|
Vistaril 25 mg Charge
|
Professional
|
Both
|
$7.00
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
2958853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.08 |
| Max. Negotiated Rate |
$34.67 |
| Rate for Payer: Aetna Commercial |
$6.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.87
|
| Rate for Payer: Health EOS Commercial |
$6.37
|
| Rate for Payer: HFN Commercial |
$6.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.19
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6.65
|
| Rate for Payer: Quartz Beloit One Network |
$3.08
|
| Rate for Payer: Quartz Commercial |
$3.99
|
| Rate for Payer: The Alliance Commercial |
$3.50
|
| Rate for Payer: United Healthcare Medicaid |
$13.87
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$34.67
|
|
|
Vistaril 25 mg Charge
|
Facility
|
IP
|
$7.00
|
|
|
Service Code
|
HCPCS J3410
|
| Hospital Charge Code |
2958853
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.43 |
| Max. Negotiated Rate |
$6.44 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.71
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.44
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Multiplan Commercial |
$5.60
|
| Rate for Payer: NAPHCARE Commercial |
$4.20
|
| Rate for Payer: Preferred Network Access Commercial |
$6.44
|
| Rate for Payer: Quartz Beloit One Network |
$3.43
|
| Rate for Payer: Quartz Commercial |
$4.20
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
VISUAL FIELD EXAMINATION(S) 92082
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 92082
|
| Hospital Charge Code |
3015325
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$161.39 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.85
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.20
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: HFN Commercial |
$63.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$161.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$161.39
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: United Healthcare Medicaid |
$54.85
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Visual Field Examination(s) 9208226
|
Professional
|
Both
|
$67.00
|
|
|
Service Code
|
CPT 92082 26
|
| Hospital Charge Code |
4616612
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.48 |
| Max. Negotiated Rate |
$72.82 |
| Rate for Payer: Aetna Commercial |
$63.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$57.62
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cash Price |
$20.10
|
| Rate for Payer: Cigna Commercial |
$63.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$33.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.20
|
| Rate for Payer: Health EOS Commercial |
$60.97
|
| Rate for Payer: HFN Commercial |
$63.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$72.82
|
| Rate for Payer: Multiplan Commercial |
$53.60
|
| Rate for Payer: Preferred Network Access Commercial |
$63.65
|
| Rate for Payer: Quartz Beloit One Network |
$29.48
|
| Rate for Payer: Quartz Commercial |
$38.19
|
| Rate for Payer: The Alliance Commercial |
$33.50
|
| Rate for Payer: WEA Trust Commercial |
$36.85
|
| Rate for Payer: WPS Commercial |
$49.63
|
|
|
Visual Field Examinations (S) 92083
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
CPT 92083
|
| Hospital Charge Code |
3713512
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$29.93 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.52
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna Commercial |
$410.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$259.20
|
| Rate for Payer: Health EOS Commercial |
$393.12
|
| Rate for Payer: HFN Commercial |
$410.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$215.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$215.47
|
| Rate for Payer: Multiplan Commercial |
$345.60
|
| Rate for Payer: Preferred Network Access Commercial |
$410.40
|
| Rate for Payer: Quartz Beloit One Network |
$190.08
|
| Rate for Payer: Quartz Commercial |
$246.24
|
| Rate for Payer: The Alliance Commercial |
$216.00
|
| Rate for Payer: United Healthcare Medicaid |
$29.93
|
| Rate for Payer: WEA Trust Commercial |
$237.60
|
| Rate for Payer: WPS Commercial |
$319.98
|
|
|
Visual Field Exam (S) 9208326
|
Professional
|
Both
|
$432.00
|
|
|
Service Code
|
CPT 92083 26
|
| Hospital Charge Code |
3147511
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$93.26 |
| Max. Negotiated Rate |
$410.40 |
| Rate for Payer: Aetna Commercial |
$410.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$371.52
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cash Price |
$129.60
|
| Rate for Payer: Cigna Commercial |
$410.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$216.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$259.20
|
| Rate for Payer: Health EOS Commercial |
$393.12
|
| Rate for Payer: HFN Commercial |
$410.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$93.26
|
| Rate for Payer: Multiplan Commercial |
$345.60
|
| Rate for Payer: Preferred Network Access Commercial |
$410.40
|
| Rate for Payer: Quartz Beloit One Network |
$190.08
|
| Rate for Payer: Quartz Commercial |
$246.24
|
| Rate for Payer: The Alliance Commercial |
$216.00
|
| Rate for Payer: WEA Trust Commercial |
$237.60
|
| Rate for Payer: WPS Commercial |
$319.98
|
|
|
VISUAL FIELD XM UNI/BI W/INTERPRET LIMITED EXAM - 92081
|
Professional
|
Both
|
$153.00
|
|
|
Service Code
|
CPT 92081
|
