|
Hearing Aid, Digit, Mon, Bte
|
Facility
|
OP
|
$2,610.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
3243617
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$760.03 |
| Max. Negotiated Rate |
$2,497.25 |
| Rate for Payer: Aetna Commercial |
$2,442.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.38
|
| Rate for Payer: Aetna Managed Medicare |
$760.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,764.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,357.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,302.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,438.63
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,497.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,519.02
|
| Rate for Payer: Health EOS Commercial |
$2,415.82
|
| Rate for Payer: HFN Commercial |
$2,497.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,035.80
|
| Rate for Payer: Multiplan Commercial |
$2,171.52
|
| Rate for Payer: NAPHCARE Commercial |
$1,628.64
|
| Rate for Payer: Preferred Network Access Commercial |
$2,497.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,330.06
|
| Rate for Payer: Quartz Commercial |
$1,764.36
|
| Rate for Payer: Quartz Medicare Advantage |
$1,628.64
|
| Rate for Payer: The Alliance Commercial |
$1,357.20
|
| Rate for Payer: United Healthcare PPO |
$2,035.80
|
| Rate for Payer: WEA Trust Commercial |
$1,492.92
|
| Rate for Payer: WPS Commercial |
$2,010.48
|
|
|
Hearing Aid, Digit, Mon, Bte
|
Facility
|
IP
|
$2,610.00
|
|
|
Service Code
|
HCPCS V5257
|
| Hospital Charge Code |
3243617
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$1,330.06 |
| Max. Negotiated Rate |
$2,497.25 |
| Rate for Payer: Aetna Commercial |
$2,442.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,334.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,438.63
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,497.25
|
| Rate for Payer: Health EOS Commercial |
$2,415.82
|
| Rate for Payer: HFN Commercial |
$2,497.25
|
| Rate for Payer: Multiplan Commercial |
$2,171.52
|
| Rate for Payer: Preferred Network Access Commercial |
$2,497.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,330.06
|
| Rate for Payer: Quartz Commercial |
$1,628.64
|
| Rate for Payer: WEA Trust Commercial |
$1,492.92
|
| Rate for Payer: WPS Commercial |
$2,010.48
|
|
|
Hearing Aid, Digit, Mon, Itc
|
Facility
|
OP
|
$2,595.00
|
|
|
Service Code
|
HCPCS V5255
|
| Hospital Charge Code |
3243603
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$755.66 |
| Max. Negotiated Rate |
$2,482.90 |
| Rate for Payer: Aetna Commercial |
$2,428.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,320.97
|
| Rate for Payer: Aetna Managed Medicare |
$755.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,754.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,349.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,295.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.36
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna Commercial |
$2,482.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,510.29
|
| Rate for Payer: Health EOS Commercial |
$2,401.93
|
| Rate for Payer: HFN Commercial |
$2,482.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,024.10
|
| Rate for Payer: Multiplan Commercial |
$2,159.04
|
| Rate for Payer: NAPHCARE Commercial |
$1,619.28
|
| Rate for Payer: Preferred Network Access Commercial |
$2,482.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.41
|
| Rate for Payer: Quartz Commercial |
$1,754.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,619.28
|
| Rate for Payer: The Alliance Commercial |
$1,349.40
|
| Rate for Payer: United Healthcare PPO |
$2,024.10
|
| Rate for Payer: WEA Trust Commercial |
$1,484.34
|
| Rate for Payer: WPS Commercial |
$1,998.93
|
|
|
Hearing Aid, Digit, Mon, Itc
|
Professional
|
Both
|
$2,595.00
|
|
|
Service Code
|
HCPCS V5255
|
| Hospital Charge Code |
3243603
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$1,187.47 |
| Max. Negotiated Rate |
$2,563.86 |
| Rate for Payer: Aetna Commercial |
$2,563.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,320.97
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna Commercial |
$2,563.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,349.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,619.28
|
| Rate for Payer: Health EOS Commercial |
$2,455.91
|
| Rate for Payer: HFN Commercial |
$2,563.86
|
| Rate for Payer: Multiplan Commercial |
$2,159.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,563.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,187.47
|
| Rate for Payer: Quartz Commercial |
$1,538.32
|
| Rate for Payer: The Alliance Commercial |
$1,349.40
|
| Rate for Payer: WEA Trust Commercial |
$1,484.34
|
| Rate for Payer: WPS Commercial |
$1,998.93
|
|
|
Hearing Aid, Digit, Mon, Itc
|
Facility
|
IP
|
$2,595.00
|
|
|
Service Code
|
HCPCS V5255
|
| Hospital Charge Code |
3243603
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$1,322.41 |
| Max. Negotiated Rate |
$2,482.90 |
| Rate for Payer: Aetna Commercial |
$2,428.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,320.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,430.36
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna Commercial |
$2,482.90
|
| Rate for Payer: Health EOS Commercial |
$2,401.93
|
| Rate for Payer: HFN Commercial |
