|
PROGRAMMER INTERSTIM X (RECHARGE FREE) TH90Q01
|
Facility
|
IP
|
$7,741.00
|
|
| Hospital Charge Code |
6049664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,944.81 |
| Max. Negotiated Rate |
$7,406.59 |
| Rate for Payer: Aetna Commercial |
$7,245.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,923.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,266.84
|
| Rate for Payer: Cash Price |
$2,322.30
|
| Rate for Payer: Cigna Commercial |
$7,406.59
|
| Rate for Payer: Health EOS Commercial |
$7,165.07
|
| Rate for Payer: HFN Commercial |
$7,406.59
|
| Rate for Payer: Multiplan Commercial |
$6,440.51
|
| Rate for Payer: Preferred Network Access Commercial |
$7,406.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,944.81
|
| Rate for Payer: Quartz Commercial |
$4,830.38
|
| Rate for Payer: WEA Trust Commercial |
$4,427.85
|
| Rate for Payer: WPS Commercial |
$5,962.89
|
|
|
PROGRAMMER INTERSTIM X (RECHARGE FREE) TH90Q01
|
Facility
|
OP
|
$7,741.00
|
|
| Hospital Charge Code |
6049664
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,254.18 |
| Max. Negotiated Rate |
$7,406.59 |
| Rate for Payer: Aetna Commercial |
$7,245.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,923.55
|
| Rate for Payer: Aetna Managed Medicare |
$2,254.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,232.92
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,025.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,864.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,266.84
|
| Rate for Payer: Cash Price |
$2,322.30
|
| Rate for Payer: Cigna Commercial |
$7,406.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,505.26
|
| Rate for Payer: Health EOS Commercial |
$7,165.07
|
| Rate for Payer: HFN Commercial |
$7,406.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,037.98
|
| Rate for Payer: Multiplan Commercial |
$6,440.51
|
| Rate for Payer: NAPHCARE Commercial |
$4,830.38
|
| Rate for Payer: Preferred Network Access Commercial |
$7,406.59
|
| Rate for Payer: Quartz Beloit One Network |
$3,944.81
|
| Rate for Payer: Quartz Commercial |
$5,232.92
|
| Rate for Payer: Quartz Medicare Advantage |
$4,830.38
|
| Rate for Payer: The Alliance Commercial |
$4,025.32
|
| Rate for Payer: WEA Trust Commercial |
$4,427.85
|
| Rate for Payer: WPS Commercial |
$5,962.89
|
|
|
Programming Device Evaluation 93279
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 93279
|
| Hospital Charge Code |
4586628
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$267.20 |
| Rate for Payer: Aetna Commercial |
$62.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$66.80
|
| Rate for Payer: Anthem Medicare Advantage |
$66.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$66.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$66.80
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$62.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.80
|
| Rate for Payer: Health EOS Commercial |
$59.62
|
| Rate for Payer: HFN Commercial |
$62.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$235.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$66.80
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$100.20
|
| Rate for Payer: Preferred Network Access Commercial |
$62.24
|
| Rate for Payer: Quartz Beloit One Network |
$28.83
|
| Rate for Payer: Quartz Commercial |
$37.35
|
| Rate for Payer: Quartz Medicare Advantage |
$66.80
|
| Rate for Payer: The Alliance Commercial |
$253.84
|
| Rate for Payer: United Healthcare Medicaid |
$43.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$66.80
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$267.20
|
|
|
Programming Device Evaluation 9327926
|
Professional
|
Both
|
$63.00
|
|
|
Service Code
|
CPT 93279 26
|
| Hospital Charge Code |
3328179
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$28.83 |
| Max. Negotiated Rate |
$124.34 |
| Rate for Payer: Aetna Commercial |
$62.24
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.35
|
| Rate for Payer: Aetna Managed Medicare |
$31.09
|
| Rate for Payer: Anthem Medicare Advantage |
$31.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.09
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cash Price |
$18.90
|
| Rate for Payer: Cigna Commercial |
$62.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.09
|
| Rate for Payer: Health EOS Commercial |
$59.62
|
| Rate for Payer: HFN Commercial |
$62.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$114.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.09
|
| Rate for Payer: Multiplan Commercial |
$52.42
|
| Rate for Payer: NAPHCARE Commercial |
$46.63
|
| Rate for Payer: Preferred Network Access Commercial |
