|
T vulgaris
|
Professional
|
Both
|
$105.00
|
|
|
Service Code
|
CPT 86609
|
| Hospital Charge Code |
2942921
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$45.47 |
| Max. Negotiated Rate |
$99.75 |
| Rate for Payer: Aetna Commercial |
$99.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$90.30
|
| 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 |
$63.00
|
| Rate for Payer: Health EOS Commercial |
$95.55
|
| Rate for Payer: HFN Commercial |
$99.75
|
| 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: 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: The Alliance Commercial |
$52.50
|
| Rate for Payer: WEA Trust Commercial |
$57.75
|
| Rate for Payer: WPS Commercial |
$77.77
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$1,257.32
|
| 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
|
|
|
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 |
$5,848.00 |
| 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: The Alliance Commercial |
$5,848.00
|
| Rate for Payer: WEA Trust Commercial |
$804.10
|
| Rate for Payer: WPS Commercial |
$1,082.90
|
|
|
Tx Devices Design-Complex 7733426
|
Professional
|
Both
|
$451.00
|
|
|
Service Code
|
CPT 77334 26
|
| Hospital Charge Code |
5258640
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$198.44 |
| Max. Negotiated Rate |
$428.45 |
| Rate for Payer: Aetna Commercial |
$428.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$387.86
|
| 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 |
$270.60
|
| Rate for Payer: Health EOS Commercial |
$410.41
|
| Rate for Payer: HFN Commercial |
$428.45
|
| 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: 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: The Alliance Commercial |
$225.50
|
| Rate for Payer: WEA Trust Commercial |
$248.05
|
| Rate for Payer: WPS Commercial |
$334.06
|
|
|
Tx Devices Design-Intermediate 7733326
|
Professional
|
Both
|
$472.00
|
|
|
Service Code
|
CPT 77333 26
|
| Hospital Charge Code |
5258639
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.62 |
| Max. Negotiated Rate |
$448.40 |
| Rate for Payer: Aetna Commercial |
$448.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$405.92
|
| 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 |
$283.20
|
| Rate for Payer: Health EOS Commercial |
$429.52
|
| Rate for Payer: HFN Commercial |
$448.40
|
| 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: 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: The Alliance Commercial |
$236.00
|
| Rate for Payer: WEA Trust Commercial |
$259.60
|
| Rate for Payer: WPS Commercial |
$349.61
|
|
|
Tx Devices Design-Simple 7733226
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 77332 26
|
| Hospital Charge Code |
5258634
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.68 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| 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 |
$196.80
|
| Rate for Payer: Health EOS Commercial |
$298.48
|
| Rate for Payer: HFN Commercial |
$311.60
|
| 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: 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: The Alliance Commercial |
$164.00
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
Tymp And Art
|
Professional
|
Both
|
$263.00
|
|
|
Service Code
|
CPT 92550
|
| Hospital Charge Code |
3203502
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$76.32 |
| Max. Negotiated Rate |
$249.85 |
| Rate for Payer: Aetna Commercial |
$249.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| 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 |
$157.80
|
| Rate for Payer: Health EOS Commercial |
$239.33
|
| Rate for Payer: HFN Commercial |
$249.85
|
| 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: 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: The Alliance Commercial |
$131.50
|
| Rate for Payer: WEA Trust Commercial |
$144.65
|
| Rate for Payer: WPS Commercial |
$194.80
|
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$226.18
|
| 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 |
$617.56 |
| 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: The Alliance Commercial |
$617.56
|
| 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
|
Both
|
$673.00
|
|
|
Service Code
|
CPT 69610
|
| Hospital Charge Code |
1152802
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.33 |
| Max. Negotiated Rate |
$952.96 |
| Rate for Payer: Aetna Commercial |
$639.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.78
|
| 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 |
$47.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.80
|
| Rate for Payer: Health EOS Commercial |
$612.43
|
| Rate for Payer: HFN Commercial |
$639.35
|
| 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: 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: The Alliance Commercial |
$336.50
|
| Rate for Payer: United Healthcare Medicaid |
$47.33
|
| Rate for Payer: WEA Trust Commercial |
$370.15
|
| Rate for Payer: WPS Commercial |
$498.49
|
|
|
Tympanometry
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
1152820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| 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 |
$62.40
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| 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: 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: The Alliance Commercial |
$52.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| 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
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
1152820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$158.56 |
| 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: The Alliance Commercial |
$158.56
|
| 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 9256750
|
Professional
|
Both
|
$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: HFN Commercial |
$123.50
|
| 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
|
|
|
Tympanometry Binaural
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$158.56 |
| 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: The Alliance Commercial |
$158.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$39.64
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Tympanometry Binaural
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| 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 Binaural
