|
Office/OutPatient Visit, Established 99211DSH
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5500672
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$134.91 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.72
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$134.91
|
| Rate for Payer: Health EOS Commercial |
$130.51
|
| Rate for Payer: HFN Commercial |
$134.91
|
| Rate for Payer: Multiplan Commercial |
$117.31
|
| Rate for Payer: Preferred Network Access Commercial |
$134.91
|
| Rate for Payer: Quartz Beloit One Network |
$71.85
|
| Rate for Payer: Quartz Commercial |
$87.98
|
| Rate for Payer: WEA Trust Commercial |
$80.65
|
| Rate for Payer: WPS Commercial |
$108.61
|
|
|
Office/OutPatient Visit, Established 99211DSH
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5500672
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$134.91 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.11
|
| Rate for Payer: Aetna Managed Medicare |
$41.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.72
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$134.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.06
|
| Rate for Payer: Health EOS Commercial |
$130.51
|
| Rate for Payer: HFN Commercial |
$134.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$109.98
|
| Rate for Payer: Multiplan Commercial |
$117.31
|
| Rate for Payer: NAPHCARE Commercial |
$87.98
|
| Rate for Payer: Preferred Network Access Commercial |
$134.91
|
| Rate for Payer: Quartz Beloit One Network |
$71.85
|
| Rate for Payer: Quartz Commercial |
$95.32
|
| Rate for Payer: Quartz Medicare Advantage |
$87.98
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: WEA Trust Commercial |
$80.65
|
| Rate for Payer: WPS Commercial |
$108.61
|
|
|
Office/Outpatient Visit Level 1 Established
|
Professional
|
Both
|
$14.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
1122814
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$31.87 |
| Rate for Payer: Aetna Commercial |
$13.83
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12.52
|
| Rate for Payer: Aetna Managed Medicare |
$7.69
|
| Rate for Payer: Anthem Medicare Advantage |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7.69
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cash Price |
$4.20
|
| Rate for Payer: Cigna Commercial |
$13.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.69
|
| Rate for Payer: Health EOS Commercial |
$13.25
|
| Rate for Payer: HFN Commercial |
$13.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7.69
|
| Rate for Payer: Multiplan Commercial |
$11.65
|
| Rate for Payer: NAPHCARE Commercial |
$11.53
|
| Rate for Payer: Preferred Network Access Commercial |
$13.83
|
| Rate for Payer: Quartz Beloit One Network |
$6.41
|
| Rate for Payer: Quartz Commercial |
$8.30
|
| Rate for Payer: Quartz Medicare Advantage |
$7.69
|
| Rate for Payer: The Alliance Commercial |
$18.45
|
| Rate for Payer: United Healthcare Medicaid |
$16.90
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7.69
|
| Rate for Payer: WEA Trust Commercial |
$8.01
|
| Rate for Payer: WPS Commercial |
$16.14
|
|
|
Office/OutPatient Visit Level 1 Est O2 Eval RT
|
Facility
|
OP
|
$121.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
4125577
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: United Healthcare PPO |
$94.38
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Office/OutPatient Visit Level 1 Est O2 Eval RT
|
Facility
|
IP
|
$121.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
4125577
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Office/Outpatient Visit Level 2 Established
|
Professional
|
Both
|
$51.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
1122815
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$23.34 |
| Max. Negotiated Rate |
$126.55 |
| Rate for Payer: Aetna Commercial |
$50.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Aetna Managed Medicare |
$30.62
|
| Rate for Payer: Anthem Medicare Advantage |
$30.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$30.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$30.62
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$50.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30.62
|
| Rate for Payer: Health EOS Commercial |
$48.27
|
| Rate for Payer: HFN Commercial |
$50.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$126.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$126.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$45.93
|
| Rate for Payer: Preferred Network Access Commercial |
$50.39
|
| Rate for Payer: Quartz Beloit One Network |
$23.34
|
| Rate for Payer: Quartz Commercial |
$30.23
|
| Rate for Payer: Quartz Medicare Advantage |
$30.62
|
| Rate for Payer: The Alliance Commercial |
$73.48
|
| Rate for Payer: United Healthcare Medicaid |
$39.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$30.62
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$64.30
