|
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 |
$1,148.40 |
| Max. Negotiated Rate |
$2,479.50 |
| Rate for Payer: Aetna Commercial |
$2,479.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,244.60
|
| Rate for Payer: Cash Price |
$783.00
|
| Rate for Payer: Cigna Commercial |
$2,479.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,305.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,566.00
|
| Rate for Payer: Health EOS Commercial |
$2,375.10
|
| Rate for Payer: HFN Commercial |
$2,479.50
|
| Rate for Payer: Multiplan Commercial |
$2,088.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,479.50
|
| Rate for Payer: Quartz Beloit One Network |
$1,148.40
|
| Rate for Payer: Quartz Commercial |
$1,487.70
|
| Rate for Payer: The Alliance Commercial |
$1,305.00
|
| Rate for Payer: WEA Trust Commercial |
$1,435.50
|
| Rate for Payer: WPS Commercial |
$1,933.23
|
|
|
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 |
$1,141.80 |
| Max. Negotiated Rate |
$2,465.25 |
| Rate for Payer: Aetna Commercial |
$2,465.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,231.70
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna Commercial |
$2,465.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,297.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,557.00
|
| Rate for Payer: Health EOS Commercial |
$2,361.45
|
| Rate for Payer: HFN Commercial |
$2,465.25
|
| Rate for Payer: Multiplan Commercial |
$2,076.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,465.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,141.80
|
| Rate for Payer: Quartz Commercial |
$1,479.15
|
| Rate for Payer: The Alliance Commercial |
$1,297.50
|
| Rate for Payer: WEA Trust Commercial |
$1,427.25
|
| Rate for Payer: WPS Commercial |
$1,922.12
|
|
|
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 |
$1,271.55 |
| Max. Negotiated Rate |
$2,387.40 |
| Rate for Payer: Aetna Commercial |
$2,335.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,231.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.35
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna Commercial |
$2,387.40
|
| Rate for Payer: Health EOS Commercial |
$2,309.55
|
| Rate for Payer: HFN Commercial |
$2,387.40
|
| Rate for Payer: Multiplan Commercial |
$2,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,387.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.55
|
| Rate for Payer: Quartz Commercial |
$1,557.00
|
| Rate for Payer: WEA Trust Commercial |
$1,427.25
|
| Rate for Payer: WPS Commercial |
$1,922.12
|
|
|
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 |
$726.60 |
| Max. Negotiated Rate |
$10,380.00 |
| Rate for Payer: Aetna Commercial |
$2,335.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,231.70
|
| Rate for Payer: Aetna Managed Medicare |
$726.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,686.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,297.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,245.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,375.35
|
| Rate for Payer: Cash Price |
$778.50
|
| Rate for Payer: Cigna Commercial |
$2,387.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,452.16
|
| Rate for Payer: Health EOS Commercial |
$2,309.55
|
| Rate for Payer: HFN Commercial |
$2,387.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,946.25
|
| Rate for Payer: Multiplan Commercial |
$2,076.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,557.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,387.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,271.55
|
| Rate for Payer: Quartz Commercial |
$1,686.75
|
| Rate for Payer: Quartz Medicare Advantage |
$1,557.00
|
| Rate for Payer: The Alliance Commercial |
$10,380.00
|
| Rate for Payer: United Healthcare PPO |
$1,946.25
|
| Rate for Payer: WEA Trust Commercial |
$1,427.25
|
| Rate for Payer: WPS Commercial |
$1,922.12
|
|
|
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 |
$576.73 |
| Max. Negotiated Rate |
$1,082.84 |
| Rate for Payer: Aetna Commercial |
$1,059.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,012.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$623.81
|
| Rate for Payer: Cash Price |
$353.10
|
| Rate for Payer: Cigna Commercial |
$1,082.84
|
| Rate for Payer: Health EOS Commercial |
$1,047.53
|
| Rate for Payer: HFN Commercial |
$1,082.84
|
| Rate for Payer: Multiplan Commercial |
$941.60
|
| Rate for Payer: NAPHCARE Commercial |
$706.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,082.84
|
| Rate for Payer: Quartz Beloit One Network |
$576.73
|
| Rate for Payer: Quartz Commercial |
$706.20
|
| Rate for Payer: WEA Trust Commercial |
$647.35
|
| Rate for Payer: WPS Commercial |
$871.80
|
|
|
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 |
$329.56 |
| Max. Negotiated Rate |
$4,708.00 |
| Rate for Payer: Aetna Commercial |
$1,059.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,012.22
|
| Rate for Payer: Aetna Managed Medicare |
$329.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$765.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$588.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$564.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$623.81
|
| Rate for Payer: Cash Price |
$353.10
|
| Rate for Payer: Cigna Commercial |
$1,082.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$658.65
|
| Rate for Payer: Health EOS Commercial |
$1,047.53
|
| Rate for Payer: HFN Commercial |
$1,082.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$882.75
|
| Rate for Payer: Multiplan Commercial |
$941.60
|
| Rate for Payer: NAPHCARE Commercial |
$706.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,082.84
|
| Rate for Payer: Quartz Beloit One Network |
$576.73
|
| Rate for Payer: Quartz Commercial |
$765.05
|
| Rate for Payer: Quartz Medicare Advantage |
$706.20
|
| Rate for Payer: The Alliance Commercial |
$4,708.00
|
| Rate for Payer: United Healthcare PPO |
$882.75
|
| Rate for Payer: WEA Trust Commercial |
$647.35
|
| Rate for Payer: WPS Commercial |
$871.80
|
|
|
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 |
$517.88 |
| Max. Negotiated Rate |
$1,118.15 |
| Rate for Payer: Aetna Commercial |
$1,118.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,012.22
|
| Rate for Payer: Cash Price |
$353.10
|
| Rate for Payer: Cigna Commercial |
