|
PROSTATECTOMY, OPEN
|
Facility
|
OP
|
$8,521.00
|
|
| Hospital Charge Code |
2960323
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,481.32 |
| Max. Negotiated Rate |
$8,152.89 |
| Rate for Payer: Aetna Commercial |
$7,975.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,621.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,481.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,760.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,430.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,253.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,696.78
|
| Rate for Payer: Cash Price |
$2,556.30
|
| Rate for Payer: Cigna Commercial |
$8,152.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,959.22
|
| Rate for Payer: Health EOS Commercial |
$7,887.04
|
| Rate for Payer: HFN Commercial |
$8,152.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,646.38
|
| Rate for Payer: Multiplan Commercial |
$7,089.47
|
| Rate for Payer: NAPHCARE Commercial |
$5,317.10
|
| Rate for Payer: Preferred Network Access Commercial |
$8,152.89
|
| Rate for Payer: Quartz Beloit One Network |
$4,342.30
|
| Rate for Payer: Quartz Commercial |
$5,760.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,317.10
|
| Rate for Payer: The Alliance Commercial |
$4,430.92
|
| Rate for Payer: WEA Trust Commercial |
$4,874.01
|
| Rate for Payer: WPS Commercial |
$6,563.73
|
|
|
PROSTATECTOMY PROCEDURES
|
Facility
|
IP
|
$38,405.20
|
|
|
Service Code
|
APR-DRG 4854
|
| Min. Negotiated Rate |
$34,113.89 |
| Max. Negotiated Rate |
$38,405.20 |
| Rate for Payer: Anthem Medicaid |
$36,775.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$36,775.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36,775.09
|
| Rate for Payer: Dean Health Medicaid |
$36,775.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$34,113.89
|
| Rate for Payer: Managed Health Services Medicaid |
$38,405.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,775.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36,775.09
|
| Rate for Payer: United Healthcare Medicaid |
$36,775.09
|
|
|
PROSTATECTOMY PROCEDURES
|
Facility
|
IP
|
$23,323.70
|
|
|
Service Code
|
APR-DRG 4853
|
| Min. Negotiated Rate |
$20,717.57 |
| Max. Negotiated Rate |
$23,323.70 |
| Rate for Payer: Anthem Medicaid |
$22,333.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,333.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,333.73
|
| Rate for Payer: Dean Health Medicaid |
$22,333.73
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,717.57
|
| Rate for Payer: Managed Health Services Medicaid |
$23,323.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,333.73
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,333.73
|
| Rate for Payer: United Healthcare Medicaid |
$22,333.73
|
|
|
PROSTATECTOMY PROCEDURES
|
Facility
|
IP
|
$12,626.37
|
|
|
Service Code
|
APR-DRG 4851
|
| Min. Negotiated Rate |
$11,215.53 |
| Max. Negotiated Rate |
$12,626.37 |
| Rate for Payer: Anthem Medicaid |
$12,090.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,090.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,090.44
|
| Rate for Payer: Dean Health Medicaid |
$12,090.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,215.53
|
| Rate for Payer: Managed Health Services Medicaid |
$12,626.37
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,090.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,090.44
|
| Rate for Payer: United Healthcare Medicaid |
$12,090.44
|
|
|
PROSTATECTOMY PROCEDURES
|
Facility
|
IP
|
$14,555.39
|
|
|
Service Code
|
APR-DRG 4852
|
| Min. Negotiated Rate |
$12,929.01 |
| Max. Negotiated Rate |
$14,555.39 |
| Rate for Payer: Anthem Medicaid |
$13,937.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,937.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,937.59
|
| Rate for Payer: Dean Health Medicaid |
$13,937.59
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,929.01
|
| Rate for Payer: Managed Health Services Medicaid |
$14,555.39
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,937.59
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,937.59
|
| Rate for Payer: United Healthcare Medicaid |
$13,937.59
|
|
|
PROSTATECTOMY, RADICAL
|
Facility
|
OP
|
$8,521.00
|
|
| Hospital Charge Code |
2960336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,481.32 |
| Max. Negotiated Rate |
$8,152.89 |
| Rate for Payer: Aetna Commercial |
$7,975.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,621.18
|
| Rate for Payer: Aetna Managed Medicare |
$2,481.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,760.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,430.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,253.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,696.78
|
| Rate for Payer: Cash Price |
$2,556.30
|
| Rate for Payer: Cigna Commercial |
$8,152.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,959.22
|
| Rate for Payer: Health EOS Commercial |
$7,887.04
|
| Rate for Payer: HFN Commercial |
$8,152.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,646.38
|
| Rate for Payer: Multiplan Commercial |
$7,089.47
