|
Prostaglandin D2 (PGD2)
|
Professional
|
Both
|
$535.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
5098623
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.45 |
| Max. Negotiated Rate |
$508.25 |
| Rate for Payer: Aetna Commercial |
$508.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$460.10
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cash Price |
$160.50
|
| Rate for Payer: Cigna Commercial |
$508.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$267.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$321.00
|
| Rate for Payer: Health EOS Commercial |
$486.85
|
| Rate for Payer: HFN Commercial |
$508.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.45
|
| Rate for Payer: Multiplan Commercial |
$428.00
|
| Rate for Payer: Preferred Network Access Commercial |
$508.25
|
| Rate for Payer: Quartz Beloit One Network |
$235.40
|
| Rate for Payer: Quartz Commercial |
$304.95
|
| Rate for Payer: The Alliance Commercial |
$267.50
|
| Rate for Payer: WEA Trust Commercial |
$294.25
|
| Rate for Payer: WPS Commercial |
$396.27
|
|
|
Prostaglandin D2, Urine
|
Professional
|
Both
|
$578.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
5098632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$147.45 |
| Max. Negotiated Rate |
$549.10 |
| Rate for Payer: Aetna Commercial |
$549.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.08
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$549.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$289.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$346.80
|
| Rate for Payer: Health EOS Commercial |
$525.98
|
| Rate for Payer: HFN Commercial |
$549.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$147.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$147.45
|
| Rate for Payer: Multiplan Commercial |
$462.40
|
| Rate for Payer: Preferred Network Access Commercial |
$549.10
|
| Rate for Payer: Quartz Beloit One Network |
$254.32
|
| Rate for Payer: Quartz Commercial |
$329.46
|
| Rate for Payer: The Alliance Commercial |
$289.00
|
| Rate for Payer: WEA Trust Commercial |
$317.90
|
| Rate for Payer: WPS Commercial |
$428.12
|
|
|
Prostaglandin D2, Urine
|
Facility
|
OP
|
$578.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
5098632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$35.09 |
| Max. Negotiated Rate |
$531.76 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.08
|
| Rate for Payer: Aetna Managed Medicare |
$41.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$156.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$69.34
|
| Rate for Payer: Anthem Medicaid |
$35.09
|
| Rate for Payer: Anthem Medicare Advantage |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.77
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$531.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$41.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$323.45
|
| Rate for Payer: Dean Health Medicaid |
$35.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$41.77
|
| Rate for Payer: Health EOS Commercial |
$514.42
|
| Rate for Payer: HFN Commercial |
$531.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$155.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$35.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.77
|
| Rate for Payer: Managed Health Services Medicaid |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$41.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$41.77
|
| Rate for Payer: Multiplan Commercial |
$462.40
|
| Rate for Payer: NAPHCARE Commercial |
$62.66
|
| Rate for Payer: Preferred Network Access Commercial |
$531.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$35.09
|
| Rate for Payer: Quartz Beloit One Network |
$283.22
|
| Rate for Payer: Quartz Commercial |
$375.70
|
| Rate for Payer: Quartz Medicare Advantage |
$41.77
|
| Rate for Payer: The Alliance Commercial |
$167.08
|
| Rate for Payer: United Healthcare Medicaid |
$35.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.77
|
| Rate for Payer: United Healthcare PPO |
$433.50
|
| Rate for Payer: WEA Trust Commercial |
$317.90
|
| Rate for Payer: Wellcare Medicare |
$41.77
|
| Rate for Payer: WMAP Medicaid |
$35.09
|
| Rate for Payer: WPS Commercial |
$428.12
|
|
|
Prostaglandin D2, Urine
|
Facility
|
IP
|
$578.00
|
|
|
Service Code
|
CPT 84150
|
| Hospital Charge Code |
5098632
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$283.22 |
| Max. Negotiated Rate |
$531.76 |
| Rate for Payer: Aetna Commercial |
$520.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$497.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$306.34
|
| Rate for Payer: Cash Price |
$173.40
|
| Rate for Payer: Cigna Commercial |
$531.76
|
| Rate for Payer: Health EOS Commercial |
$514.42
|
| Rate for Payer: HFN Commercial |
$531.76
|
| Rate for Payer: Multiplan Commercial |
$462.40
|
| Rate for Payer: NAPHCARE Commercial |
$346.80
|
| Rate for Payer: Preferred Network Access Commercial |
$531.76
|
| Rate for Payer: Quartz Beloit One Network |
$283.22
|
| Rate for Payer: Quartz Commercial |
$346.80
|
| Rate for Payer: WEA Trust Commercial |
$317.90
|
| Rate for Payer: WPS Commercial |
$428.12
|
|
|
PROSTATECTOMY, OPEN
|
Facility
|
OP
|
$8,521.00
|
|
| Hospital Charge Code |
2960323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,385.88 |
| Max. Negotiated Rate |
$34,084.00 |
| Rate for Payer: Aetna Commercial |
$7,668.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,328.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,385.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,538.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,090.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,516.13