|
|
|
Office/Outpatient Visit Level 2 Established 95199-99212
|
Professional
|
Both
|
$59.00
|
|
|
Service Code
|
CPT 95199
|
| Hospital Charge Code |
5322740
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$27.00 |
| Max. Negotiated Rate |
$58.29 |
| Rate for Payer: Aetna Commercial |
$58.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$58.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.82
|
| Rate for Payer: Health EOS Commercial |
$55.84
|
| Rate for Payer: HFN Commercial |
$58.29
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$58.29
|
| Rate for Payer: Quartz Beloit One Network |
$27.00
|
| Rate for Payer: Quartz Commercial |
$34.98
|
| Rate for Payer: The Alliance Commercial |
$30.68
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
Office/Outpatient Visit Level 2 New
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
1122810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.71 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$40.71
|
| Rate for Payer: Anthem Medicare Advantage |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.71
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$127.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.71
|
| Rate for Payer: Health EOS Commercial |
$122.09
|
| Rate for Payer: HFN Commercial |
$127.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.71
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$61.06
|
| Rate for Payer: Preferred Network Access Commercial |
$127.45
|
| Rate for Payer: Quartz Beloit One Network |
$59.03
|
| Rate for Payer: Quartz Commercial |
$76.47
|
| Rate for Payer: Quartz Medicare Advantage |
$40.71
|
| Rate for Payer: The Alliance Commercial |
$97.69
|
| Rate for Payer: United Healthcare Medicaid |
$51.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.71
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$85.48
|
|
|
Office/Outpatient Visit Level 3 Established
|
Professional
|
Both
|
$125.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
1122816
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$57.11 |
| Max. Negotiated Rate |
$236.68 |
| Rate for Payer: Aetna Commercial |
$123.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$111.80
|
| Rate for Payer: Aetna Managed Medicare |
$57.11
|
| Rate for Payer: Anthem Medicare Advantage |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57.11
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cash Price |
$37.50
|
| Rate for Payer: Cigna Commercial |
$123.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$62.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$57.11
|
| Rate for Payer: Health EOS Commercial |
$118.30
|
| Rate for Payer: HFN Commercial |
$123.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$236.68
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$236.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57.11
|
| Rate for Payer: Multiplan Commercial |
$104.00
|
| Rate for Payer: NAPHCARE Commercial |
$85.66
|
| Rate for Payer: Preferred Network Access Commercial |
$123.50
|
| Rate for Payer: Quartz Beloit One Network |
$57.20
|
| Rate for Payer: Quartz Commercial |
$74.10
|
| Rate for Payer: Quartz Medicare Advantage |
$57.11
|
| Rate for Payer: The Alliance Commercial |
$137.06
|
| Rate for Payer: United Healthcare Medicaid |
$62.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57.11
|
| Rate for Payer: WEA Trust Commercial |
$71.50
|
| Rate for Payer: WPS Commercial |
$119.92
|
|
|
Office/Outpatient Visit Level 3 Established 99213SM
|
Professional
|
Both
|
$139.00
|
|
| Hospital Charge Code |
4596872
|
| Min. Negotiated Rate |
$63.61 |
| Max. Negotiated Rate |
$137.33 |
| Rate for Payer: Aetna Commercial |
$137.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$124.32
|
| Rate for Payer: Cash Price |
$41.70
|
| Rate for Payer: Cigna Commercial |
$137.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$72.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.74
|
| Rate for Payer: Health EOS Commercial |
$131.55
|
| Rate for Payer: HFN Commercial |
$137.33
|
| Rate for Payer: Multiplan Commercial |
$115.65
|
| Rate for Payer: Preferred Network Access Commercial |
$137.33
|
| Rate for Payer: Quartz Beloit One Network |
$63.61
|
| Rate for Payer: Quartz Commercial |
$82.40
|
| Rate for Payer: The Alliance Commercial |
$72.28
|
| Rate for Payer: WEA Trust Commercial |
$79.51
|
| Rate for Payer: WPS Commercial |
$107.07
|
|
|
Office/Outpatient Visit Level 3 New
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
1122811
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.94 |
| Max. Negotiated Rate |
$291.49 |
| Rate for Payer: Aetna Commercial |
$152.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Aetna Managed Medicare |
$69.94
|
| Rate for Payer: Anthem Medicare Advantage |
$69.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.94
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.94
