|
HEAD RESTRAINT ALLEN UNIVERSAL A-90023
|
Facility
|
OP
|
$447.00
|
|
| Hospital Charge Code |
5106864
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.16 |
| Max. Negotiated Rate |
$1,788.00 |
| Rate for Payer: Aetna Commercial |
$402.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$384.42
|
| Rate for Payer: Aetna Managed Medicare |
$125.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$290.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$223.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$214.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$236.91
|
| Rate for Payer: Cash Price |
$134.10
|
| Rate for Payer: Cigna Commercial |
$411.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.14
|
| Rate for Payer: Health EOS Commercial |
$397.83
|
| Rate for Payer: HFN Commercial |
$411.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$335.25
|
| Rate for Payer: Multiplan Commercial |
$357.60
|
| Rate for Payer: NAPHCARE Commercial |
$268.20
|
| Rate for Payer: Preferred Network Access Commercial |
$411.24
|
| Rate for Payer: Quartz Beloit One Network |
$219.03
|
| Rate for Payer: Quartz Commercial |
$290.55
|
| Rate for Payer: Quartz Medicare Advantage |
$268.20
|
| Rate for Payer: The Alliance Commercial |
$1,788.00
|
| Rate for Payer: WEA Trust Commercial |
$245.85
|
| Rate for Payer: WPS Commercial |
$331.09
|
|
|
HEALON PRO 0.85ML
|
Facility
|
IP
|
$618.00
|
|
| Hospital Charge Code |
6175034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$302.82 |
| Max. Negotiated Rate |
$568.56 |
| Rate for Payer: Aetna Commercial |
$556.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.54
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$568.56
|
| Rate for Payer: Health EOS Commercial |
$550.02
|
| Rate for Payer: HFN Commercial |
$568.56
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: NAPHCARE Commercial |
$370.80
|
| Rate for Payer: Preferred Network Access Commercial |
$568.56
|
| Rate for Payer: Quartz Beloit One Network |
$302.82
|
| Rate for Payer: Quartz Commercial |
$370.80
|
| Rate for Payer: WEA Trust Commercial |
$339.90
|
| Rate for Payer: WPS Commercial |
$457.75
|
|
|
HEALON PRO 0.85ML
|
Facility
|
OP
|
$618.00
|
|
| Hospital Charge Code |
6175034
|
|
Hospital Revenue Code
|
270
|
| Min. Negotiated Rate |
$173.04 |
| Max. Negotiated Rate |
$2,472.00 |
| Rate for Payer: Aetna Commercial |
$556.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$531.48
|
| Rate for Payer: Aetna Managed Medicare |
$173.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$401.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$309.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$296.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$327.54
|
| Rate for Payer: Cash Price |
$185.40
|
| Rate for Payer: Cigna Commercial |
$568.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$345.83
|
| Rate for Payer: Health EOS Commercial |
$550.02
|
| Rate for Payer: HFN Commercial |
$568.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$463.50
|
| Rate for Payer: Multiplan Commercial |
$494.40
|
| Rate for Payer: NAPHCARE Commercial |
$370.80
|
| Rate for Payer: Preferred Network Access Commercial |
$568.56
|
| Rate for Payer: Quartz Beloit One Network |
$302.82
|
| Rate for Payer: Quartz Commercial |
$401.70
|
| Rate for Payer: Quartz Medicare Advantage |
$370.80
|
| Rate for Payer: The Alliance Commercial |
$2,472.00
|
| Rate for Payer: WEA Trust Commercial |
$339.90
|
| Rate for Payer: WPS Commercial |
$457.75
|
|
|
Healthy Shot
|
Facility
|
OP
|
$7.00
|
|
| Hospital Charge Code |
3031438
|
|
Hospital Revenue Code
|
250
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$28.00 |
| Rate for Payer: Aetna Commercial |
$6.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.02
|
| Rate for Payer: Aetna Managed Medicare |
$1.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.36
|
| 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: Dean Health DHI/DHP/ASO |
$3.92
|
| Rate for Payer: Health EOS Commercial |
$6.23
|
| Rate for Payer: HFN Commercial |
$6.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5.25
|
| 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 |
$4.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.20
|
| Rate for Payer: The Alliance Commercial |
$28.00
|
| Rate for Payer: WEA Trust Commercial |
$3.85
|
| Rate for Payer: WPS Commercial |
$5.18
|
|
|
Healthy Shot
|
Facility
|
IP
|
$7.00
|
|
| Hospital Charge Code |
3031438
|
|
Hospital Revenue Code
|
250
|
| 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
|
|
|
Hearing Aid Check; Binaural
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230816
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: HFN Commercial |
$92.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.09
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: The Alliance Commercial |
$48.50
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Hearing Aid Check; Binaural
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230816