|
| Rate for Payer: Cash Price |
$2,556.30
|
| Rate for Payer: Cigna Commercial |
$7,839.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,768.35
|
| Rate for Payer: Health EOS Commercial |
$7,583.69
|
| Rate for Payer: HFN Commercial |
$7,839.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,390.75
|
| Rate for Payer: Multiplan Commercial |
$6,816.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,112.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,839.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,175.29
|
| Rate for Payer: Quartz Commercial |
$5,538.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,112.60
|
| Rate for Payer: The Alliance Commercial |
$34,084.00
|
| Rate for Payer: WEA Trust Commercial |
$4,686.55
|
| Rate for Payer: WPS Commercial |
$6,311.50
|
|
|
PROSTATECTOMY, OPEN
|
Facility
|
IP
|
$8,521.00
|
|
| Hospital Charge Code |
2960323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,175.29 |
| Max. Negotiated Rate |
$7,839.32 |
| Rate for Payer: Aetna Commercial |
$7,668.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,328.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,516.13
|
| Rate for Payer: Cash Price |
$2,556.30
|
| Rate for Payer: Cigna Commercial |
$7,839.32
|
| Rate for Payer: Health EOS Commercial |
$7,583.69
|
| Rate for Payer: HFN Commercial |
$7,839.32
|
| Rate for Payer: Multiplan Commercial |
$6,816.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,112.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,839.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,175.29
|
| Rate for Payer: Quartz Commercial |
$5,112.60
|
| Rate for Payer: WEA Trust Commercial |
$4,686.55
|
| Rate for Payer: WPS Commercial |
$6,311.50
|
|
|
PROSTATECTOMY, RADICAL
|
Facility
|
IP
|
$8,521.00
|
|
| Hospital Charge Code |
2960336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,175.29 |
| Max. Negotiated Rate |
$7,839.32 |
| Rate for Payer: Aetna Commercial |
$7,668.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,328.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,516.13
|
| Rate for Payer: Cash Price |
$2,556.30
|
| Rate for Payer: Cigna Commercial |
$7,839.32
|
| Rate for Payer: Health EOS Commercial |
$7,583.69
|
| Rate for Payer: HFN Commercial |
$7,839.32
|
| Rate for Payer: Multiplan Commercial |
$6,816.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,112.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,839.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,175.29
|
| Rate for Payer: Quartz Commercial |
$5,112.60
|
| Rate for Payer: WEA Trust Commercial |
$4,686.55
|
| Rate for Payer: WPS Commercial |
$6,311.50
|
|
|
PROSTATECTOMY, RADICAL
|
Facility
|
OP
|
$8,521.00
|
|
| Hospital Charge Code |
2960336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,385.88 |
| Max. Negotiated Rate |
$34,084.00 |
| Rate for Payer: Aetna Commercial |
$7,668.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,328.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,385.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,538.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,260.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,090.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,516.13
|
| Rate for Payer: Cash Price |
$2,556.30
|
| Rate for Payer: Cigna Commercial |
$7,839.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,768.35
|
| Rate for Payer: Health EOS Commercial |
$7,583.69
|
| Rate for Payer: HFN Commercial |
$7,839.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,390.75
|
| Rate for Payer: Multiplan Commercial |
$6,816.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,112.60
|
| Rate for Payer: Preferred Network Access Commercial |
$7,839.32
|
| Rate for Payer: Quartz Beloit One Network |
$4,175.29
|
| Rate for Payer: Quartz Commercial |
$5,538.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,112.60
|
| Rate for Payer: The Alliance Commercial |
$34,084.00
|
| Rate for Payer: WEA Trust Commercial |
$4,686.55
|
| Rate for Payer: WPS Commercial |
$6,311.50
|
|
|
PROSTATECTOMY WITH CC
|
Facility
|
IP
|
$45,979.00
|
|
|
Service Code
|
MSDRG 666
|
| Min. Negotiated Rate |
$16,539.28 |
| Max. Negotiated Rate |
$45,979.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,539.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,085.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,659.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,278.16
|
| Rate for Payer: Anthem Medicare Advantage |
$16,539.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,539.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,539.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,539.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,171.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,539.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,489.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,539.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,539.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,539.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,539.28
|
| Rate for Payer: NAPHCARE Commercial |
$24,808.92
|
| Rate for Payer: Quartz Medicare Advantage |
$16,539.28
|
| Rate for Payer: The Alliance Commercial |
$45,979.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,539.28
|
| Rate for Payer: United Healthcare PPO |
$26,071.85
|
| Rate for Payer: Wellcare Medicare |
$16,539.28
|
|
|
PROSTATECTOMY WITH MCC
|
Facility
|
IP
|
$82,447.00
|
|
|
Service Code