|
| Rate for Payer: Health EOS Commercial |
$145.75
|
| Rate for Payer: HFN Commercial |
$152.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$291.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.94
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: NAPHCARE Commercial |
$104.91
|
| Rate for Payer: Preferred Network Access Commercial |
$152.15
|
| Rate for Payer: Quartz Beloit One Network |
$70.47
|
| Rate for Payer: Quartz Commercial |
$91.29
|
| Rate for Payer: Quartz Medicare Advantage |
$69.94
|
| Rate for Payer: The Alliance Commercial |
$167.86
|
| Rate for Payer: United Healthcare Medicaid |
$77.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.94
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$146.87
|
|
|
Office/Outpatient Visit Level 4 Established
|
Professional
|
Both
|
$178.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
1122817
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$81.45 |
| Max. Negotiated Rate |
$350.20 |
| Rate for Payer: Aetna Commercial |
$175.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$159.20
|
| Rate for Payer: Aetna Managed Medicare |
$83.83
|
| Rate for Payer: Anthem Medicare Advantage |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$83.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$83.83
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cash Price |
$53.40
|
| Rate for Payer: Cigna Commercial |
$175.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.83
|
| Rate for Payer: Health EOS Commercial |
$168.46
|
| Rate for Payer: HFN Commercial |
$175.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$350.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$350.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$83.83
|
| Rate for Payer: Multiplan Commercial |
$148.10
|
| Rate for Payer: NAPHCARE Commercial |
$125.75
|
| Rate for Payer: Preferred Network Access Commercial |
$175.86
|
| Rate for Payer: Quartz Beloit One Network |
$81.45
|
| Rate for Payer: Quartz Commercial |
$105.52
|
| Rate for Payer: Quartz Medicare Advantage |
$83.83
|
| Rate for Payer: The Alliance Commercial |
$201.20
|
| Rate for Payer: United Healthcare Medicaid |
$89.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$83.83
|
| Rate for Payer: WEA Trust Commercial |
$101.82
|
| Rate for Payer: WPS Commercial |
$176.05
|
|
|
Office/Outpatient Visit Level 4 Established 99214SM
|
Professional
|
Both
|
$266.00
|
|
| Hospital Charge Code |
4596873
|
| Min. Negotiated Rate |
$121.72 |
| Max. Negotiated Rate |
$262.81 |
| Rate for Payer: Aetna Commercial |
$262.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.91
|
| Rate for Payer: Cash Price |
$79.80
|
| Rate for Payer: Cigna Commercial |
$262.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.98
|
| Rate for Payer: Health EOS Commercial |
$251.74
|
| Rate for Payer: HFN Commercial |
$262.81
|
| Rate for Payer: Multiplan Commercial |
$221.31
|
| Rate for Payer: Preferred Network Access Commercial |
$262.81
|
| Rate for Payer: Quartz Beloit One Network |
$121.72
|
| Rate for Payer: Quartz Commercial |
$157.68
|
| Rate for Payer: The Alliance Commercial |
$138.32
|
| Rate for Payer: WEA Trust Commercial |
$152.15
|
| Rate for Payer: WPS Commercial |
$204.90
|
|
|
Office/Outpatient Visit Level 4 New
|
Professional
|
Both
|
$182.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
1122812
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$83.28 |
| Max. Negotiated Rate |
$475.72 |
| Rate for Payer: Aetna Commercial |
$179.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$162.78
|
| Rate for Payer: Aetna Managed Medicare |
$114.85
|
| Rate for Payer: Anthem Medicare Advantage |
$114.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.85
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cash Price |
$54.60
|
| Rate for Payer: Cigna Commercial |
$179.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.85
|
| Rate for Payer: Health EOS Commercial |
$172.24
|
| Rate for Payer: HFN Commercial |
$179.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.85
|
| Rate for Payer: Multiplan Commercial |
$151.42
|
| Rate for Payer: NAPHCARE Commercial |
$172.27
|
| Rate for Payer: Preferred Network Access Commercial |
$179.82
|
| Rate for Payer: Quartz Beloit One Network |
$83.28
|
| Rate for Payer: Quartz Commercial |
$107.89
|
| Rate for Payer: Quartz Medicare Advantage |
$114.85
|
| Rate for Payer: The Alliance Commercial |
$275.63
|
| Rate for Payer: United Healthcare Medicaid |
$115.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.85
|
| Rate for Payer: WEA Trust Commercial |
$104.10
|
| Rate for Payer: WPS Commercial |
$241.18
|
|
|
Office/Outpatient Visit Level 5 Established
|
Professional
|
Both
|
$496.00
|
|
|
Service Code
|
CPT 99215
|
| Hospital Charge Code |
1122818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$124.47 |
| Max. Negotiated Rate |
$515.07 |
| Rate for Payer: Aetna Commercial |