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$58.20
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Hearing Aid Check; Binaural
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230816
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$27.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| Rate for Payer: Quartz Medicare Advantage |
$58.20
|
| Rate for Payer: The Alliance Commercial |
$388.00
|
| Rate for Payer: United Healthcare PPO |
$72.75
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
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 |
$64.24 |
| Max. Negotiated Rate |
$138.70 |
| Rate for Payer: Aetna Commercial |
$138.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$125.56
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cash Price |
$43.80
|
| Rate for Payer: Cigna Commercial |
$138.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.60
|
| Rate for Payer: Health EOS Commercial |
$132.86
|
| Rate for Payer: HFN Commercial |
$138.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$123.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$123.34
|
| Rate for Payer: Multiplan Commercial |
$116.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.70
|
| Rate for Payer: Quartz Beloit One Network |
$64.24
|
| Rate for Payer: Quartz Commercial |
$83.22
|
| Rate for Payer: The Alliance Commercial |
$73.00
|
| Rate for Payer: WEA Trust Commercial |
$80.30
|
| Rate for Payer: WPS Commercial |
$108.14
|
|
|
Hearing Aid Check; Monaural
|
Facility
|
IP
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230815
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$47.53 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$58.20
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Hearing Aid Check; Monaural
|
Professional
|
Both
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230815
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$42.68 |
| Max. Negotiated Rate |
$92.15 |
| Rate for Payer: Aetna Commercial |
$92.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$92.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58.20
|
| Rate for Payer: Health EOS Commercial |
$88.27
|
| Rate for Payer: HFN Commercial |
$92.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.09
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: Preferred Network Access Commercial |
$92.15
|
| Rate for Payer: Quartz Beloit One Network |
$42.68
|
| Rate for Payer: Quartz Commercial |
$55.29
|
| Rate for Payer: The Alliance Commercial |
$48.50
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
Hearing Aid Check; Monaural
|
Facility
|
OP
|
$97.00
|
|
|
Service Code
|
CPT 92592
|
| Hospital Charge Code |
1230815
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$27.16 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$27.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| Rate for Payer: Quartz Medicare Advantage |
$58.20
|
| Rate for Payer: The Alliance Commercial |
$388.00
|
| Rate for Payer: United Healthcare PPO |
$72.75
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
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 |
$27.16 |
| Max. Negotiated Rate |
$388.00 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Aetna Managed Medicare |
$27.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.75
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$63.05
|
| Rate for Payer: Quartz Medicare Advantage |
$58.20
|
| Rate for Payer: The Alliance Commercial |
$388.00
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
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 |
$47.53 |
| Max. Negotiated Rate |
$89.24 |
| Rate for Payer: Aetna Commercial |
$87.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.41
|
| Rate for Payer: Cash Price |
$29.10
|
| Rate for Payer: Cigna Commercial |
$89.24
|
| Rate for Payer: Health EOS Commercial |
$86.33
|
| Rate for Payer: HFN Commercial |
$89.24
|
| Rate for Payer: Multiplan Commercial |
$77.60
|
| Rate for Payer: NAPHCARE Commercial |
$58.20
|
| Rate for Payer: Preferred Network Access Commercial |
$89.24
|
| Rate for Payer: Quartz Beloit One Network |
$47.53
|
| Rate for Payer: Quartz Commercial |
$58.20
|
| Rate for Payer: WEA Trust Commercial |
$53.35
|
| Rate for Payer: WPS Commercial |
$71.85
|
|
|
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 |
$1,824.76 |
| Max. Negotiated Rate |
$3,426.08 |
| Rate for Payer: Aetna Commercial |
$3,351.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,202.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,973.72
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,426.08
|
| Rate for Payer: Health EOS Commercial |
$3,314.36
|
| Rate for Payer: HFN Commercial |
$3,426.08
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,426.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.76
|
| Rate for Payer: Quartz Commercial |
$2,234.40
|
| Rate for Payer: WEA Trust Commercial |
$2,048.20
|
| Rate for Payer: WPS Commercial |
$2,758.37