$62.24
|
| Rate for Payer: Quartz Beloit One Network |
$28.83
|
| Rate for Payer: Quartz Commercial |
$37.35
|
| Rate for Payer: Quartz Medicare Advantage |
$31.09
|
| Rate for Payer: The Alliance Commercial |
$118.13
|
| Rate for Payer: United Healthcare Medicaid |
$28.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.09
|
| Rate for Payer: WEA Trust Commercial |
$36.04
|
| Rate for Payer: WPS Commercial |
$124.34
|
|
|
Programming Device Evaluation, Dual Lead 9328326
|
Professional
|
Both
|
$700.00
|
|
|
Service Code
|
CPT 93283 26
|
| Hospital Charge Code |
4514729
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$47.48 |
| Max. Negotiated Rate |
$691.60 |
| Rate for Payer: Aetna Commercial |
$691.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.08
|
| Rate for Payer: Aetna Managed Medicare |
$54.97
|
| Rate for Payer: Anthem Medicare Advantage |
$54.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$54.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$54.97
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cash Price |
$210.00
|
| Rate for Payer: Cigna Commercial |
$691.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$47.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.97
|
| Rate for Payer: Health EOS Commercial |
$662.48
|
| Rate for Payer: HFN Commercial |
$691.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$204.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$204.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$54.97
|
| Rate for Payer: Multiplan Commercial |
$582.40
|
| Rate for Payer: NAPHCARE Commercial |
$82.46
|
| Rate for Payer: Preferred Network Access Commercial |
$691.60
|
| Rate for Payer: Quartz Beloit One Network |
$320.32
|
| Rate for Payer: Quartz Commercial |
$414.96
|
| Rate for Payer: Quartz Medicare Advantage |
$54.97
|
| Rate for Payer: The Alliance Commercial |
$208.90
|
| Rate for Payer: United Healthcare Medicaid |
$47.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$54.97
|
| Rate for Payer: WEA Trust Commercial |
$400.40
|
| Rate for Payer: WPS Commercial |
$219.90
|
|
|
Programming Device Evaluation, Dual Lead Implantable Cardioverter-Defibrillator
|
Professional
|
Both
|
$701.00
|
|
|
Service Code
|
CPT 93283
|
| Hospital Charge Code |
1190892
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.87 |
| Max. Negotiated Rate |
$692.59 |
| Rate for Payer: Aetna Commercial |
$692.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$626.97
|
| Rate for Payer: Aetna Managed Medicare |
$96.68
|
| Rate for Payer: Anthem Medicare Advantage |
$96.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.68
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cash Price |
$210.30
|
| Rate for Payer: Cigna Commercial |
$692.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.68
|
| Rate for Payer: Health EOS Commercial |
$663.43
|
| Rate for Payer: HFN Commercial |
$692.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$347.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$347.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.68
|
| Rate for Payer: Multiplan Commercial |
$583.23
|
| Rate for Payer: NAPHCARE Commercial |
$145.02
|
| Rate for Payer: Preferred Network Access Commercial |
$692.59
|
| Rate for Payer: Quartz Beloit One Network |
$320.78
|
| Rate for Payer: Quartz Commercial |
$415.55
|
| Rate for Payer: Quartz Medicare Advantage |
$96.68
|
| Rate for Payer: The Alliance Commercial |
$367.38
|
| Rate for Payer: United Healthcare Medicaid |
$67.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.68
|
| Rate for Payer: WEA Trust Commercial |
$400.97
|
| Rate for Payer: WPS Commercial |
$386.71
|
|
|
Programming Device Evaluation, Implantable Loop Recorder System
|
Professional
|
Both
|
$321.00
|
|
|
Service Code
|
CPT 93285
|
| Hospital Charge Code |
1190894
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.72 |
| Max. Negotiated Rate |
$317.15 |
| Rate for Payer: Aetna Commercial |
$317.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.10
|
| Rate for Payer: Aetna Managed Medicare |
$59.30
|
| Rate for Payer: Anthem Medicare Advantage |
$59.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cash Price |
$96.30
|
| Rate for Payer: Cigna Commercial |
$317.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$35.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.30
|
| Rate for Payer: Health EOS Commercial |
$303.79
|
| Rate for Payer: HFN Commercial |
$317.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$210.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.30
|
| Rate for Payer: Multiplan Commercial |