$490.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$443.62
|
| Rate for Payer: Aetna Managed Medicare |
$124.47
|
| Rate for Payer: Anthem Medicare Advantage |
$124.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$124.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$124.47
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cash Price |
$148.80
|
| Rate for Payer: Cigna Commercial |
$490.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$124.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$124.47
|
| Rate for Payer: Health EOS Commercial |
$469.41
|
| Rate for Payer: HFN Commercial |
$490.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$515.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$515.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$124.47
|
| Rate for Payer: Multiplan Commercial |
$412.67
|
| Rate for Payer: NAPHCARE Commercial |
$186.70
|
| Rate for Payer: Preferred Network Access Commercial |
$490.05
|
| Rate for Payer: Quartz Beloit One Network |
$226.97
|
| Rate for Payer: Quartz Commercial |
$294.03
|
| Rate for Payer: Quartz Medicare Advantage |
$124.47
|
| Rate for Payer: The Alliance Commercial |
$298.72
|
| Rate for Payer: United Healthcare Medicaid |
$124.77
|
| Rate for Payer: United Healthcare Medicare Advantage |
$124.47
|
| Rate for Payer: WEA Trust Commercial |
$283.71
|
| Rate for Payer: WPS Commercial |
$261.38
|
|
|
Office/Outpatient Visit Level 5 Established 99215SM
|
Professional
|
Both
|
$512.00
|
|
| Hospital Charge Code |
4596874
|
| Min. Negotiated Rate |
$234.29 |
| Max. Negotiated Rate |
$505.86 |
| Rate for Payer: Aetna Commercial |
$505.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$457.93
|
| Rate for Payer: Cash Price |
$153.60
|
| Rate for Payer: Cigna Commercial |
$505.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$266.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$319.49
|
| Rate for Payer: Health EOS Commercial |
$484.56
|
| Rate for Payer: HFN Commercial |
$505.86
|
| Rate for Payer: Multiplan Commercial |
$425.98
|
| Rate for Payer: Preferred Network Access Commercial |
$505.86
|
| Rate for Payer: Quartz Beloit One Network |
$234.29
|
| Rate for Payer: Quartz Commercial |
$303.51
|
| Rate for Payer: The Alliance Commercial |
$266.24
|
| Rate for Payer: WEA Trust Commercial |
$292.86
|
| Rate for Payer: WPS Commercial |
$394.39
|
|
|
Office/Outpatient Visit Level 5 New
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
1122813
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.27 |
| Max. Negotiated Rate |
$645.94 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$156.71
|
| Rate for Payer: Anthem Medicare Advantage |
$156.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$156.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$156.71
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$152.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.71
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: HFN Commercial |
$543.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$645.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$156.71
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$235.06
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: Quartz Medicare Advantage |
$156.71
|
| Rate for Payer: The Alliance Commercial |
$376.10
|
| Rate for Payer: United Healthcare Medicaid |
$152.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.71
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$329.09
|
|
|
Office/Outpatient Visit Level New 99205HS
|
Professional
|
Both
|
$550.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
5510885
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.27 |
| Max. Negotiated Rate |
$645.94 |
| Rate for Payer: Aetna Commercial |
$543.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.92
|
| Rate for Payer: Aetna Managed Medicare |
$156.71
|
| Rate for Payer: Anthem Medicare Advantage |
$156.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$156.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$156.71
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cash Price |
$165.00
|
| Rate for Payer: Cigna Commercial |
$543.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$152.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.71
|
| Rate for Payer: Health EOS Commercial |
$520.52
|
| Rate for Payer: HFN Commercial |
$543.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$645.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$156.71
|
| Rate for Payer: Multiplan Commercial |
$457.60
|
| Rate for Payer: NAPHCARE Commercial |
$235.06
|
| Rate for Payer: Preferred Network Access Commercial |
$543.40
|
| Rate for Payer: Quartz Beloit One Network |
$251.68
|
| Rate for Payer: Quartz Commercial |
$326.04
|
| Rate for Payer: Quartz Medicare Advantage |
$156.71
|
| Rate for Payer: The Alliance Commercial |
$376.10
|
| Rate for Payer: United Healthcare Medicaid |
