|
HEAD TRAUMA WITH COMA > 1 HOUR OR HEMORRHAGE
|
Facility
|
IP
|
$14,029.30
|
|
|
Service Code
|
APR-DRG 0553
|
| Min. Negotiated Rate |
$12,461.70 |
| Max. Negotiated Rate |
$14,029.30 |
| Rate for Payer: Anthem Medicaid |
$13,433.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,433.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,433.82
|
| Rate for Payer: Dean Health Medicaid |
$13,433.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,461.70
|
| Rate for Payer: Managed Health Services Medicaid |
$14,029.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,433.82
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,433.82
|
| Rate for Payer: United Healthcare Medicaid |
$13,433.82
|
|
|
HEAD TRAUMA WITH LOC/COMA MORE THEN 1 HR
|
Facility
|
OP
|
$96.96
|
|
|
Service Code
|
EAPG 00538
|
| Min. Negotiated Rate |
$93.23 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Anthem Medicaid |
$93.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$93.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.23
|
| Rate for Payer: Dean Health Medicaid |
$93.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$93.23
|
| Rate for Payer: Managed Health Services Medicaid |
$96.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$93.23
|
| Rate for Payer: United Healthcare Medicaid |
$93.23
|
|
|
HEALON PRO 0.85ML
|
Facility
|
OP
|
$618.00
|
|
| Hospital Charge Code |
6175034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$179.96 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna Commercial |
$578.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.74
|
| Rate for Payer: Aetna Managed Medicare |
$179.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$417.77
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$308.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.64
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$591.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$359.68
|
| Rate for Payer: Health EOS Commercial |
$572.02
|
| Rate for Payer: HFN Commercial |
$591.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$482.04
|
| Rate for Payer: Multiplan Commercial |
$514.18
|
| Rate for Payer: NAPHCARE Commercial |
$385.63
|
| Rate for Payer: Preferred Network Access Commercial |
$591.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.93
|
| Rate for Payer: Quartz Commercial |
$417.77
|
| Rate for Payer: Quartz Medicare Advantage |
$385.63
|
| Rate for Payer: The Alliance Commercial |
$321.36
|
| Rate for Payer: WEA Trust Commercial |
$353.50
|
| Rate for Payer: WPS Commercial |
$476.05
|
|
|
HEALON PRO 0.85ML
|
Facility
|
IP
|
$618.00
|
|
| Hospital Charge Code |
6175034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$314.93 |
| Max. Negotiated Rate |
$591.30 |
| Rate for Payer: Aetna Commercial |
$578.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$552.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$340.64
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$591.30
|
| Rate for Payer: Health EOS Commercial |
$572.02
|
| Rate for Payer: HFN Commercial |
$591.30
|
| Rate for Payer: Multiplan Commercial |
$514.18
|
| Rate for Payer: Preferred Network Access Commercial |
$591.30
|
| Rate for Payer: Quartz Beloit One Network |
$314.93
|
| Rate for Payer: Quartz Commercial |
$385.63
|
| Rate for Payer: WEA Trust Commercial |
$353.50
|
| Rate for Payer: WPS Commercial |
$476.05
|
|
|
Healthy Shot
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
3031438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Aetna Managed Medicare |
$2.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.07
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.46
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: NAPHCARE Commercial |
$4.37
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.73
|
| Rate for Payer: Quartz Medicare Advantage |
$4.37
|
| Rate for Payer: The Alliance Commercial |
$3.64
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Healthy Shot
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
3031438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$3.57 |
| Max. Negotiated Rate |
$6.70 |
| Rate for Payer: Aetna Commercial |
$6.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3.86
|
| Rate for Payer: Cash Price |
$2.10
|
| Rate for Payer: Cigna Commercial |
$6.70
|
| Rate for Payer: Health EOS Commercial |
$6.48
|
| Rate for Payer: HFN Commercial |
$6.70
|
| Rate for Payer: Multiplan Commercial |
$5.82
|
| Rate for Payer: Preferred Network Access Commercial |
$6.70
|
| Rate for Payer: Quartz Beloit One Network |
$3.57
|
| Rate for Payer: Quartz Commercial |
$4.37
|
| Rate for Payer: WEA Trust Commercial |
$4.00
|
| Rate for Payer: WPS Commercial |
$5.39
|
|
|
Hearing Aid Check; Binaural
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230816
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$28.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.66
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$60.53
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$65.57
|
| Rate for Payer: Quartz Medicare Advantage |
$60.53
|
| Rate for Payer: The Alliance Commercial |
$50.44
|
| Rate for Payer: United Healthcare PPO |
$75.66
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
Hearing Aid Check; Binaural
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230816