$1,118.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$588.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$706.20
|
| Rate for Payer: Health EOS Commercial |
$1,071.07
|
| Rate for Payer: HFN Commercial |
$1,118.15
|
| Rate for Payer: Multiplan Commercial |
$941.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,118.15
|
| Rate for Payer: Quartz Beloit One Network |
$517.88
|
| Rate for Payer: Quartz Commercial |
$670.89
|
| Rate for Payer: The Alliance Commercial |
$588.50
|
| Rate for Payer: WEA Trust Commercial |
$647.35
|
| Rate for Payer: WPS Commercial |
$871.80
|
|
|
Hearing Aid Dispensing Fee
|
Facility
|
OP
|
$1,309.00
|
|
| Hospital Charge Code |
3203493
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$366.52 |
| Max. Negotiated Rate |
$5,236.00 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Aetna Managed Medicare |
$366.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$850.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$628.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,204.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.52
|
| Rate for Payer: Health EOS Commercial |
$1,165.01
|
| Rate for Payer: HFN Commercial |
$1,204.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$981.75
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$785.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.28
|
| Rate for Payer: Quartz Beloit One Network |
$641.41
|
| Rate for Payer: Quartz Commercial |
$850.85
|
| Rate for Payer: Quartz Medicare Advantage |
$785.40
|
| Rate for Payer: The Alliance Commercial |
$5,236.00
|
| Rate for Payer: United Healthcare PPO |
$981.75
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
Hearing Aid Dispensing Fee
|
Professional
|
Both
|
$1,309.00
|
|
| Hospital Charge Code |
3203493
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$575.96 |
| Max. Negotiated Rate |
$1,243.55 |
| Rate for Payer: Aetna Commercial |
$1,243.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,243.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$654.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$785.40
|
| Rate for Payer: Health EOS Commercial |
$1,191.19
|
| Rate for Payer: HFN Commercial |
$1,243.55
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,243.55
|
| Rate for Payer: Quartz Beloit One Network |
$575.96
|
| Rate for Payer: Quartz Commercial |
$746.13
|
| Rate for Payer: The Alliance Commercial |
$654.50
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
Hearing Aid Dispensing Fee
|
Facility
|
IP
|
$1,309.00
|
|
| Hospital Charge Code |
3203493
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$641.41 |
| Max. Negotiated Rate |
$1,204.28 |
| Rate for Payer: Aetna Commercial |
$1,178.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,125.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.77
|
| Rate for Payer: Cash Price |
$392.70
|
| Rate for Payer: Cigna Commercial |
$1,204.28
|
| Rate for Payer: Health EOS Commercial |
$1,165.01
|
| Rate for Payer: HFN Commercial |
$1,204.28
|
| Rate for Payer: Multiplan Commercial |
$1,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$785.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.28
|
| Rate for Payer: Quartz Beloit One Network |
$641.41
|
| Rate for Payer: Quartz Commercial |
$785.40
|
| Rate for Payer: WEA Trust Commercial |
$719.95
|
| Rate for Payer: WPS Commercial |
$969.58
|
|
|
Hearing Aid Eval Monaural
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
3203494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$64.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.27
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.25
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$138.60
|
| Rate for Payer: The Alliance Commercial |
$924.00
|
| Rate for Payer: United Healthcare PPO |
$173.25
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Hearing Aid Eval Monaural
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
3203494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Hearing Aid Eval Monaural
|
Professional
|
Both
|
$231.00
|
|
|
Service Code
|
CPT 92590
|
| Hospital Charge Code |
3203494
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$101.64 |
| Max. Negotiated Rate |
$219.45 |
| Rate for Payer: Aetna Commercial |
$219.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$219.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$138.60
|
| Rate for Payer: Health EOS Commercial |
$210.21
|
| Rate for Payer: HFN Commercial |
$219.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$188.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$188.01
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: Preferred Network Access Commercial |
$219.45
|
| Rate for Payer: Quartz Beloit One Network |
$101.64
|
| Rate for Payer: Quartz Commercial |
$131.67
|
| Rate for Payer: The Alliance Commercial |
$115.50
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Hearing Aid Exam, Both Ears
|
Facility
|
IP
|
$277.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
3203495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$135.73 |
| Max. Negotiated Rate |
$254.84 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$166.20
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
Hearing Aid Exam, Both Ears
|
Facility
|
OP
|
$277.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
3203495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$77.56 |
| Max. Negotiated Rate |
$1,108.00 |
| Rate for Payer: Aetna Commercial |
$249.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Aetna Managed Medicare |
$77.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$180.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$138.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$132.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.81
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$254.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$155.01
|
| Rate for Payer: Health EOS Commercial |
$246.53
|
| Rate for Payer: HFN Commercial |
$254.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$207.75
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: NAPHCARE Commercial |
$166.20
|
| Rate for Payer: Preferred Network Access Commercial |
$254.84
|
| Rate for Payer: Quartz Beloit One Network |
$135.73
|
| Rate for Payer: Quartz Commercial |