$152.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.71
|
| Rate for Payer: WEA Trust Commercial |
$314.60
|
| Rate for Payer: WPS Commercial |
$329.09
|
|
|
Office/OutPatient Visit, New 99202DSC
|
Professional
|
Both
|
$128.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
3301483
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$40.71 |
| Max. Negotiated Rate |
$172.04 |
| Rate for Payer: Aetna Commercial |
$126.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$114.48
|
| Rate for Payer: Aetna Managed Medicare |
$40.71
|
| Rate for Payer: Anthem Medicare Advantage |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$40.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$40.71
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cash Price |
$38.40
|
| Rate for Payer: Cigna Commercial |
$126.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$40.71
|
| Rate for Payer: Health EOS Commercial |
$121.14
|
| Rate for Payer: HFN Commercial |
$126.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$172.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$172.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$40.71
|
| Rate for Payer: Multiplan Commercial |
$106.50
|
| Rate for Payer: NAPHCARE Commercial |
$61.06
|
| Rate for Payer: Preferred Network Access Commercial |
$126.46
|
| Rate for Payer: Quartz Beloit One Network |
$58.57
|
| Rate for Payer: Quartz Commercial |
$75.88
|
| Rate for Payer: Quartz Medicare Advantage |
$40.71
|
| Rate for Payer: The Alliance Commercial |
$97.69
|
| Rate for Payer: United Healthcare Medicaid |
$51.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$40.71
|
| Rate for Payer: WEA Trust Commercial |
$73.22
|
| Rate for Payer: WPS Commercial |
$85.48
|
|
|
Office/OutPatient Visit, New 99203DSC
|
Professional
|
Both
|
$165.00
|
|
|
Service Code
|
CPT 99203
|
| Hospital Charge Code |
3301485
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$69.94 |
| Max. Negotiated Rate |
$291.49 |
| Rate for Payer: Aetna Commercial |
$163.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$147.58
|
| Rate for Payer: Aetna Managed Medicare |
$69.94
|
| Rate for Payer: Anthem Medicare Advantage |
$69.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.94
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cash Price |
$49.50
|
| Rate for Payer: Cigna Commercial |
$163.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$77.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$69.94
|
| Rate for Payer: Health EOS Commercial |
$156.16
|
| Rate for Payer: HFN Commercial |
$163.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$291.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$291.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.94
|
| Rate for Payer: Multiplan Commercial |
$137.28
|
| Rate for Payer: NAPHCARE Commercial |
$104.91
|
| Rate for Payer: Preferred Network Access Commercial |
$163.02
|
| Rate for Payer: Quartz Beloit One Network |
$75.50
|
| Rate for Payer: Quartz Commercial |
$97.81
|
| Rate for Payer: Quartz Medicare Advantage |
$69.94
|
| Rate for Payer: The Alliance Commercial |
$167.86
|
| Rate for Payer: United Healthcare Medicaid |
$77.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.94
|
| Rate for Payer: WEA Trust Commercial |
$94.38
|
| Rate for Payer: WPS Commercial |
$146.87
|
|
|
Office/OutPatient Visit, New 99204DSC
|
Professional
|
Both
|
$308.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3301487
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$114.85 |
| Max. Negotiated Rate |
$475.72 |
| Rate for Payer: Aetna Commercial |
$304.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$275.48
|
| Rate for Payer: Aetna Managed Medicare |
$114.85
|
| Rate for Payer: Anthem Medicare Advantage |
$114.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$114.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$114.85
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cash Price |
$92.40
|
| Rate for Payer: Cigna Commercial |
$304.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$115.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$114.85
|
| Rate for Payer: Health EOS Commercial |
$291.49
|
| Rate for Payer: HFN Commercial |
$304.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$475.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$475.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$114.85
|
| Rate for Payer: Multiplan Commercial |
$256.26
|
| Rate for Payer: NAPHCARE Commercial |
$172.27
|
| Rate for Payer: Preferred Network Access Commercial |
$304.30
|
| Rate for Payer: Quartz Beloit One Network |
$140.94
|
| Rate for Payer: Quartz Commercial |
$182.58
|
| Rate for Payer: Quartz Medicare Advantage |
$114.85
|
| Rate for Payer: The Alliance Commercial |
$275.63
|
| Rate for Payer: United Healthcare Medicaid |
$115.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$114.85
|