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203504
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| 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 |
$62.40
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| 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: 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: The Alliance Commercial |
$52.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Tympanometry Monaural
|
Professional
|
Both
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$45.76 |
| Max. Negotiated Rate |
$98.80 |
| Rate for Payer: Aetna Commercial |
$98.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| 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 |
$62.40
|
| Rate for Payer: Health EOS Commercial |
$94.64
|
| Rate for Payer: HFN Commercial |
$98.80
|
| 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: 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: The Alliance Commercial |
$52.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
Tympanometry Monaural
|
Facility
|
IP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| 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 Monaural
|
Facility
|
OP
|
$104.00
|
|
|
Service Code
|
CPT 92567
|
| Hospital Charge Code |
3203505
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$39.64 |
| Max. Negotiated Rate |
$158.56 |
| 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: The Alliance Commercial |
$158.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.64
|
| Rate for Payer: United Healthcare PPO |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: Wellcare Medicare |
$39.64
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
|
TYMPANOPLASTY/TYMPANOMASTOIDECTOMY
|
Facility
|
IP
|
$5,417.00
|
|
| Hospital Charge Code |
2960463
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,654.33 |
| Max. Negotiated Rate |
$4,983.64 |
| Rate for Payer: Aetna Commercial |
$4,875.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,658.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,871.01
|
| Rate for Payer: Cash Price |
$1,625.10
|
| Rate for Payer: Cigna Commercial |
$4,983.64
|
| Rate for Payer: Health EOS Commercial |
$4,821.13
|
| Rate for Payer: HFN Commercial |
$4,983.64
|
| Rate for Payer: Multiplan Commercial |
$4,333.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,250.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,983.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,654.33
|
| Rate for Payer: Quartz Commercial |
$3,250.20
|
| Rate for Payer: WEA Trust Commercial |
$2,979.35
|
| Rate for Payer: WPS Commercial |
$4,012.37
|
|
|
TYMPANOPLASTY/TYMPANOMASTOIDECTOMY
|
Facility
|
OP
|
$5,417.00
|
|
| Hospital Charge Code |
2960463
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,516.76 |
| Max. Negotiated Rate |
$21,668.00 |
| Rate for Payer: Aetna Commercial |
$4,875.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,658.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,516.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,521.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,708.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,600.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,871.01
|
| Rate for Payer: Cash Price |
$1,625.10
|
| Rate for Payer: Cigna Commercial |
$4,983.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,031.35
|
| Rate for Payer: Health EOS Commercial |
$4,821.13
|
| Rate for Payer: HFN Commercial |
$4,983.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,062.75
|
| Rate for Payer: Multiplan Commercial |
$4,333.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,250.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,983.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,654.33
|
| Rate for Payer: Quartz Commercial |
$3,521.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,250.20
|
| Rate for Payer: The Alliance Commercial |
$21,668.00
|
| Rate for Payer: WEA Trust Commercial |
$2,979.35
|
| Rate for Payer: WPS Commercial |
$4,012.37
|
|
|
TYMPANOSTOMY (REQUIRING INSERTION OF VENTILATING TUBE), GENERAL ANESTHESIA
|
Facility
|
OP
|
$6,546.14
|
|
|
Service Code
|
CPT 69436
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,507.37 |
| Max. Negotiated Rate |
$6,546.14 |
| Rate for Payer: Aetna Managed Medicare |
$1,507.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,507.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,507.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,507.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,607.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,507.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,507.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,507.37
|
| Rate for Payer: NAPHCARE Commercial |
$2,261.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,507.37
|
| Rate for Payer: The Alliance Commercial |
$6,029.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,507.37
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,507.37
|
|
|
Tympanostomy With Tube
|
Professional
|
Both
|
$519.00
|
|
|
Service Code
|
CPT 69433
|
| Hospital Charge Code |
1152801
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.08 |
| Max. Negotiated Rate |
$493.05 |
| Rate for Payer: Aetna Commercial |
$493.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$446.34
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cash Price |
$155.70
|
| Rate for Payer: Cigna Commercial |
$493.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$165.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$311.40
|
| Rate for Payer: Health EOS Commercial |
$472.29
|
| Rate for Payer: HFN Commercial |
$493.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$436.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$436.59
|
| Rate for Payer: Multiplan Commercial |
$415.20
|
| Rate for Payer: Preferred Network Access Commercial |
$493.05
|
| Rate for Payer: Quartz Beloit One Network |
$228.36
|
| Rate for Payer: Quartz Commercial |
$295.83
|
| Rate for Payer: The Alliance Commercial |
$259.50
|
| Rate for Payer: United Healthcare Medicaid |
$165.08
|
| Rate for Payer: WEA Trust Commercial |
$285.45
|
| Rate for Payer: WPS Commercial |
$384.42
|
|
|
TYMPANOSTOMY WITH TUBES, BILATERAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959854
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