|
| Rate for Payer: NAPHCARE Commercial |
$5,317.10
|
| Rate for Payer: Preferred Network Access Commercial |
$8,152.89
|
| Rate for Payer: Quartz Beloit One Network |
$4,342.30
|
| Rate for Payer: Quartz Commercial |
$5,760.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5,317.10
|
| Rate for Payer: The Alliance Commercial |
$4,430.92
|
| Rate for Payer: WEA Trust Commercial |
$4,874.01
|
| Rate for Payer: WPS Commercial |
$6,563.73
|
|
|
PROSTATECTOMY, RADICAL
|
Facility
|
IP
|
$8,521.00
|
|
| Hospital Charge Code |
2960336
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,342.30 |
| Max. Negotiated Rate |
$8,152.89 |
| Rate for Payer: Aetna Commercial |
$7,975.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,621.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,696.78
|
| Rate for Payer: Cash Price |
$2,556.30
|
| Rate for Payer: Cigna Commercial |
$8,152.89
|
| Rate for Payer: Health EOS Commercial |
$7,887.04
|
| Rate for Payer: HFN Commercial |
$8,152.89
|
| Rate for Payer: Multiplan Commercial |
$7,089.47
|
| Rate for Payer: Preferred Network Access Commercial |
$8,152.89
|
| Rate for Payer: Quartz Beloit One Network |
$4,342.30
|
| Rate for Payer: Quartz Commercial |
$5,317.10
|
| Rate for Payer: WEA Trust Commercial |
$4,874.01
|
| Rate for Payer: WPS Commercial |
$6,563.73
|
|
|
PROSTATECTOMY WITH CC
|
Facility
|
IP
|
$47,818.16
|
|
|
Service Code
|
MSDRG 666
|
| Min. Negotiated Rate |
$13,903.26 |
| Max. Negotiated Rate |
$47,818.16 |
| Rate for Payer: Aetna Managed Medicare |
$13,903.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38,168.33
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,255.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,794.84
|
| Rate for Payer: Anthem Medicare Advantage |
$13,903.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,903.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,903.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,903.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,854.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,903.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,828.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,903.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,903.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,903.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,903.26
|
| Rate for Payer: NAPHCARE Commercial |
$20,854.89
|
| Rate for Payer: Quartz Medicare Advantage |
$13,903.26
|
| Rate for Payer: The Alliance Commercial |
$47,818.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,903.26
|
| Rate for Payer: United Healthcare PPO |
$27,114.72
|
| Rate for Payer: Wellcare Medicare |
$13,903.26
|
|
|
PROSTATECTOMY WITH MCC
|
Facility
|
IP
|
$85,744.88
|
|
|
Service Code
|
MSDRG 665
|
| Min. Negotiated Rate |
$24,409.55 |
| Max. Negotiated Rate |
$85,744.88 |
| Rate for Payer: Aetna Managed Medicare |
$24,409.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68,102.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$52,199.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$49,593.12
|
| Rate for Payer: Anthem Medicare Advantage |
$24,409.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$24,409.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$24,409.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$24,409.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$55,052.91
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$24,409.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$62,646.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$24,409.55
|
| Rate for Payer: Independent Care Health Plan Medicare |
$24,409.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$24,409.55
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$24,409.55
|
| Rate for Payer: NAPHCARE Commercial |
$36,614.32
|
| Rate for Payer: Quartz Medicare Advantage |
$24,409.55
|
| Rate for Payer: The Alliance Commercial |
$85,744.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$24,409.55
|
| Rate for Payer: United Healthcare PPO |
$48,771.46
|
| Rate for Payer: Wellcare Medicare |
$24,409.55
|
|
|
PROSTATECTOMY WITHOUT CC/MCC
|
Facility
|
IP
|
$29,354.00
|
|
|
Service Code
|
MSDRG 667
|
| Min. Negotiated Rate |
$8,978.28 |
| Max. Negotiated Rate |
$29,354.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,978.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,136.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,500.35
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,576.54
|
| Rate for Payer: Anthem Medicare Advantage |
$8,978.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,978.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,978.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,978.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,511.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,978.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,285.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,978.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,978.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,978.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,978.28