| Hospital Charge Code |
5785967
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.86 |
| Max. Negotiated Rate |
$145.35 |
| Rate for Payer: Aetna Commercial |
$145.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$131.58
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cash Price |
$45.90
|
| Rate for Payer: Cigna Commercial |
$145.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.80
|
| Rate for Payer: Health EOS Commercial |
$139.23
|
| Rate for Payer: HFN Commercial |
$145.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.27
|
| Rate for Payer: Multiplan Commercial |
$122.40
|
| Rate for Payer: Preferred Network Access Commercial |
$145.35
|
| Rate for Payer: Quartz Beloit One Network |
$67.32
|
| Rate for Payer: Quartz Commercial |
$87.21
|
| Rate for Payer: The Alliance Commercial |
$76.50
|
| Rate for Payer: United Healthcare Medicaid |
$42.86
|
| Rate for Payer: WEA Trust Commercial |
$84.15
|
| Rate for Payer: WPS Commercial |
$113.33
|
|
|
VISUALIZATION OF WINDPIPE 31615
|
Professional
|
Both
|
$1,397.00
|
|
|
Service Code
|
CPT 31615
|
| Hospital Charge Code |
3014397
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$158.46 |
| Max. Negotiated Rate |
$1,327.15 |
| Rate for Payer: Aetna Commercial |
$1,327.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,201.42
|
| Rate for Payer: Cash Price |
$419.10
|
| Rate for Payer: Cash Price |
$419.10
|
| Rate for Payer: Cigna Commercial |
$1,327.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$838.20
|
| Rate for Payer: Health EOS Commercial |
$1,271.27
|
| Rate for Payer: HFN Commercial |
$1,327.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$379.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$379.62
|
| Rate for Payer: Multiplan Commercial |
$1,117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,327.15
|
| Rate for Payer: Quartz Beloit One Network |
$614.68
|
| Rate for Payer: Quartz Commercial |
$796.29
|
| Rate for Payer: The Alliance Commercial |
$698.50
|
| Rate for Payer: United Healthcare Medicaid |
$158.46
|
| Rate for Payer: WEA Trust Commercial |
$768.35
|
| Rate for Payer: WPS Commercial |
$1,034.76
|
|
|
VISUALIZATION SYSTEM CLEARIFY 21-345
|
Facility
|
IP
|
$646.00
|
|
| Hospital Charge Code |
4493782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$316.54 |
| Max. Negotiated Rate |
$594.32 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$387.60
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
VISUALIZATION SYSTEM CLEARIFY 21-345
|
Facility
|
OP
|
$646.00
|
|
| Hospital Charge Code |
4493782
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$180.88 |
| Max. Negotiated Rate |
$2,584.00 |
| Rate for Payer: Aetna Commercial |
$581.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$555.56
|
| Rate for Payer: Aetna Managed Medicare |
$180.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$419.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$323.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$310.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$342.38
|
| Rate for Payer: Cash Price |
$193.80
|
| Rate for Payer: Cigna Commercial |
$594.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$361.50
|
| Rate for Payer: Health EOS Commercial |
$574.94
|
| Rate for Payer: HFN Commercial |
$594.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$484.50
|
| Rate for Payer: Multiplan Commercial |
$516.80
|
| Rate for Payer: NAPHCARE Commercial |
$387.60
|
| Rate for Payer: Preferred Network Access Commercial |
$594.32
|
| Rate for Payer: Quartz Beloit One Network |
$316.54
|
| Rate for Payer: Quartz Commercial |
$419.90
|
| Rate for Payer: Quartz Medicare Advantage |
$387.60
|
| Rate for Payer: The Alliance Commercial |
$2,584.00
|
| Rate for Payer: WEA Trust Commercial |
$355.30
|
| Rate for Payer: WPS Commercial |
$478.49
|
|
|
Visual Reinforcement Audiometry
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
1188814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.84 |
| Max. Negotiated Rate |
$617.56 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.84
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| 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 |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| 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 |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| 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: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Visual Reinforcement Audiometry
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
1188814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$130.61 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.61
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Visual Reinforcement Audiometry
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
1188814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Visual Reinforcement Audiomety
|
Facility
|
OP
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
3203506
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$39.84 |
| Max. Negotiated Rate |
$617.56 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Aetna Managed Medicare |
$154.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$41.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$39.84
|
| Rate for Payer: Anthem Medicare Advantage |
$154.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| 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 |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$154.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$154.39
