Charge Code |
977767
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.42 |
| Max. Negotiated Rate |
$372.20 |
| Rate for Payer: Aetna Commercial |
$364.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.92
|
| Rate for Payer: Aetna Managed Medicare |
$13.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.27
|
| Rate for Payer: Anthem Medicare Advantage |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.42
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cash Price |
$116.70
|
| Rate for Payer: Cigna Commercial |
$372.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.42
|
| Rate for Payer: Health EOS Commercial |
$360.06
|
| Rate for Payer: HFN Commercial |
$372.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.42
|
| Rate for Payer: Multiplan Commercial |
$323.65
|
| Rate for Payer: NAPHCARE Commercial |
$20.12
|
| Rate for Payer: Preferred Network Access Commercial |
$372.20
|
| Rate for Payer: Quartz Beloit One Network |
$198.23
|
| Rate for Payer: Quartz Commercial |
$262.96
|
| Rate for Payer: Quartz Medicare Advantage |
$13.42
|
| Rate for Payer: The Alliance Commercial |
$53.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.42
|
| Rate for Payer: United Healthcare PPO |
$303.42
|
| Rate for Payer: WEA Trust Commercial |
$222.51
|
| Rate for Payer: Wellcare Medicare |
$13.42
|
| Rate for Payer: WPS Commercial |
$299.65
|
|
|
U24 Creat
|
Facility
|
IP
|
$4.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
4619170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
U24 Creat
|
Professional
|
Both
|
$4.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
4619170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$1.83 |
| Max. Negotiated Rate |
$95.23 |
| Rate for Payer: Aetna Commercial |
$3.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$3.79
|
| Rate for Payer: HFN Commercial |
$3.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$76.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$76.40
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3.95
|
| Rate for Payer: Quartz Beloit One Network |
$1.83
|
| Rate for Payer: Quartz Commercial |
$2.37
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$85.49
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$95.23
|
|
|
U24 Creat
|
Facility
|
OP
|
$4.00
|
|
|
Service Code
|
CPT 86316
|
| Hospital Charge Code |
4619170
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$86.57 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$21.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.87
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.93
|
| Rate for Payer: Anthem Medicare Advantage |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.64
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$21.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$21.64
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.64
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$21.64
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$21.64
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$32.46
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$21.64
|
| Rate for Payer: The Alliance Commercial |
$86.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.64
|
| Rate for Payer: United Healthcare PPO |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: Wellcare Medicare |
$21.64
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
U24 Creatinine
|
Facility
|
OP
|
$116.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
978113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.39 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Aetna Managed Medicare |
$5.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.43
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.94
|
| Rate for Payer: Anthem Medicare Advantage |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.39
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.39
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.39
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: NAPHCARE Commercial |
$8.08
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$78.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5.39
|
| Rate for Payer: The Alliance Commercial |
$21.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.39
|
| Rate for Payer: United Healthcare PPO |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: Wellcare Medicare |
$5.39
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
|
U24 Creatinine
|
Facility
|
IP
|
$116.00
|
|
|
Service Code
|
CPT 82570
|
| Hospital Charge Code |
978113
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.11 |
| Max. Negotiated Rate |
$110.99 |
| Rate for Payer: Aetna Commercial |
$108.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$103.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.94
|
| Rate for Payer: Cash Price |
$34.80
|
| Rate for Payer: Cigna Commercial |
$110.99
|
| Rate for Payer: Health EOS Commercial |
$107.37
|
| Rate for Payer: HFN Commercial |
$110.99
|
| Rate for Payer: Multiplan Commercial |
$96.51
|
| Rate for Payer: Preferred Network Access Commercial |
$110.99
|
| Rate for Payer: Quartz Beloit One Network |
$59.11
|
| Rate for Payer: Quartz Commercial |
$72.38
|
| Rate for Payer: WEA Trust Commercial |
$66.35
|
| Rate for Payer: WPS Commercial |
$89.35
|
|