|
MSDRG 665
|
| Min. Negotiated Rate |
$29,657.24 |
| Max. Negotiated Rate |
$82,447.00 |
| Rate for Payer: Aetna Managed Medicare |
$29,657.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64,828.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49,690.29
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$47,209.02
|
| Rate for Payer: Anthem Medicare Advantage |
$29,657.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$29,657.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$29,657.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$29,657.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52,406.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$29,657.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60,237.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29,657.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$29,657.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$29,657.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$29,657.24
|
| Rate for Payer: NAPHCARE Commercial |
$44,485.86
|
| Rate for Payer: Quartz Medicare Advantage |
$29,657.24
|
| Rate for Payer: The Alliance Commercial |
$82,447.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$29,657.24
|
| Rate for Payer: United Healthcare PPO |
$46,895.63
|
| Rate for Payer: Wellcare Medicare |
$29,657.24
|
|
|
PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$28,225.00
|
|
|
Service Code
|
MSDRG 667
|
| Min. Negotiated Rate |
$10,152.90 |
| Max. Negotiated Rate |
$28,225.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,152.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,029.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,885.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,041.90
|
| Rate for Payer: Anthem Medicare Advantage |
$10,152.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,152.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,152.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,152.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,807.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,152.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,467.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,152.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,152.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,152.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,152.90
|
| Rate for Payer: NAPHCARE Commercial |
$15,229.35
|
| Rate for Payer: Quartz Medicare Advantage |
$10,152.90
|
| Rate for Payer: The Alliance Commercial |
$28,225.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,152.90
|
| Rate for Payer: United Healthcare PPO |
$15,933.98
|
| Rate for Payer: Wellcare Medicare |
$10,152.90
|
|
|
Prostate Health Index
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
5911628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$64.92 |
| Max. Negotiated Rate |
$170.05 |
| Rate for Payer: Aetna Commercial |
$170.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$170.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$89.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$107.40
|
| Rate for Payer: Health EOS Commercial |
$162.89
|
| Rate for Payer: HFN Commercial |
$170.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.92
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: Preferred Network Access Commercial |
$170.05
|
| Rate for Payer: Quartz Beloit One Network |
$78.76
|
| Rate for Payer: Quartz Commercial |
$102.03
|
| Rate for Payer: The Alliance Commercial |
$89.50
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
Prostate Health Index
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
5911628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Aetna Managed Medicare |
$18.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.53
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.39
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.17
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.39
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.39
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.39
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.58
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$116.35
|
| Rate for Payer: Quartz Medicare Advantage |
$18.39
|
| Rate for Payer: The Alliance Commercial |
$73.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare PPO |
$134.25
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: Wellcare Medicare |
$18.39
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
Prostate Health Index
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
5911628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$87.71 |
| Max. Negotiated Rate |
$164.68 |
| Rate for Payer: Aetna Commercial |
$161.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$94.87
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$164.68
|
| Rate for Payer: Health EOS Commercial |
$159.31
|
| Rate for Payer: HFN Commercial |
$164.68
|
| Rate for Payer: Multiplan Commercial |
$143.20
|
| Rate for Payer: NAPHCARE Commercial |
$107.40
|
| Rate for Payer: Preferred Network Access Commercial |
$164.68
|
| Rate for Payer: Quartz Beloit One Network |
$87.71
|
| Rate for Payer: Quartz Commercial |
$107.40
|
| Rate for Payer: WEA Trust Commercial |
$98.45
|
| Rate for Payer: WPS Commercial |
$132.59
|
|
|
Prostate Histology
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
4510694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$197.96 |
| Max. Negotiated Rate |
$371.68 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$242.40