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$44.39 |
| Max. Negotiated Rate |
$95.84 |
| Rate for Payer: Aetna Commercial |
$95.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$95.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$91.80
|
| Rate for Payer: HFN Commercial |
$95.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.05
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: Preferred Network Access Commercial |
$95.84
|
| Rate for Payer: Quartz Beloit One Network |
$44.39
|
| Rate for Payer: Quartz Commercial |
$57.50
|
| Rate for Payer: The Alliance Commercial |
$50.44
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
Hearing Aid Check; Binaural
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230816
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$49.43 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$60.53
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
HEARING AID CHECK, BOTH EARS 92593
|
Professional
|
Both
|
$146.00
|
|
|
Service Code
|
CPT 92593
|
| Hospital Charge Code |
3015346
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$66.81 |
| Max. Negotiated Rate |
$144.25 |
| Rate for Payer: Aetna Commercial |
$144.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$130.58
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$144.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.10
|
| Rate for Payer: Health EOS Commercial |
$138.17
|
| Rate for Payer: HFN Commercial |
$144.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.27
|
| Rate for Payer: Multiplan Commercial |
$121.47
|
| Rate for Payer: Preferred Network Access Commercial |
$144.25
|
| Rate for Payer: Quartz Beloit One Network |
$66.81
|
| Rate for Payer: Quartz Commercial |
$86.55
|
| Rate for Payer: The Alliance Commercial |
$75.92
|
| Rate for Payer: WEA Trust Commercial |
$83.51
|
| Rate for Payer: WPS Commercial |
$112.46
|
|
|
Hearing Aid Check; Monaural
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230815
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$44.39 |
| Max. Negotiated Rate |
$95.84 |
| Rate for Payer: Aetna Commercial |
$95.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$95.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$60.53
|
| Rate for Payer: Health EOS Commercial |
$91.80
|
| Rate for Payer: HFN Commercial |
$95.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$77.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77.05
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: Preferred Network Access Commercial |
$95.84
|
| Rate for Payer: Quartz Beloit One Network |
$44.39
|
| Rate for Payer: Quartz Commercial |
$57.50
|
| Rate for Payer: The Alliance Commercial |
$50.44
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
Hearing Aid Check; Monaural
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230815
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$28.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.66
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$60.53
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$65.57
|
| Rate for Payer: Quartz Medicare Advantage |
$60.53
|
| Rate for Payer: The Alliance Commercial |
$50.44
|
| Rate for Payer: United Healthcare PPO |
$75.66
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
Hearing Aid Check; Monaural
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230815
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$49.43 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$60.53
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
HEARING AID CHECK, ONE EAR 92592
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
3015345
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$49.43 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$60.53
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
HEARING AID CHECK, ONE EAR 92592
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
3015345
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.25 |
| Max. Negotiated Rate |
$92.81 |
| Rate for Payer: Aetna Commercial |
$90.79
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$86.76
|
| Rate for Payer: Aetna Managed Medicare |
$28.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$65.57
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$50.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$48.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$53.47
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$89.78
|
| Rate for Payer: HFN Commercial |
$92.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75.66
|
| Rate for Payer: Multiplan Commercial |
$80.70
|
| Rate for Payer: NAPHCARE Commercial |
$60.53
|
| Rate for Payer: Preferred Network Access Commercial |
$92.81
|
| Rate for Payer: Quartz Beloit One Network |
$49.43
|
| Rate for Payer: Quartz Commercial |
$65.57
|
| Rate for Payer: Quartz Medicare Advantage |
$60.53
|
| Rate for Payer: The Alliance Commercial |
$50.44
|
| Rate for Payer: WEA Trust Commercial |
$55.48
|
| Rate for Payer: WPS Commercial |
$74.72
|
|
|
Hearing aid, contralateral routing system, binaural, bte/bte V5221
|
Facility
|
IP
|
$3,724.00
|
|
|
Service Code
|
HCPCS V5221
|
| Hospital Charge Code |
5455119
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$1,897.75 |
| Max. Negotiated Rate |
$3,563.12 |
| Rate for Payer: Aetna Commercial |