$2,482.90
|
| Rate for Payer: Multiplan Commercial |
$2,159.04
|
| Rate for Payer: Preferred Network Access Commercial |
$2,482.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,322.41
|
| Rate for Payer: Quartz Commercial |
$1,619.28
|
| Rate for Payer: WEA Trust Commercial |
$1,484.34
|
| Rate for Payer: WPS Commercial |
$1,998.93
|
|
|
Hearing Aid, Digit, Mon, Ite
|
Facility
|
OP
|
$1,177.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
3243610
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$342.74 |
| Max. Negotiated Rate |
$1,126.15 |
| Rate for Payer: Aetna Commercial |
$1,101.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,052.71
|
| Rate for Payer: Aetna Managed Medicare |
$342.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$795.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$612.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$587.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$648.76
|
| Rate for Payer: Cash Price |
$353.10
|
| Rate for Payer: Cigna Commercial |
$1,126.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$685.01
|
| Rate for Payer: Health EOS Commercial |
$1,089.43
|
| Rate for Payer: HFN Commercial |
$1,126.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$918.06
|
| Rate for Payer: Multiplan Commercial |
$979.26
|
| Rate for Payer: NAPHCARE Commercial |
$734.45
|
| Rate for Payer: Preferred Network Access Commercial |
$1,126.15
|
| Rate for Payer: Quartz Beloit One Network |
$599.80
|
| Rate for Payer: Quartz Commercial |
$795.65
|
| Rate for Payer: Quartz Medicare Advantage |
$734.45
|
| Rate for Payer: The Alliance Commercial |
$612.04
|
| Rate for Payer: United Healthcare PPO |
$918.06
|
| Rate for Payer: WEA Trust Commercial |
$673.24
|
| Rate for Payer: WPS Commercial |
$906.64
|
|
|
Hearing Aid, Digit, Mon, Ite
|
Professional
|
Both
|
$1,177.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
3243610
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$538.60 |
| Max. Negotiated Rate |
$1,162.88 |
| Rate for Payer: Aetna Commercial |
$1,162.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,052.71
|
| Rate for Payer: Cash Price |
$353.10
|
| Rate for Payer: Cigna Commercial |
$1,162.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$612.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$734.45
|
| Rate for Payer: Health EOS Commercial |
$1,113.91
|
| Rate for Payer: HFN Commercial |
$1,162.88
|
| Rate for Payer: Multiplan Commercial |
$979.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,162.88
|
| Rate for Payer: Quartz Beloit One Network |
$538.60
|
| Rate for Payer: Quartz Commercial |
$697.73
|
| Rate for Payer: The Alliance Commercial |
$612.04
|
| Rate for Payer: WEA Trust Commercial |
$673.24
|
| Rate for Payer: WPS Commercial |
$906.64
|
|
|
Hearing Aid, Digit, Mon, Ite
|
Facility
|
IP
|
$1,177.00
|
|
|
Service Code
|
HCPCS V5256
|
| Hospital Charge Code |
3243610
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$599.80 |
| Max. Negotiated Rate |
$1,126.15 |
| Rate for Payer: Aetna Commercial |
$1,101.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,052.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$648.76
|
| Rate for Payer: Cash Price |
$353.10
|
| Rate for Payer: Cigna Commercial |
$1,126.15
|
| Rate for Payer: Health EOS Commercial |
$1,089.43
|
| Rate for Payer: HFN Commercial |
$1,126.15
|
| Rate for Payer: Multiplan Commercial |
$979.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,126.15
|
| Rate for Payer: Quartz Beloit One Network |
$599.80
|
| Rate for Payer: Quartz Commercial |
$734.45
|
| Rate for Payer: WEA Trust Commercial |
$673.24
|
| Rate for Payer: WPS Commercial |
$906.64
|
|
|
Hearing Aid Dispensing Fee
|
Professional
|
Both
|
$1,309.00
|
|
| Hospital Charge Code |
3203493
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$599.00 |
| Max. Negotiated Rate |
$1,293.29 |
| Rate for Payer: Aetna Commercial |
$1,293.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,293.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$680.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$816.82
|
| Rate for Payer: Health EOS Commercial |
$1,238.84
|
| Rate for Payer: HFN Commercial |
$1,293.29
|
| Rate for Payer: Multiplan Commercial |
$1,089.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,293.29
|
| Rate for Payer: Quartz Beloit One Network |
$599.00
|
| Rate for Payer: Quartz Commercial |
$775.98
|
| Rate for Payer: The Alliance Commercial |
$680.68
|
| Rate for Payer: WEA Trust Commercial |
$748.75
|
| Rate for Payer: WPS Commercial |
$1,008.32
|
|
|
Hearing Aid Dispensing Fee
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
3203493
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$381.18 |
| Max. Negotiated Rate |
$1,252.45 |
| Rate for Payer: Aetna Commercial |
$1,225.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.77
|
| Rate for Payer: Aetna Managed Medicare |
$381.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$884.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$680.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$653.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.52
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,252.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$761.84
|
| Rate for Payer: Health EOS Commercial |
$1,211.61
|