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| 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 |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$231.58
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$53.95
|
| 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 |
$62.25
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: Wellcare Medicare |
$154.39
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Visual Reinforcement Audiomety
|
Professional
|
Both
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
3203506
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$36.52 |
| Max. Negotiated Rate |
$130.61 |
| Rate for Payer: Aetna Commercial |
$78.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$78.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$75.53
|
| Rate for Payer: HFN Commercial |
$78.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$130.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$130.61
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: Preferred Network Access Commercial |
$78.85
|
| Rate for Payer: Quartz Beloit One Network |
$36.52
|
| Rate for Payer: Quartz Commercial |
$47.31
|
| Rate for Payer: The Alliance Commercial |
$41.50
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Visual Reinforcement Audiomety
|
Facility
|
IP
|
$83.00
|
|
|
Service Code
|
CPT 92579
|
| Hospital Charge Code |
3203506
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$40.67 |
| Max. Negotiated Rate |
$76.36 |
| Rate for Payer: Aetna Commercial |
$74.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$71.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$43.99
|
| Rate for Payer: Cash Price |
$24.90
|
| Rate for Payer: Cigna Commercial |
$76.36
|
| Rate for Payer: Health EOS Commercial |
$73.87
|
| Rate for Payer: HFN Commercial |
$76.36
|
| Rate for Payer: Multiplan Commercial |
$66.40
|
| Rate for Payer: NAPHCARE Commercial |
$49.80
|
| Rate for Payer: Preferred Network Access Commercial |
$76.36
|
| Rate for Payer: Quartz Beloit One Network |
$40.67
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: WEA Trust Commercial |
$45.65
|
| Rate for Payer: WPS Commercial |
$61.48
|
|
|
Vital 1.0
|
Facility
|
OP
|
$77.00
|
|
|
Service Code
|
HCPCS B4153
|
| Hospital Charge Code |
3031455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$21.56 |
| Max. Negotiated Rate |
$308.00 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Aetna Managed Medicare |
$21.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.09
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.75
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$50.05
|
| Rate for Payer: Quartz Medicare Advantage |
$46.20
|
| Rate for Payer: The Alliance Commercial |
$308.00
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
Vital 1.0
|
Facility
|
IP
|
$77.00
|
|
|
Service Code
|
HCPCS B4153
|
| Hospital Charge Code |
3031455
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$37.73 |
| Max. Negotiated Rate |
$70.84 |
| Rate for Payer: Aetna Commercial |
$69.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.81
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$70.84
|
| Rate for Payer: Health EOS Commercial |
$68.53
|
| Rate for Payer: HFN Commercial |
$70.84
|
| Rate for Payer: Multiplan Commercial |
$61.60
|
| Rate for Payer: NAPHCARE Commercial |
$46.20
|
| Rate for Payer: Preferred Network Access Commercial |
$70.84
|
| Rate for Payer: Quartz Beloit One Network |
$37.73
|
| Rate for Payer: Quartz Commercial |
$46.20
|
| Rate for Payer: WEA Trust Commercial |
$42.35
|
| Rate for Payer: WPS Commercial |
$57.03
|
|
|
VITAL CAPACITY TEST 94150
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
CPT 94150
|
| Hospital Charge Code |
3015454
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$9.68 |
| Max. Negotiated Rate |
$83.63 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.20
|
| Rate for Payer: Health EOS Commercial |
$20.02
|
| Rate for Payer: HFN Commercial |
$20.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.63
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Preferred Network Access Commercial |
$20.90
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$12.54
|
| Rate for Payer: The Alliance Commercial |
$11.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.15
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
Vital Signs Monitor Dymap
|
Facility
|
IP
|
$371.00
|
|
| Hospital Charge Code |
3101752
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$181.79 |
| Max. Negotiated Rate |
$341.32 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$222.60
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
Vital Signs Monitor Dymap
|
Facility
|
OP
|
$371.00
|
|
| Hospital Charge Code |
3101752
|
|
Hospital Revenue Code
|
370
|
| Min. Negotiated Rate |
$103.88 |
| Max. Negotiated Rate |
$1,484.00 |
| Rate for Payer: Aetna Commercial |
$333.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$319.06
|
| Rate for Payer: Aetna Managed Medicare |
$103.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$241.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$185.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$178.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$196.63
|
| Rate for Payer: Cash Price |
$111.30
|
| Rate for Payer: Cigna Commercial |