|
| Rate for Payer: NAPHCARE Commercial |
$13,467.42
|
| Rate for Payer: Quartz Medicare Advantage |
$8,978.28
|
| Rate for Payer: The Alliance Commercial |
$29,354.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,978.28
|
| Rate for Payer: United Healthcare PPO |
$16,571.34
|
| Rate for Payer: Wellcare Medicare |
$8,978.28
|
|
|
Prostate Health Index
|
Facility
|
IP
|
$179.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
5911628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$91.22 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$111.70
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
Prostate Health Index
|
Facility
|
OP
|
$179.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
5911628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$171.27 |
| Rate for Payer: Aetna Commercial |
$167.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$19.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$98.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.13
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$171.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$165.68
|
| Rate for Payer: HFN Commercial |
$171.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.13
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$171.27
|
| Rate for Payer: Quartz Beloit One Network |
$91.22
|
| Rate for Payer: Quartz Commercial |
$121.00
|
| Rate for Payer: Quartz Medicare Advantage |
$19.13
|
| Rate for Payer: The Alliance Commercial |
$76.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.13
|
| Rate for Payer: United Healthcare PPO |
$139.62
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: Wellcare Medicare |
$19.13
|
| Rate for Payer: WPS Commercial |
$137.88
|
|
|
Prostate Health Index
|
Professional
|
Both
|
$179.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
5911628
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$176.85 |
| Rate for Payer: Aetna Commercial |
$176.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$160.10
|
| Rate for Payer: Aetna Managed Medicare |
$19.13
|
| Rate for Payer: Anthem Medicare Advantage |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.13
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cash Price |
$53.70
|
| Rate for Payer: Cigna Commercial |
$176.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$169.41
|
| Rate for Payer: HFN Commercial |
$176.85
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.13
|
| Rate for Payer: Multiplan Commercial |
$148.93
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$176.85
|
| Rate for Payer: Quartz Beloit One Network |
$81.91
|
| Rate for Payer: Quartz Commercial |
$106.11
|
| Rate for Payer: Quartz Medicare Advantage |
$19.13
|
| Rate for Payer: The Alliance Commercial |
$75.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.13
|
| Rate for Payer: WEA Trust Commercial |
$102.39
|
| Rate for Payer: WPS Commercial |
$84.15
|
|
|
Prostate Histology
|
Facility
|
IP
|
$404.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
4510694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$205.88 |
| Max. Negotiated Rate |
$386.55 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$252.10
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
Prostate Histology
|
Facility
|
OP
|
$404.00
|
|
|
Service Code
|
HCPCS G0416
|
| Hospital Charge Code |
4510694
|
|
Hospital Revenue Code
|
310
|
| Min. Negotiated Rate |
$201.68 |
| Max. Negotiated Rate |
$1,508.92 |
| Rate for Payer: Aetna Commercial |
$378.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.34
|
| Rate for Payer: Aetna Managed Medicare |
$377.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$273.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$210.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$201.68
|
| Rate for Payer: Anthem Medicare Advantage |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$377.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$377.23
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cash Price |
$121.20
|
| Rate for Payer: Cigna Commercial |
$386.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$377.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$377.23
|
| Rate for Payer: Health EOS Commercial |
$373.94
|
| Rate for Payer: HFN Commercial |
$386.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,403.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$377.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$377.23
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$377.23
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$377.23
|
| Rate for Payer: Multiplan Commercial |
$336.13
|
| Rate for Payer: NAPHCARE Commercial |
$565.84
|
| Rate for Payer: Preferred Network Access Commercial |
$386.55
|
| Rate for Payer: Quartz Beloit One Network |
$205.88
|
| Rate for Payer: Quartz Commercial |
$273.10
|
| Rate for Payer: Quartz Medicare Advantage |
$377.23
|
| Rate for Payer: The Alliance Commercial |
$1,508.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$377.23
|
| Rate for Payer: United Healthcare PPO |
$315.12