| Rate for Payer: HFN Commercial |
$1,252.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,021.02
|
| Rate for Payer: Multiplan Commercial |
$1,089.09
|
| Rate for Payer: NAPHCARE Commercial |
$816.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.45
|
| Rate for Payer: Quartz Beloit One Network |
$667.07
|
| Rate for Payer: Quartz Commercial |
$884.88
|
| Rate for Payer: Quartz Medicare Advantage |
$816.82
|
| Rate for Payer: The Alliance Commercial |
$680.68
|
| Rate for Payer: United Healthcare PPO |
$1,021.02
|
| Rate for Payer: WEA Trust Commercial |
$748.75
|
| Rate for Payer: WPS Commercial |
$1,008.32
|
|
|
Hearing Aid Dispensing Fee
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
3203493
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$667.07 |
| Max. Negotiated Rate |
$1,252.45 |
| Rate for Payer: Aetna Commercial |
$1,225.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,170.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$721.52
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,252.45
|
| Rate for Payer: Health EOS Commercial |
$1,211.61
|
| Rate for Payer: HFN Commercial |
$1,252.45
|
| Rate for Payer: Multiplan Commercial |
$1,089.09
|
| Rate for Payer: Preferred Network Access Commercial |
$1,252.45
|
| Rate for Payer: Quartz Beloit One Network |
$667.07
|
| Rate for Payer: Quartz Commercial |
$816.82
|
| Rate for Payer: WEA Trust Commercial |
$748.75
|
| Rate for Payer: WPS Commercial |
$1,008.32
|
|
|
Hearing Aid Eval Monaural
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
3203494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Hearing Aid Eval Monaural
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
3203494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$67.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$144.14
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$156.16
|
| Rate for Payer: Quartz Medicare Advantage |
$144.14
|
| Rate for Payer: The Alliance Commercial |
$120.12
|
| Rate for Payer: United Healthcare PPO |
$180.18
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Hearing Aid Eval Monaural
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
3203494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$105.71 |
| Max. Negotiated Rate |
$228.23 |
| Rate for Payer: Aetna Commercial |
$228.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$228.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$120.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.14
|
| Rate for Payer: Health EOS Commercial |
$218.62
|
| Rate for Payer: HFN Commercial |
$228.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$195.53
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$228.23
|
| Rate for Payer: Quartz Beloit One Network |
$105.71
|
| Rate for Payer: Quartz Commercial |
$136.94
|
| Rate for Payer: The Alliance Commercial |
$120.12
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Hearing Aid Exam, Both Ears
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
3203495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$126.76 |
| Max. Negotiated Rate |
$273.68 |
| Rate for Payer: Aetna Commercial |
$273.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$273.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.85
|
| Rate for Payer: Health EOS Commercial |
$262.15
|
| Rate for Payer: HFN Commercial |
$273.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$250.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$250.41
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: Preferred Network Access Commercial |
$273.68
|
| Rate for Payer: Quartz Beloit One Network |
$126.76
|
| Rate for Payer: Quartz Commercial |
$164.21
|
| Rate for Payer: The Alliance Commercial |
$144.04
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
Hearing Aid Exam, Both Ears
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
3203495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$141.16 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$172.85
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
Hearing Aid Exam, Both Ears
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
3203495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$80.66 |
| Max. Negotiated Rate |
$265.03 |
| Rate for Payer: Aetna Commercial |
$259.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Aetna Managed Medicare |
$80.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$187.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$144.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$138.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.68
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$265.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.21
|
| Rate for Payer: Health EOS Commercial |
$256.39
|
| Rate for Payer: HFN Commercial |
$265.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$216.06
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: NAPHCARE Commercial |
$172.85
|
| Rate for Payer: Preferred Network Access Commercial |
$265.03
|
| Rate for Payer: Quartz Beloit One Network |
$141.16
|
| Rate for Payer: Quartz Commercial |
$187.25
|
| Rate for Payer: Quartz Medicare Advantage |
$172.85
|
| Rate for Payer: The Alliance Commercial |
$144.04
|
| Rate for Payer: United Healthcare PPO |
$216.06
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$213.37
|
|
|