$267.07
|
| Rate for Payer: NAPHCARE Commercial |
$88.95
|
| Rate for Payer: Preferred Network Access Commercial |
$317.15
|
| Rate for Payer: Quartz Beloit One Network |
$146.89
|
| Rate for Payer: Quartz Commercial |
$190.29
|
| Rate for Payer: Quartz Medicare Advantage |
$59.30
|
| Rate for Payer: The Alliance Commercial |
$225.34
|
| Rate for Payer: United Healthcare Medicaid |
$35.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.30
|
| Rate for Payer: WEA Trust Commercial |
$183.61
|
| Rate for Payer: WPS Commercial |
$237.20
|
|
|
Programming Device Evaluation, Multiple Lead Implantable Cardioverter-Defibrillator
|
Professional
|
Both
|
$619.00
|
|
|
Service Code
|
CPT 93284
|
| Hospital Charge Code |
1190893
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$56.51 |
| Max. Negotiated Rate |
$611.57 |
| Rate for Payer: Aetna Commercial |
$611.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$104.48
|
| Rate for Payer: Anthem Medicare Advantage |
$104.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$104.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$104.48
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$611.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$56.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$104.48
|
| Rate for Payer: Health EOS Commercial |
$585.82
|
| Rate for Payer: HFN Commercial |
$611.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$375.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$375.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$104.48
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$156.72
|
| Rate for Payer: Preferred Network Access Commercial |
$611.57
|
| Rate for Payer: Quartz Beloit One Network |
$283.25
|
| Rate for Payer: Quartz Commercial |
$366.94
|
| Rate for Payer: Quartz Medicare Advantage |
$104.48
|
| Rate for Payer: The Alliance Commercial |
$397.02
|
| Rate for Payer: United Healthcare Medicaid |
$56.51
|
| Rate for Payer: United Healthcare Medicare Advantage |
$104.48
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$417.91
|
|
|
Programming Device Evaluation, Single Lead Implantable Cardioverter-Defibrillator
|
Professional
|
Both
|
$912.00
|
|
|
Service Code
|
CPT 93282
|
| Hospital Charge Code |
1190891
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$55.66 |
| Max. Negotiated Rate |
$901.06 |
| Rate for Payer: Aetna Commercial |
$901.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$815.69
|
| Rate for Payer: Aetna Managed Medicare |
$78.51
|
| Rate for Payer: Anthem Medicare Advantage |
$78.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$78.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$78.51
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cash Price |
$273.60
|
| Rate for Payer: Cigna Commercial |
$901.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$78.51
|
| Rate for Payer: Health EOS Commercial |
$863.12
|
| Rate for Payer: HFN Commercial |
$901.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$282.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$282.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$78.51
|
| Rate for Payer: Multiplan Commercial |
$758.78
|
| Rate for Payer: NAPHCARE Commercial |
$117.76
|
| Rate for Payer: Preferred Network Access Commercial |
$901.06
|
| Rate for Payer: Quartz Beloit One Network |
$417.33
|
| Rate for Payer: Quartz Commercial |
$540.63
|
| Rate for Payer: Quartz Medicare Advantage |
$78.51
|
| Rate for Payer: The Alliance Commercial |
$298.34
|
| Rate for Payer: United Healthcare Medicaid |
$55.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$78.51
|
| Rate for Payer: WEA Trust Commercial |
$521.66
|
| Rate for Payer: WPS Commercial |
$314.04
|
|
|
Proinsulin
|
Professional
|
Both
|
$634.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
983368
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$626.39 |
| Rate for Payer: Aetna Commercial |
$626.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Aetna Managed Medicare |
$27.76
|
| Rate for Payer: Anthem Medicare Advantage |
$27.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.76
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$626.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$329.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.76
|
| Rate for Payer: Health EOS Commercial |
$600.02
|
| Rate for Payer: HFN Commercial |
$626.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$97.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$97.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.76
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: NAPHCARE Commercial |