|
| Rate for Payer: WEA Trust Commercial |
$231.09
|
| Rate for Payer: Wellcare Medicare |
$377.23
|
| Rate for Payer: WPS Commercial |
$311.20
|
|
|
Prostate Specific Antigen Free
|
Professional
|
Both
|
$84.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
2942976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$84.15 |
| Rate for Payer: Aetna Commercial |
$82.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$19.13
|
| Rate for Payer: Anthem Medicare Advantage |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.13
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$82.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$79.50
|
| Rate for Payer: HFN Commercial |
$82.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.13
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$82.99
|
| Rate for Payer: Quartz Beloit One Network |
$38.44
|
| Rate for Payer: Quartz Commercial |
$49.80
|
| Rate for Payer: Quartz Medicare Advantage |
$19.13
|
| Rate for Payer: The Alliance Commercial |
$75.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.13
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$84.15
|
|
|
Prostate Specific Antigen Free
|
Facility
|
IP
|
$84.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
2942976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$42.81 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$52.42
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
Prostate Specific Antigen Free
|
Facility
|
OP
|
$84.00
|
|
|
Service Code
|
CPT 84154
|
| Hospital Charge Code |
2942976
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$80.37 |
| Rate for Payer: Aetna Commercial |
$78.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$75.13
|
| Rate for Payer: Aetna Managed Medicare |
$19.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.75
|
| Rate for Payer: Anthem Medicare Advantage |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$46.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$19.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$19.13
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cash Price |
$25.20
|
| Rate for Payer: Cigna Commercial |
$80.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$77.75
|
| Rate for Payer: HFN Commercial |
$80.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$19.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$19.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$19.13
|
| Rate for Payer: Multiplan Commercial |
$69.89
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$80.37
|
| Rate for Payer: Quartz Beloit One Network |
$42.81
|
| Rate for Payer: Quartz Commercial |
$56.78
|
| Rate for Payer: Quartz Medicare Advantage |
$19.13
|
| Rate for Payer: The Alliance Commercial |
$76.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$19.13
|
| Rate for Payer: United Healthcare PPO |
$65.52
|
| Rate for Payer: WEA Trust Commercial |
$48.05
|
| Rate for Payer: Wellcare Medicare |
$19.13
|
| Rate for Payer: WPS Commercial |
$64.71
|
|
|
PROSTATE, TRANSURETHRAL RESECTION
|
Facility
|
IP
|
$5,017.00
|
|
| Hospital Charge Code |
2960459
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,556.66 |
| Max. Negotiated Rate |
$4,800.27 |
| Rate for Payer: Aetna Commercial |
$4,695.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,487.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,765.37
|
| Rate for Payer: Cash Price |
$1,505.10
|
| Rate for Payer: Cigna Commercial |
$4,800.27
|
| Rate for Payer: Health EOS Commercial |
$4,643.74
|
| Rate for Payer: HFN Commercial |
$4,800.27
|
| Rate for Payer: Multiplan Commercial |
$4,174.14
|
| Rate for Payer: Preferred Network Access Commercial |
$4,800.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,556.66
|
| Rate for Payer: Quartz Commercial |
$3,130.61
|
| Rate for Payer: WEA Trust Commercial |
$2,869.72
|
| Rate for Payer: WPS Commercial |
$3,864.60
|
|
|
PROSTATE, TRANSURETHRAL RESECTION
|
Facility
|
OP
|
$5,017.00
|
|
| Hospital Charge Code |
2960459
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,460.95 |
| Max. Negotiated Rate |
$4,800.27 |
| Rate for Payer: Aetna Commercial |
$4,695.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,487.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,460.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,391.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,608.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,504.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,765.37
|
| Rate for Payer: Cash Price |
$1,505.10
|
| Rate for Payer: Cigna Commercial |
$4,800.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,919.89
|
| Rate for Payer: Health EOS Commercial |
$4,643.74
|
| Rate for Payer: HFN Commercial |
$4,800.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,913.26
|
| Rate for Payer: Multiplan Commercial |
$4,174.14
|
| Rate for Payer: NAPHCARE Commercial |
$3,130.61
|
| Rate for Payer: Preferred Network Access Commercial |
$4,800.27
|
| Rate for Payer: Quartz Beloit One Network |
$2,556.66
|
| Rate for Payer: Quartz Commercial |
$3,391.49
|
| Rate for Payer: Quartz Medicare Advantage |