HEARING AID EXAM, ONE EAR 92590
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
3015343
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.27 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Aetna Managed Medicare |
$67.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$120.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$115.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.44
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$180.18
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: NAPHCARE Commercial |
$144.14
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$156.16
|
| Rate for Payer: Quartz Medicare Advantage |
$144.14
|
| Rate for Payer: The Alliance Commercial |
$120.12
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
HEARING AID EXAM, ONE EAR 92590
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
3015343
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$117.72 |
| Max. Negotiated Rate |
$221.02 |
| Rate for Payer: Aetna Commercial |
$216.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$206.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$127.33
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$221.02
|
| Rate for Payer: Health EOS Commercial |
$213.81
|
| Rate for Payer: HFN Commercial |
$221.02
|
| Rate for Payer: Multiplan Commercial |
$192.19
|
| Rate for Payer: Preferred Network Access Commercial |
$221.02
|
| Rate for Payer: Quartz Beloit One Network |
$117.72
|
| Rate for Payer: Quartz Commercial |
$144.14
|
| Rate for Payer: WEA Trust Commercial |
$132.13
|
| Rate for Payer: WPS Commercial |
$177.94
|
|
|
Hearing Aid Fitting/Checking
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS V5011
|
| Hospital Charge Code |
3243556
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
Hearing Aid Fitting/Checking
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS V5011
|
| Hospital Charge Code |
3243556
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.98
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$8.11
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$6.24
|
| Rate for Payer: United Healthcare PPO |
$9.36
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
Hearing Aid Fitting/Checking
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS V5011
|
| Hospital Charge Code |
3243556
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$5.49 |
| Max. Negotiated Rate |
$278.75 |
| Rate for Payer: Aetna Commercial |
$11.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.49
|
| Rate for Payer: Health EOS Commercial |
$11.36
|
| Rate for Payer: HFN Commercial |
$11.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$278.75
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.86
|
| Rate for Payer: Quartz Beloit One Network |
$5.49
|
| Rate for Payer: Quartz Commercial |
$7.11
|
| Rate for Payer: The Alliance Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
Hearing aid, stocking fee; not otherwise spec - V5298
|
Professional
|
Both
|
$337.00
|
|
|
Service Code
|
HCPCS V5298
|
| Hospital Charge Code |
5786051
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$154.21 |
| Max. Negotiated Rate |
$332.96 |
| Rate for Payer: Aetna Commercial |
$332.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$332.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$175.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.29
|
| Rate for Payer: Health EOS Commercial |
$318.94
|
| Rate for Payer: HFN Commercial |
$332.96
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: Preferred Network Access Commercial |
$332.96
|
| Rate for Payer: Quartz Beloit One Network |
$154.21
|
| Rate for Payer: Quartz Commercial |
$199.77
|
| Rate for Payer: The Alliance Commercial |
$175.24
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
Hearing aid, stocking fee; not otherwise spec - V5298
|
Facility
|
IP
|
$337.00
|
|
|
Service Code
|
HCPCS V5298
|
| Hospital Charge Code |
5786051
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$171.74 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$210.29
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
|
Hearing aid, stocking fee; not otherwise spec - V5298
|
Facility
|
OP
|
$337.00
|
|
|
Service Code
|
HCPCS V5298
|
| Hospital Charge Code |
5786051
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$98.13 |
| Max. Negotiated Rate |
$322.44 |
| Rate for Payer: Aetna Commercial |
$315.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.41
|
| Rate for Payer: Aetna Managed Medicare |
$98.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.75
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$322.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.13
|
| Rate for Payer: Health EOS Commercial |
$311.93
|
| Rate for Payer: HFN Commercial |
$322.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.86
|
| Rate for Payer: Multiplan Commercial |
$280.38
|
| Rate for Payer: NAPHCARE Commercial |
$210.29
|
| Rate for Payer: Preferred Network Access Commercial |
$322.44
|
| Rate for Payer: Quartz Beloit One Network |
$171.74
|
| Rate for Payer: Quartz Commercial |
$227.81
|
| Rate for Payer: Quartz Medicare Advantage |
$210.29
|
| Rate for Payer: The Alliance Commercial |
$175.24
|
| Rate for Payer: United Healthcare PPO |
$262.86
|
| Rate for Payer: WEA Trust Commercial |
$192.76
|
| Rate for Payer: WPS Commercial |
$259.59
|
|