$180.05
|
| Rate for Payer: Quartz Medicare Advantage |
$166.20
|
| Rate for Payer: The Alliance Commercial |
$1,108.00
|
| Rate for Payer: United Healthcare PPO |
$207.75
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
Hearing Aid Exam, Both Ears
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
CPT 92591
|
| Hospital Charge Code |
3203495
|
|
Hospital Revenue Code
|
471
|
| Min. Negotiated Rate |
$121.88 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Aetna Commercial |
$263.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$263.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.20
|
| Rate for Payer: Health EOS Commercial |
$252.07
|
| Rate for Payer: HFN Commercial |
$263.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$240.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$240.78
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.15
|
| Rate for Payer: Quartz Beloit One Network |
$121.88
|
| Rate for Payer: Quartz Commercial |
$157.89
|
| Rate for Payer: The Alliance Commercial |
$138.50
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
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 |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
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 |
$64.68 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$64.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.27
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.25
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$138.60
|
| Rate for Payer: The Alliance Commercial |
$924.00
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Hearing Aid Fitting/Checking
|
Facility
|
IP
|
$12.00
|
|
|
Service Code
|
HCPCS V5011
|
| Hospital Charge Code |
3243556
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.20
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Hearing Aid Fitting/Checking
|
Professional
|
Both
|
$12.00
|
|
|
Service Code
|
HCPCS V5011
|
| Hospital Charge Code |
3243556
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$268.03 |
| Rate for Payer: Aetna Commercial |
$11.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.20
|
| Rate for Payer: Health EOS Commercial |
$10.92
|
| Rate for Payer: HFN Commercial |
$11.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$268.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$268.03
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: Preferred Network Access Commercial |
$11.40
|
| Rate for Payer: Quartz Beloit One Network |
$5.28
|
| Rate for Payer: Quartz Commercial |
$6.84
|
| Rate for Payer: The Alliance Commercial |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Hearing Aid Fitting/Checking
|
Facility
|
OP
|
$12.00
|
|
|
Service Code
|
HCPCS V5011
|
| Hospital Charge Code |
3243556
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Managed Medicare |
$3.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.72
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.20
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: United Healthcare PPO |
$9.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
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 |
$94.36 |
| Max. Negotiated Rate |
$1,348.00 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Aetna Managed Medicare |
$94.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$219.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$168.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$161.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$188.59
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.75
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$202.20
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$219.05
|
| Rate for Payer: Quartz Medicare Advantage |
$202.20
|
| Rate for Payer: The Alliance Commercial |
$1,348.00
|
| Rate for Payer: United Healthcare PPO |
$252.75
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
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 |
$165.13 |
| Max. Negotiated Rate |
$310.04 |
| Rate for Payer: Aetna Commercial |
$303.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$178.61
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$310.04
|
| Rate for Payer: Health EOS Commercial |
$299.93
|
| Rate for Payer: HFN Commercial |
$310.04
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: NAPHCARE Commercial |
$202.20
|
| Rate for Payer: Preferred Network Access Commercial |
$310.04
|
| Rate for Payer: Quartz Beloit One Network |
$165.13
|
| Rate for Payer: Quartz Commercial |
$202.20
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
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 |
$148.28 |
| Max. Negotiated Rate |
$320.15 |
| Rate for Payer: Aetna Commercial |
$320.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$289.82
|
| Rate for Payer: Cash Price |
$101.10
|
| Rate for Payer: Cigna Commercial |
$320.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$202.20
|
| Rate for Payer: Health EOS Commercial |
$306.67
|
| Rate for Payer: HFN Commercial |
$320.15
|
| Rate for Payer: Multiplan Commercial |
$269.60
|
| Rate for Payer: Preferred Network Access Commercial |
$320.15
|
| Rate for Payer: Quartz Beloit One Network |
$148.28
|
| Rate for Payer: Quartz Commercial |
$192.09
|
| Rate for Payer: The Alliance Commercial |
$168.50
|
| Rate for Payer: WEA Trust Commercial |
$185.35
|
| Rate for Payer: WPS Commercial |
$249.62
|
|
|
Hearing Aid Supplies / Accessories
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS V5267
|
| Hospital Charge Code |
1228811
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$39.76 |
| Max. Negotiated Rate |
$568.00 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Aetna Managed Medicare |
$39.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$92.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$71.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$68.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.46
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$106.50
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$85.20
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$92.30
|
| Rate for Payer: Quartz Medicare Advantage |
$85.20
|
| Rate for Payer: The Alliance Commercial |
$568.00
|
| Rate for Payer: United Healthcare PPO |
$106.50
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