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
Prostate Histology
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
4510694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$193.92 |
| Max. Negotiated Rate |
$1,421.12 |
| Rate for Payer: Aetna Commercial |
$363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$347.44
|
| Rate for Payer: Aetna Managed Medicare |
$355.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$262.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$193.92
|
| Rate for Payer: Anthem Medicare Advantage |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$214.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$355.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$355.28
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$371.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$355.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$226.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$355.28
|
| Rate for Payer: Health EOS Commercial |
$359.56
|
| Rate for Payer: HFN Commercial |
$371.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,321.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$355.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$355.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$355.28
|
| Rate for Payer: Multiplan Commercial |
$323.20
|
| Rate for Payer: NAPHCARE Commercial |
$532.92
|
| Rate for Payer: Preferred Network Access Commercial |
$371.68
|
| Rate for Payer: Quartz Beloit One Network |
$197.96
|
| Rate for Payer: Quartz Commercial |
$262.60
|
| Rate for Payer: Quartz Medicare Advantage |
$355.28
|
| Rate for Payer: The Alliance Commercial |
$1,421.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$355.28
|
| Rate for Payer: United Healthcare PPO |
$303.00
|
| Rate for Payer: WEA Trust Commercial |
$222.20
|
| Rate for Payer: Wellcare Medicare |
$355.28
|
| Rate for Payer: WPS Commercial |
$299.24
|
|
|
Prostate Specific Antigen Free
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
2942976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.96 |
| Max. Negotiated Rate |
$79.80 |
| Rate for Payer: Aetna Commercial |
$79.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$79.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.40
|
| Rate for Payer: Health EOS Commercial |
$76.44
|
| Rate for Payer: HFN Commercial |
$79.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.92
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: Preferred Network Access Commercial |
$79.80
|
| Rate for Payer: Quartz Beloit One Network |
$36.96
|
| Rate for Payer: Quartz Commercial |
$47.88
|
| Rate for Payer: The Alliance Commercial |
$42.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Prostate Specific Antigen Free
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
2942976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.39 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Aetna Managed Medicare |
$18.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.53
|
| Rate for Payer: Anthem Medicaid |
$19.00
|
| Rate for Payer: Anthem Medicare Advantage |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.39
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.01
|
| Rate for Payer: Dean Health Medicaid |
$19.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.39
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.39
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.39
|
| Rate for Payer: Managed Health Services Medicaid |
$19.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.39
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$27.58
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.00
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$54.60
|
| Rate for Payer: Quartz Medicare Advantage |
$18.39
|
| Rate for Payer: The Alliance Commercial |
$73.56
|
| Rate for Payer: United Healthcare Medicaid |
$19.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.39
|
| Rate for Payer: United Healthcare PPO |
$63.00
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: Wellcare Medicare |
$18.39
|
| Rate for Payer: WMAP Medicaid |
$19.00
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
Prostate Specific Antigen Free
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
2942976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.16 |
| Max. Negotiated Rate |
$77.28 |
| Rate for Payer: Aetna Commercial |
$75.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.52
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$77.28
|
| Rate for Payer: Health EOS Commercial |
$74.76
|
| Rate for Payer: HFN Commercial |
$77.28
|
| Rate for Payer: Multiplan Commercial |
$67.20
|
| Rate for Payer: NAPHCARE Commercial |
$50.40
|
| Rate for Payer: Preferred Network Access Commercial |
$77.28
|
| Rate for Payer: Quartz Beloit One Network |
$41.16
|
| Rate for Payer: Quartz Commercial |
$50.40
|
| Rate for Payer: WEA Trust Commercial |
$46.20
|
| Rate for Payer: WPS Commercial |
$62.22
|
|
|
PROSTATE, TRANSURETHRAL RESECTION
|
Facility
|
OP
|
$5,017.00
|
|
| Hospital Charge Code |
2960459
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,404.76 |
| Max. Negotiated Rate |
$20,068.00 |
| Rate for Payer: Aetna Commercial |
$4,515.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,314.62
|
| Rate for Payer: Aetna Managed Medicare |
$1,404.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,261.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,508.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,408.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,659.01
|
| Rate for Payer: Cash Price |
$1,505.10