$41.64
|
| Rate for Payer: Preferred Network Access Commercial |
$626.39
|
| Rate for Payer: Quartz Beloit One Network |
$290.12
|
| Rate for Payer: Quartz Commercial |
$375.84
|
| Rate for Payer: Quartz Medicare Advantage |
$27.76
|
| Rate for Payer: The Alliance Commercial |
$109.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.76
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$122.13
|
|
|
Proinsulin
|
Facility
|
IP
|
$634.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
983368
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$323.09 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$395.62
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
Proinsulin
|
Facility
|
OP
|
$634.00
|
|
|
Service Code
|
CPT 84206
|
| Hospital Charge Code |
983368
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.76 |
| Max. Negotiated Rate |
$606.61 |
| Rate for Payer: Aetna Commercial |
$593.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$567.05
|
| Rate for Payer: Aetna Managed Medicare |
$27.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.08
|
| Rate for Payer: Anthem Medicare Advantage |
$27.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$349.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.76
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cash Price |
$190.20
|
| Rate for Payer: Cigna Commercial |
$606.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$368.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.76
|
| Rate for Payer: Health EOS Commercial |
$586.83
|
| Rate for Payer: HFN Commercial |
$606.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.76
|
| Rate for Payer: Multiplan Commercial |
$527.49
|
| Rate for Payer: NAPHCARE Commercial |
$41.64
|
| Rate for Payer: Preferred Network Access Commercial |
$606.61
|
| Rate for Payer: Quartz Beloit One Network |
$323.09
|
| Rate for Payer: Quartz Commercial |
$428.58
|
| Rate for Payer: Quartz Medicare Advantage |
$27.76
|
| Rate for Payer: The Alliance Commercial |
$111.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.76
|
| Rate for Payer: United Healthcare PPO |
$494.52
|
| Rate for Payer: WEA Trust Commercial |
$362.65
|
| Rate for Payer: Wellcare Medicare |
$27.76
|
| Rate for Payer: WPS Commercial |
$488.37
|
|
|
Prolactin Level
|
Facility
|
OP
|
$378.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
633809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$75.58
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.46
|
| Rate for Payer: Anthem Medicare Advantage |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.16
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$361.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$20.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$220.00
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$20.16
|
| Rate for Payer: Health EOS Commercial |
$349.88
|
| Rate for Payer: HFN Commercial |
$361.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$20.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$20.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: NAPHCARE Commercial |
$30.23
|
| Rate for Payer: Preferred Network Access Commercial |
$361.67
|
| Rate for Payer: Quartz Beloit One Network |
$192.63
|
| Rate for Payer: Quartz Commercial |
$255.53
|
| Rate for Payer: Quartz Medicare Advantage |
$20.16
|
| Rate for Payer: The Alliance Commercial |
$80.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.16
|
| Rate for Payer: United Healthcare PPO |
$294.84
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: Wellcare Medicare |
$20.16
|
| Rate for Payer: WPS Commercial |
$291.17
|
|
|
Prolactin Level
|
Facility
|
IP
|
$378.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
633809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$192.63 |
| Max. Negotiated Rate |
$361.67 |
| Rate for Payer: Aetna Commercial |
$353.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$208.35
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$361.67
|
| Rate for Payer: Health EOS Commercial |
$349.88
|
| Rate for Payer: HFN Commercial |
$361.67
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: Preferred Network Access Commercial |
$361.67
|
| Rate for Payer: Quartz Beloit One Network |
$192.63
|
| Rate for Payer: Quartz Commercial |
$235.87
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$291.17
|
|
|
Prolactin Level
|
Professional
|
Both
|
$378.00
|
|
|
Service Code
|
CPT 84146
|
| Hospital Charge Code |
633809
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.16 |
| Max. Negotiated Rate |
$373.46 |
| Rate for Payer: Aetna Commercial |