$3,130.61
|
| Rate for Payer: The Alliance Commercial |
$2,608.84
|
| Rate for Payer: WEA Trust Commercial |
$2,869.72
|
| Rate for Payer: WPS Commercial |
$3,864.60
|
|
|
Prostatic Acid Phosphatase
|
Facility
|
IP
|
$276.00
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
980576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$140.65 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$172.22
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
Prostatic Acid Phosphatase
|
Facility
|
OP
|
$276.00
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
980576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$264.08 |
| Rate for Payer: Aetna Commercial |
$258.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$10.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16.68
|
| Rate for Payer: Anthem Medicare Advantage |
$10.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$152.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.05
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$264.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$160.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.05
|
| Rate for Payer: Health EOS Commercial |
$255.47
|
| Rate for Payer: HFN Commercial |
$264.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$15.07
|
| Rate for Payer: Preferred Network Access Commercial |
$264.08
|
| Rate for Payer: Quartz Beloit One Network |
$140.65
|
| Rate for Payer: Quartz Commercial |
$186.58
|
| Rate for Payer: Quartz Medicare Advantage |
$10.05
|
| Rate for Payer: The Alliance Commercial |
$40.19
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.05
|
| Rate for Payer: United Healthcare PPO |
$215.28
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: Wellcare Medicare |
$10.05
|
| Rate for Payer: WPS Commercial |
$212.60
|
|
|
Prostatic Acid Phosphatase
|
Professional
|
Both
|
$276.00
|
|
|
Service Code
|
CPT 84066
|
| Hospital Charge Code |
980576
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$10.05 |
| Max. Negotiated Rate |
$272.69 |
| Rate for Payer: Aetna Commercial |
$272.69
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$246.85
|
| Rate for Payer: Aetna Managed Medicare |
$10.05
|
| Rate for Payer: Anthem Medicare Advantage |
$10.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.05
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cash Price |
$82.80
|
| Rate for Payer: Cigna Commercial |
$272.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.05
|
| Rate for Payer: Health EOS Commercial |
$261.21
|
| Rate for Payer: HFN Commercial |
$272.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$35.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10.05
|
| Rate for Payer: Multiplan Commercial |
$229.63
|
| Rate for Payer: NAPHCARE Commercial |
$15.07
|
| Rate for Payer: Preferred Network Access Commercial |
$272.69
|
| Rate for Payer: Quartz Beloit One Network |
$126.30
|
| Rate for Payer: Quartz Commercial |
$163.61
|
| Rate for Payer: Quartz Medicare Advantage |
$10.05
|
| Rate for Payer: The Alliance Commercial |
$39.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10.05
|
| Rate for Payer: WEA Trust Commercial |
$157.87
|
| Rate for Payer: WPS Commercial |
$44.20
|
|
|
PROSTATITIS
|
Facility
|
OP
|
$85.17
|
|
|
Service Code
|
EAPG 00743
|
| Min. Negotiated Rate |
$81.89 |
| Max. Negotiated Rate |
$85.17 |
| Rate for Payer: Anthem Medicaid |
$81.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$81.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$81.89
|
| Rate for Payer: Dean Health Medicaid |
$81.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$81.89
|
| Rate for Payer: Managed Health Services Medicaid |
$85.17
|
| Rate for Payer: Molina Healthcare Medicaid |
$81.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$81.89
|
| Rate for Payer: United Healthcare Medicaid |
$81.89
|
|
|
PROSTATOLITHOTOMY
|
Facility
|
OP
|
$7,912.00
|
|
| Hospital Charge Code |
2960324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,303.97 |
| Max. Negotiated Rate |
$7,570.20 |
| Rate for Payer: Aetna Commercial |
$7,405.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,303.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,348.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,114.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,949.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,361.09
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,570.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,604.78
|
| Rate for Payer: Health EOS Commercial |
$7,323.35
|
| Rate for Payer: HFN Commercial |
$7,570.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$6,582.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,937.09
|
| Rate for Payer: Preferred Network Access Commercial |
$7,570.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.96
|
| Rate for Payer: Quartz Commercial |
$5,348.51
|
| Rate for Payer: Quartz Medicare Advantage |
$4,937.09
|
| Rate for Payer: The Alliance Commercial |
$4,114.24
|
| Rate for Payer: WEA Trust Commercial |
$4,525.66
|
| Rate for Payer: WPS Commercial |
$6,094.61
|
|