$3,485.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,330.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,052.67
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,563.12
|
| Rate for Payer: Health EOS Commercial |
$3,446.93
|
| Rate for Payer: HFN Commercial |
$3,563.12
|
| Rate for Payer: Multiplan Commercial |
$3,098.37
|
| Rate for Payer: Preferred Network Access Commercial |
$3,563.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,897.75
|
| Rate for Payer: Quartz Commercial |
$2,323.78
|
| Rate for Payer: WEA Trust Commercial |
$2,130.13
|
| Rate for Payer: WPS Commercial |
$2,868.60
|
|
|
Hearing aid, contralateral routing system, binaural, bte/bte V5221
|
Professional
|
Both
|
$3,724.00
|
|
|
Service Code
|
HCPCS V5221
|
| Hospital Charge Code |
5455119
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$1,704.10 |
| Max. Negotiated Rate |
$3,679.31 |
| Rate for Payer: Aetna Commercial |
$3,679.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,330.75
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,679.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,936.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,323.78
|
| Rate for Payer: Health EOS Commercial |
$3,524.39
|
| Rate for Payer: HFN Commercial |
$3,679.31
|
| Rate for Payer: Multiplan Commercial |
$3,098.37
|
| Rate for Payer: Preferred Network Access Commercial |
$3,679.31
|
| Rate for Payer: Quartz Beloit One Network |
$1,704.10
|
| Rate for Payer: Quartz Commercial |
$2,207.59
|
| Rate for Payer: The Alliance Commercial |
$1,936.48
|
| Rate for Payer: WEA Trust Commercial |
$2,130.13
|
| Rate for Payer: WPS Commercial |
$2,868.60
|
|
|
Hearing aid, contralateral routing system, binaural, bte/bte V5221
|
Facility
|
OP
|
$3,724.00
|
|
|
Service Code
|
HCPCS V5221
|
| Hospital Charge Code |
5455119
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$1,084.43 |
| Max. Negotiated Rate |
$3,563.12 |
| Rate for Payer: Aetna Commercial |
$3,485.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,330.75
|
| Rate for Payer: Aetna Managed Medicare |
$1,084.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,517.42
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,936.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,859.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,052.67
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,563.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,167.37
|
| Rate for Payer: Health EOS Commercial |
$3,446.93
|
| Rate for Payer: HFN Commercial |
$3,563.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,904.72
|
| Rate for Payer: Multiplan Commercial |
$3,098.37
|
| Rate for Payer: NAPHCARE Commercial |
$2,323.78
|
| Rate for Payer: Preferred Network Access Commercial |
$3,563.12
|
| Rate for Payer: Quartz Beloit One Network |
$1,897.75
|
| Rate for Payer: Quartz Commercial |
$2,517.42
|
| Rate for Payer: Quartz Medicare Advantage |
$2,323.78
|
| Rate for Payer: The Alliance Commercial |
$1,936.48
|
| Rate for Payer: United Healthcare PPO |
$2,904.72
|
| Rate for Payer: WEA Trust Commercial |
$2,130.13
|
| Rate for Payer: WPS Commercial |
$2,868.60
|
|
|
Hearing Aid, Digit, Bin, Bte
|
Facility
|
OP
|
$4,602.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
3243639
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$1,340.10 |
| Max. Negotiated Rate |
$4,403.19 |
| Rate for Payer: Aetna Commercial |
$4,307.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.03
|
| Rate for Payer: Aetna Managed Medicare |
$1,340.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,110.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,393.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,297.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.62
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$4,403.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,678.36
|
| Rate for Payer: Health EOS Commercial |
$4,259.61
|
| Rate for Payer: HFN Commercial |
$4,403.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,589.56
|
| Rate for Payer: Multiplan Commercial |
$3,828.86
|
| Rate for Payer: NAPHCARE Commercial |
$2,871.65
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.18
|
| Rate for Payer: Quartz Commercial |
$3,110.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,871.65
|
| Rate for Payer: The Alliance Commercial |
$2,393.04
|
| Rate for Payer: United Healthcare PPO |
$3,589.56
|
| Rate for Payer: WEA Trust Commercial |
$2,632.34
|
| Rate for Payer: WPS Commercial |
$3,544.92
|
|
|
Hearing Aid, Digit, Bin, Bte
|
Professional
|
Both
|
$4,602.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
3243639
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$2,105.88 |
| Max. Negotiated Rate |
$4,546.78 |
| Rate for Payer: Aetna Commercial |
$4,546.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.03
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$4,546.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,393.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,871.65
|
| Rate for Payer: Health EOS Commercial |
$4,355.33
|
| Rate for Payer: HFN Commercial |
$4,546.78
|
| Rate for Payer: Multiplan Commercial |
$3,828.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,546.78
|
| Rate for Payer: Quartz Beloit One Network |
$2,105.88
|
| Rate for Payer: Quartz Commercial |