| Rate for Payer: WEA Trust Commercial |
$176.18
|
| Rate for Payer: WPS Commercial |
$241.18
|
|
|
Office/OutPatient Visit, New 99205DSC
|
Professional
|
Both
|
$396.00
|
|
|
Service Code
|
CPT 99205
|
| Hospital Charge Code |
3301489
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$152.27 |
| Max. Negotiated Rate |
$645.94 |
| Rate for Payer: Aetna Commercial |
$391.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$354.18
|
| Rate for Payer: Aetna Managed Medicare |
$156.71
|
| Rate for Payer: Anthem Medicare Advantage |
$156.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$156.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$156.71
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cash Price |
$118.80
|
| Rate for Payer: Cigna Commercial |
$391.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$152.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.71
|
| Rate for Payer: Health EOS Commercial |
$374.77
|
| Rate for Payer: HFN Commercial |
$391.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$645.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$156.71
|
| Rate for Payer: Multiplan Commercial |
$329.47
|
| Rate for Payer: NAPHCARE Commercial |
$235.06
|
| Rate for Payer: Preferred Network Access Commercial |
$391.25
|
| Rate for Payer: Quartz Beloit One Network |
$181.21
|
| Rate for Payer: Quartz Commercial |
$234.75
|
| Rate for Payer: Quartz Medicare Advantage |
$156.71
|
| Rate for Payer: The Alliance Commercial |
$376.10
|
| Rate for Payer: United Healthcare Medicaid |
$152.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$156.71
|
| Rate for Payer: WEA Trust Commercial |
$226.51
|
| Rate for Payer: WPS Commercial |
$329.09
|
|
|
Office/OutPatient Visit Respiratory
|
Facility
|
OP
|
$170.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5252606
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$30.74 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Aetna Managed Medicare |
$49.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$114.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$88.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$84.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$98.94
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$132.60
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: NAPHCARE Commercial |
$106.08
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$114.92
|
| Rate for Payer: Quartz Medicare Advantage |
$106.08
|
| Rate for Payer: The Alliance Commercial |
$30.74
|
| Rate for Payer: United Healthcare PPO |
$132.60
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
Office/OutPatient Visit Respiratory
|
Facility
|
IP
|
$170.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
5252606
|
|
Hospital Revenue Code
|
460
|
| Min. Negotiated Rate |
$86.63 |
| Max. Negotiated Rate |
$162.66 |
| Rate for Payer: Aetna Commercial |
$159.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$152.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$93.70
|
| Rate for Payer: Cash Price |
$51.00
|
| Rate for Payer: Cigna Commercial |
$162.66
|
| Rate for Payer: Health EOS Commercial |
$157.35
|
| Rate for Payer: HFN Commercial |
$162.66
|
| Rate for Payer: Multiplan Commercial |
$141.44
|
| Rate for Payer: Preferred Network Access Commercial |
$162.66
|
| Rate for Payer: Quartz Beloit One Network |
$86.63
|
| Rate for Payer: Quartz Commercial |
$106.08
|
| Rate for Payer: WEA Trust Commercial |
$97.24
|
| Rate for Payer: WPS Commercial |
$130.95
|
|
|
Office Visit New Pt Brief
|
Facility
|
OP
|
$248.00
|
|
|
Service Code
|
CPT 99202
|
| Hospital Charge Code |
3040426
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$72.22 |
| Max. Negotiated Rate |
$237.29 |
| Rate for Payer: Aetna Commercial |
$232.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$221.81
|
| Rate for Payer: Aetna Managed Medicare |
$72.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$167.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$128.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$123.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$136.70
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cash Price |
$74.40
|
| Rate for Payer: Cigna Commercial |
$237.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$144.34
|
| Rate for Payer: Health EOS Commercial |
$229.55
|
| Rate for Payer: HFN Commercial |
$237.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$193.44
|
| Rate for Payer: Multiplan Commercial |
$206.34
|
| Rate for Payer: NAPHCARE Commercial |
$154.75
|
| Rate for Payer: Preferred Network Access Commercial |
$237.29
|
| Rate for Payer: Quartz Beloit One Network |
$126.38
|
| Rate for Payer: Quartz Commercial |
$167.65
|
| Rate for Payer: Quartz Medicare Advantage |
$154.75
|
| Rate for Payer: The Alliance Commercial |
$162.82
|
| Rate for Payer: WEA Trust Commercial |
$141.86
|
| Rate for Payer: WPS Commercial |
$191.03
|
|