|
|
|
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 |
$1,042.72 |
| Max. Negotiated Rate |
$14,896.00 |
| Rate for Payer: Aetna Commercial |
$3,351.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,202.64
|
| Rate for Payer: Aetna Managed Medicare |
$1,042.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,420.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,862.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,787.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,973.72
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,426.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,083.95
|
| Rate for Payer: Health EOS Commercial |
$3,314.36
|
| Rate for Payer: HFN Commercial |
$3,426.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,793.00
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,234.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,426.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,824.76
|
| Rate for Payer: Quartz Commercial |
$2,420.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,234.40
|
| Rate for Payer: The Alliance Commercial |
$14,896.00
|
| Rate for Payer: United Healthcare PPO |
$2,793.00
|
| Rate for Payer: WEA Trust Commercial |
$2,048.20
|
| Rate for Payer: WPS Commercial |
$2,758.37
|
|
|
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 |
$1,638.56 |
| Max. Negotiated Rate |
$3,537.80 |
| Rate for Payer: Aetna Commercial |
$3,537.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,202.64
|
| Rate for Payer: Cash Price |
$1,117.20
|
| Rate for Payer: Cigna Commercial |
$3,537.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,862.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,234.40
|
| Rate for Payer: Health EOS Commercial |
$3,388.84
|
| Rate for Payer: HFN Commercial |
$3,537.80
|
| Rate for Payer: Multiplan Commercial |
$2,979.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,537.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,638.56
|
| Rate for Payer: Quartz Commercial |
$2,122.68
|
| Rate for Payer: The Alliance Commercial |
$1,862.00
|
| Rate for Payer: WEA Trust Commercial |
$2,048.20
|
| Rate for Payer: WPS Commercial |
$2,758.37
|
|
|
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 |
$2,024.88 |
| Max. Negotiated Rate |
$4,371.90 |
| Rate for Payer: Aetna Commercial |
$4,371.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,957.72
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$4,371.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,301.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,761.20
|
| Rate for Payer: Health EOS Commercial |
$4,187.82
|
| Rate for Payer: HFN Commercial |
$4,371.90
|
| Rate for Payer: Multiplan Commercial |
$3,681.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,371.90
|
| Rate for Payer: Quartz Beloit One Network |
$2,024.88
|
| Rate for Payer: Quartz Commercial |
$2,623.14
|
| Rate for Payer: The Alliance Commercial |
$2,301.00
|
| Rate for Payer: WEA Trust Commercial |
$2,531.10
|
| Rate for Payer: WPS Commercial |
$3,408.70
|
|
|
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 |
$2,254.98 |
| Max. Negotiated Rate |
$4,233.84 |
| Rate for Payer: Aetna Commercial |
$4,141.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,957.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.06
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$4,233.84
|
| Rate for Payer: Health EOS Commercial |
$4,095.78
|
| Rate for Payer: HFN Commercial |
$4,233.84
|
| Rate for Payer: Multiplan Commercial |
$3,681.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,761.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,233.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,254.98
|
| Rate for Payer: Quartz Commercial |
$2,761.20
|
| Rate for Payer: WEA Trust Commercial |
$2,531.10
|
| Rate for Payer: WPS Commercial |
$3,408.70
|
|
|
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 |
$1,288.56 |
| Max. Negotiated Rate |
$18,408.00 |
| Rate for Payer: Aetna Commercial |
$4,141.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,957.72
|
| Rate for Payer: Aetna Managed Medicare |
$1,288.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,991.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,301.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,208.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.06
|
| Rate for Payer: Cash Price |
$1,380.60
|
| Rate for Payer: Cigna Commercial |
$4,233.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,575.28
|
| Rate for Payer: Health EOS Commercial |
$4,095.78
|
| Rate for Payer: HFN Commercial |
$4,233.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,451.50
|
| Rate for Payer: Multiplan Commercial |
$3,681.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,761.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,233.84
|
| Rate for Payer: Quartz Beloit One Network |
$2,254.98
|
| Rate for Payer: Quartz Commercial |
$2,991.30
|
| Rate for Payer: Quartz Medicare Advantage |