|
| Rate for Payer: Cigna Commercial |
$4,615.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,807.51
|
| Rate for Payer: Health EOS Commercial |
$4,465.13
|
| Rate for Payer: HFN Commercial |
$4,615.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,762.75
|
| Rate for Payer: Multiplan Commercial |
$4,013.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,010.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,615.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,458.33
|
| Rate for Payer: Quartz Commercial |
$3,261.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,010.20
|
| Rate for Payer: The Alliance Commercial |
$20,068.00
|
| Rate for Payer: WEA Trust Commercial |
$2,759.35
|
| Rate for Payer: WPS Commercial |
$3,716.09
|
|
|
PROSTATE, TRANSURETHRAL RESECTION
|
Facility
|
IP
|
$5,017.00
|
|
| Hospital Charge Code |
2960459
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,458.33 |
| Max. Negotiated Rate |
$4,615.64 |
| Rate for Payer: Aetna Commercial |
$4,515.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,314.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,659.01
|
| Rate for Payer: Cash Price |
$1,505.10
|
| Rate for Payer: Cigna Commercial |
$4,615.64
|
| Rate for Payer: Health EOS Commercial |
$4,465.13
|
| Rate for Payer: HFN Commercial |
$4,615.64
|
| Rate for Payer: Multiplan Commercial |
$4,013.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,010.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,615.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,458.33
|
| Rate for Payer: Quartz Commercial |
$3,010.20
|
| Rate for Payer: WEA Trust Commercial |
$2,759.35
|
| Rate for Payer: WPS Commercial |
$3,716.09
|
|
|
Prostatic Acid Phosphatase
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
980576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$135.24 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$165.60
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$165.60
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
Prostatic Acid Phosphatase
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
980576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$34.10 |
| Max. Negotiated Rate |
$262.20 |
| Rate for Payer: Aetna Commercial |
$262.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$262.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.60
|
| Rate for Payer: Health EOS Commercial |
$251.16
|
| Rate for Payer: HFN Commercial |
$262.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$34.10
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$262.20
|
| Rate for Payer: Quartz Beloit One Network |
$121.44
|
| Rate for Payer: Quartz Commercial |
$157.32
|
| Rate for Payer: The Alliance Commercial |
$138.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
Prostatic Acid Phosphatase
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
980576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.66 |
| Max. Negotiated Rate |
$253.92 |
| Rate for Payer: Cigna Commercial |
$253.92
|
| Rate for Payer: Aetna Commercial |
$248.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$237.36
|
| Rate for Payer: Aetna Managed Medicare |
$9.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.04
|
| Rate for Payer: Anthem Medicaid |
$9.98
|
| Rate for Payer: Anthem Medicare Advantage |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$146.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9.66
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$154.45
|
| Rate for Payer: Dean Health Medicaid |
$9.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9.66
|
| Rate for Payer: Health EOS Commercial |
$245.64
|
| Rate for Payer: HFN Commercial |
$253.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9.66
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9.66
|
| Rate for Payer: Managed Health Services Medicaid |
$10.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9.66
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9.66
|
| Rate for Payer: Multiplan Commercial |
$220.80
|
| Rate for Payer: NAPHCARE Commercial |
$14.49
|
| Rate for Payer: Preferred Network Access Commercial |
$253.92
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9.98
|
| Rate for Payer: Quartz Beloit One Network |
$135.24
|
| Rate for Payer: Quartz Commercial |
$179.40
|
| Rate for Payer: Quartz Medicare Advantage |
$9.66
|
| Rate for Payer: The Alliance Commercial |
$38.64
|
| Rate for Payer: United Healthcare Medicaid |
$9.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9.66
|
| Rate for Payer: United Healthcare PPO |
$207.00
|
| Rate for Payer: WEA Trust Commercial |
$151.80
|
| Rate for Payer: Wellcare Medicare |
$9.66
|
| Rate for Payer: WMAP Medicaid |
$9.98
|
| Rate for Payer: WPS Commercial |
$204.43
|
|
|
PROSTATOLITHOTOMY
|
Facility
|
IP
|
$7,912.00
|
|
| Hospital Charge Code |
2960324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,876.88 |
| Max. Negotiated Rate |
$7,279.04 |
| Rate for Payer: Aetna Commercial |
$7,120.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,804.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,193.36
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,279.04
|
| Rate for Payer: Health EOS Commercial |
$7,041.68
|
| Rate for Payer: HFN Commercial |
$7,279.04
|
| Rate for Payer: Multiplan Commercial |
$6,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,279.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.88
|
| Rate for Payer: Quartz Commercial |
$4,747.20
|
| Rate for Payer: WEA Trust Commercial |
$4,351.60
|
| Rate for Payer: WPS Commercial |
$5,860.42
|
|