$2,728.07
|
| Rate for Payer: The Alliance Commercial |
$2,393.04
|
| Rate for Payer: WEA Trust Commercial |
$2,632.34
|
| Rate for Payer: WPS Commercial |
$3,544.92
|
|
|
Hearing Aid, Digit, Bin, Bte
|
Facility
|
IP
|
$4,602.00
|
|
|
Service Code
|
HCPCS V5261
|
| Hospital Charge Code |
3243639
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$2,345.18 |
| Max. Negotiated Rate |
$4,403.19 |
| Rate for Payer: Aetna Commercial |
$4,307.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,116.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,536.62
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$4,403.19
|
| Rate for Payer: Health EOS Commercial |
$4,259.61
|
| Rate for Payer: HFN Commercial |
$4,403.19
|
| Rate for Payer: Multiplan Commercial |
$3,828.86
|
| Rate for Payer: Preferred Network Access Commercial |
$4,403.19
|
| Rate for Payer: Quartz Beloit One Network |
$2,345.18
|
| Rate for Payer: Quartz Commercial |
$2,871.65
|
| Rate for Payer: WEA Trust Commercial |
$2,632.34
|
| Rate for Payer: WPS Commercial |
$3,544.92
|
|
|
Hearing Aid, Digit, Bin, Ite
|
Facility
|
IP
|
$1,762.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
3243633
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$897.92 |
| Max. Negotiated Rate |
$1,685.88 |
| Rate for Payer: Aetna Commercial |
$1,649.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,575.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.21
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$1,685.88
|
| Rate for Payer: Health EOS Commercial |
$1,630.91
|
| Rate for Payer: HFN Commercial |
$1,685.88
|
| Rate for Payer: Multiplan Commercial |
$1,465.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,685.88
|
| Rate for Payer: Quartz Beloit One Network |
$897.92
|
| Rate for Payer: Quartz Commercial |
$1,099.49
|
| Rate for Payer: WEA Trust Commercial |
$1,007.86
|
| Rate for Payer: WPS Commercial |
$1,357.27
|
|
|
Hearing Aid, Digit, Bin, Ite
|
Professional
|
Both
|
$1,762.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
3243633
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$806.29 |
| Max. Negotiated Rate |
$1,740.86 |
| Rate for Payer: Aetna Commercial |
$1,740.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,575.93
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$1,740.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$916.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,099.49
|
| Rate for Payer: Health EOS Commercial |
$1,667.56
|
| Rate for Payer: HFN Commercial |
$1,740.86
|
| Rate for Payer: Multiplan Commercial |
$1,465.98
|
| Rate for Payer: Preferred Network Access Commercial |
$1,740.86
|
| Rate for Payer: Quartz Beloit One Network |
$806.29
|
| Rate for Payer: Quartz Commercial |
$1,044.51
|
| Rate for Payer: The Alliance Commercial |
$916.24
|
| Rate for Payer: WEA Trust Commercial |
$1,007.86
|
| Rate for Payer: WPS Commercial |
$1,357.27
|
|
|
Hearing Aid, Digit, Bin, Ite
|
Facility
|
OP
|
$1,762.00
|
|
|
Service Code
|
HCPCS V5260
|
| Hospital Charge Code |
3243633
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$513.09 |
| Max. Negotiated Rate |
$1,685.88 |
| Rate for Payer: Aetna Commercial |
$1,649.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,575.93
|
| Rate for Payer: Aetna Managed Medicare |
$513.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,191.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$916.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$879.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$971.21
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$1,685.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,025.48
|
| Rate for Payer: Health EOS Commercial |
$1,630.91
|
| Rate for Payer: HFN Commercial |
$1,685.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,374.36
|
| Rate for Payer: Multiplan Commercial |
$1,465.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,099.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,685.88
|
| Rate for Payer: Quartz Beloit One Network |
$897.92
|
| Rate for Payer: Quartz Commercial |
$1,191.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,099.49
|
| Rate for Payer: The Alliance Commercial |
$916.24
|
| Rate for Payer: United Healthcare PPO |
$1,374.36
|
| Rate for Payer: WEA Trust Commercial |
$1,007.86
|
| Rate for Payer: WPS Commercial |
$1,357.27
|
|
|
Hearing Aid, Digit, Mon, Bte
|
Professional
|
Both
|
$2,610.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
3243617
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$1,194.34 |
| Max. Negotiated Rate |
$2,578.68 |
| Rate for Payer: Aetna Commercial |
$2,578.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.38
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,578.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,357.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,628.64
|
| Rate for Payer: Health EOS Commercial |
$2,470.10
|
| Rate for Payer: HFN Commercial |
$2,578.68
|
| Rate for Payer: Multiplan Commercial |
$2,171.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,578.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,194.34
|
| Rate for Payer: Quartz Commercial |
$1,547.21
|
| Rate for Payer: The Alliance Commercial |
$1,357.20
|
| Rate for Payer: WEA Trust Commercial |
$1,492.92
|
| Rate for Payer: WPS Commercial |
$2,010.48
|
|