$2,761.20
|
| Rate for Payer: The Alliance Commercial |
$18,408.00
|
| Rate for Payer: United Healthcare PPO |
$3,451.50
|
| Rate for Payer: WEA Trust Commercial |
$2,531.10
|
| Rate for Payer: WPS Commercial |
$3,408.70
|
|
|
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 |
$775.28 |
| Max. Negotiated Rate |
$1,673.90 |
| Rate for Payer: Aetna Commercial |
$1,673.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,515.32
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$1,673.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$881.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,057.20
|
| Rate for Payer: Health EOS Commercial |
$1,603.42
|
| Rate for Payer: HFN Commercial |
$1,673.90
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,673.90
|
| Rate for Payer: Quartz Beloit One Network |
$775.28
|
| Rate for Payer: Quartz Commercial |
$1,004.34
|
| Rate for Payer: The Alliance Commercial |
$881.00
|
| Rate for Payer: WEA Trust Commercial |
$969.10
|
| Rate for Payer: WPS Commercial |
$1,305.11
|
|
|
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 |
$493.36 |
| Max. Negotiated Rate |
$7,048.00 |
| Rate for Payer: Aetna Commercial |
$1,585.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,515.32
|
| Rate for Payer: Aetna Managed Medicare |
$493.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,145.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$881.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$845.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$933.86
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$1,621.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$986.02
|
| Rate for Payer: Health EOS Commercial |
$1,568.18
|
| Rate for Payer: HFN Commercial |
$1,621.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.50
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.04
|
| Rate for Payer: Quartz Beloit One Network |
$863.38
|
| Rate for Payer: Quartz Commercial |
$1,145.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,057.20
|
| Rate for Payer: The Alliance Commercial |
$7,048.00
|
| Rate for Payer: United Healthcare PPO |
$1,321.50
|
| Rate for Payer: WEA Trust Commercial |
$969.10
|
| Rate for Payer: WPS Commercial |
$1,305.11
|
|
|
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 |
$863.38 |
| Max. Negotiated Rate |
$1,621.04 |
| Rate for Payer: Aetna Commercial |
$1,585.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,515.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$933.86
|
| Rate for Payer: Cash Price |
$528.60
|
| Rate for Payer: Cigna Commercial |
$1,621.04
|
| Rate for Payer: Health EOS Commercial |
$1,568.18
|
| Rate for Payer: HFN Commercial |
$1,621.04
|
| Rate for Payer: Multiplan Commercial |
$1,409.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,057.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,621.04
|
| Rate for Payer: Quartz Beloit One Network |
$863.38
|
| Rate for Payer: Quartz Commercial |
$1,057.20
|
| Rate for Payer: WEA Trust Commercial |
$969.10
|
| Rate for Payer: WPS Commercial |
$1,305.11
|
|
|
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 |
$730.80 |
| Max. Negotiated Rate |
$10,440.00 |
| Rate for Payer: Aetna Commercial |
$2,349.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,244.60
|
| Rate for Payer: Aetna Managed Medicare |
$730.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,696.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,305.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,252.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,383.30
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,401.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,460.56
|
| Rate for Payer: Health EOS Commercial |
$2,322.90
|
| Rate for Payer: HFN Commercial |
$2,401.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,957.50
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,401.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,278.90
|
| Rate for Payer: Quartz Commercial |
$1,696.50
|
| Rate for Payer: Quartz Medicare Advantage |
$1,566.00
|
| Rate for Payer: The Alliance Commercial |
$10,440.00
|
| Rate for Payer: United Healthcare PPO |
$1,957.50
|
| Rate for Payer: WEA Trust Commercial |
$1,435.50
|
| Rate for Payer: WPS Commercial |
$1,933.23
|
|
|
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 |
$1,278.90 |
| Max. Negotiated Rate |
$2,401.20 |
| Rate for Payer: Aetna Commercial |
$2,349.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,244.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,383.30
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,401.20
|
| Rate for Payer: Health EOS Commercial |
$2,322.90
|
| Rate for Payer: HFN Commercial |
$2,401.20
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,401.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,278.90
|
| Rate for Payer: Quartz Commercial |
$1,566.00
|
| Rate for Payer: WEA Trust Commercial |
$1,435.50
|
| Rate for Payer: WPS Commercial |
$1,933.23
|
|