$341.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207.61
|
| Rate for Payer: Health EOS Commercial |
$330.19
|
| Rate for Payer: HFN Commercial |
$341.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.25
|
| Rate for Payer: Multiplan Commercial |
$296.80
|
| Rate for Payer: NAPHCARE Commercial |
$222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$341.32
|
| Rate for Payer: Quartz Beloit One Network |
$181.79
|
| Rate for Payer: Quartz Commercial |
$241.15
|
| Rate for Payer: Quartz Medicare Advantage |
$222.60
|
| Rate for Payer: The Alliance Commercial |
$1,484.00
|
| Rate for Payer: WEA Trust Commercial |
$204.05
|
| Rate for Payer: WPS Commercial |
$274.80
|
|
|
Vitamin A Level
|
Facility
|
IP
|
$219.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
978090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$107.31 |
| Max. Negotiated Rate |
$201.48 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$188.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.07
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$201.48
|
| Rate for Payer: Health EOS Commercial |
$194.91
|
| Rate for Payer: HFN Commercial |
$201.48
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: NAPHCARE Commercial |
$131.40
|
| Rate for Payer: Preferred Network Access Commercial |
$201.48
|
| Rate for Payer: Quartz Beloit One Network |
$107.31
|
| Rate for Payer: Quartz Commercial |
$131.40
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
|
Vitamin A Level
|
Professional
|
Both
|
$219.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
978090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$40.98 |
| Max. Negotiated Rate |
$208.05 |
| Rate for Payer: Aetna Commercial |
$208.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$188.34
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$208.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.40
|
| Rate for Payer: Health EOS Commercial |
$199.29
|
| Rate for Payer: HFN Commercial |
$208.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.98
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: Preferred Network Access Commercial |
$208.05
|
| Rate for Payer: Quartz Beloit One Network |
$96.36
|
| Rate for Payer: Quartz Commercial |
$124.83
|
| Rate for Payer: The Alliance Commercial |
$109.50
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
|
Vitamin A Level
|
Facility
|
OP
|
$219.00
|
|
|
Service Code
|
CPT 84590
|
| Hospital Charge Code |
978090
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$11.61 |
| Max. Negotiated Rate |
$201.48 |
| Rate for Payer: Aetna Commercial |
$197.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$188.34
|
| Rate for Payer: Aetna Managed Medicare |
$11.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$43.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.27
|
| Rate for Payer: Anthem Medicaid |
$12.00
|
| Rate for Payer: Anthem Medicare Advantage |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.61
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cash Price |
$65.70
|
| Rate for Payer: Cigna Commercial |
$201.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.55
|
| Rate for Payer: Dean Health Medicaid |
$12.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.61
|
| Rate for Payer: Health EOS Commercial |
$194.91
|
| Rate for Payer: HFN Commercial |
$201.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.19
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.61
|
| Rate for Payer: Managed Health Services Medicaid |
$12.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.61
|
| Rate for Payer: Multiplan Commercial |
$175.20
|
| Rate for Payer: NAPHCARE Commercial |
$17.42
|
| Rate for Payer: Preferred Network Access Commercial |
$201.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.00
|
| Rate for Payer: Quartz Beloit One Network |
$107.31
|
| Rate for Payer: Quartz Commercial |
$142.35
|
| Rate for Payer: Quartz Medicare Advantage |
$11.61
|
| Rate for Payer: The Alliance Commercial |
$46.44
|
| Rate for Payer: United Healthcare Medicaid |
$12.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.61
|
| Rate for Payer: United Healthcare PPO |
$164.25
|
| Rate for Payer: WEA Trust Commercial |
$120.45
|
| Rate for Payer: Wellcare Medicare |
$11.61
|
| Rate for Payer: WMAP Medicaid |
$12.00
|
| Rate for Payer: WPS Commercial |
$162.21
|
|
|
Vitamin B12 Binding Capacity
|
Professional
|
Both
|
$302.00
|
|
|
Service Code
|
CPT 82608
|
| Hospital Charge Code |
983436
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$50.55 |
| Max. Negotiated Rate |
$286.90 |
| Rate for Payer: Aetna Commercial |
$286.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$259.72
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cash Price |
$90.60
|
| Rate for Payer: Cigna Commercial |
$286.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$151.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.20
|
| Rate for Payer: Health EOS Commercial |
$274.82
|
| Rate for Payer: HFN Commercial |
$286.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$50.55
|
| Rate for Payer: Multiplan Commercial |
$241.60
|
| Rate for Payer: Preferred Network Access Commercial |
$286.90
|
| Rate for Payer: Quartz Beloit One Network |
$132.88
|
| Rate for Payer: Quartz Commercial |
$172.14
|
| Rate for Payer: The Alliance Commercial |
$151.00
|
| Rate for Payer: WEA Trust Commercial |
$166.10
|
| Rate for Payer: WPS Commercial |
$223.69
|
|