$373.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$338.08
|
| Rate for Payer: Aetna Managed Medicare |
$20.16
|
| Rate for Payer: Anthem Medicare Advantage |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$20.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$20.16
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cash Price |
$113.40
|
| Rate for Payer: Cigna Commercial |
$373.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$196.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20.16
|
| Rate for Payer: Health EOS Commercial |
$357.74
|
| Rate for Payer: HFN Commercial |
$373.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$71.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$20.16
|
| Rate for Payer: Multiplan Commercial |
$314.50
|
| Rate for Payer: NAPHCARE Commercial |
$30.23
|
| Rate for Payer: Preferred Network Access Commercial |
$373.46
|
| Rate for Payer: Quartz Beloit One Network |
$172.97
|
| Rate for Payer: Quartz Commercial |
$224.08
|
| Rate for Payer: Quartz Medicare Advantage |
$20.16
|
| Rate for Payer: The Alliance Commercial |
$79.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$20.16
|
| Rate for Payer: WEA Trust Commercial |
$216.22
|
| Rate for Payer: WPS Commercial |
$88.68
|
|
|
PROLARYN GEL IMPLANT 1ML (SHORT TERM 3-6 M) 8602M0K5
|
Facility
|
IP
|
$4,823.00
|
|
|
Service Code
|
HCPCS L8607
|
| Hospital Charge Code |
5497079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,457.80 |
| Max. Negotiated Rate |
$4,614.65 |
| Rate for Payer: Aetna Commercial |
$4,514.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,313.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,658.44
|
| Rate for Payer: Cash Price |
$1,446.90
|
| Rate for Payer: Cigna Commercial |
$4,614.65
|
| Rate for Payer: Health EOS Commercial |
$4,464.17
|
| Rate for Payer: HFN Commercial |
$4,614.65
|
| Rate for Payer: Multiplan Commercial |
$4,012.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,614.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,457.80
|
| Rate for Payer: Quartz Commercial |
$3,009.55
|
| Rate for Payer: WEA Trust Commercial |
$2,758.76
|
| Rate for Payer: WPS Commercial |
$3,715.16
|
|
|
PROLARYN GEL IMPLANT 1ML (SHORT TERM 3-6 M) 8602M0K5
|
Facility
|
OP
|
$4,823.00
|
|
|
Service Code
|
HCPCS L8607
|
| Hospital Charge Code |
5497079
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$219.69 |
| Max. Negotiated Rate |
$4,614.65 |
| Rate for Payer: Aetna Commercial |
$4,514.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,313.69
|
| Rate for Payer: Aetna Managed Medicare |
$1,404.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,260.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,507.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,407.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,658.44
|
| Rate for Payer: Cash Price |
$1,446.90
|
| Rate for Payer: Cash Price |
$1,446.90
|
| Rate for Payer: Cigna Commercial |
$4,614.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,806.99
|
| Rate for Payer: Health EOS Commercial |
$4,464.17
|
| Rate for Payer: HFN Commercial |
$4,614.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,761.94
|
| Rate for Payer: Multiplan Commercial |
$4,012.74
|
| Rate for Payer: NAPHCARE Commercial |
$3,009.55
|
| Rate for Payer: Preferred Network Access Commercial |
$4,614.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,457.80
|
| Rate for Payer: Quartz Commercial |
$3,260.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,009.55
|
| Rate for Payer: The Alliance Commercial |
$219.69
|
| Rate for Payer: WEA Trust Commercial |
$2,758.76
|
| Rate for Payer: WPS Commercial |
$3,715.16
|
|
|
PROLARYN PLUS INJECTABLE IMPLANT 1ML (LONG TERM 1-2YR) 5033877
|
Facility
|
IP
|
$4,433.00
|
|
|
Service Code
|
HCPCS L8607
|
| Hospital Charge Code |
5184695
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,259.06 |
| Max. Negotiated Rate |
$4,241.49 |
| Rate for Payer: Aetna Commercial |
$4,149.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,964.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,443.47
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna Commercial |
$4,241.49
|
| Rate for Payer: Health EOS Commercial |
$4,103.18
|
| Rate for Payer: HFN Commercial |
$4,241.49
|
| Rate for Payer: Multiplan Commercial |
$3,688.26
|
| Rate for Payer: Preferred Network Access Commercial |
$4,241.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,259.06
|
| Rate for Payer: Quartz Commercial |
$2,766.19
|
| Rate for Payer: WEA Trust Commercial |
$2,535.68
|
| Rate for Payer: WPS Commercial |
$3,414.74
|
|
|
PROLARYN PLUS INJECTABLE IMPLANT 1ML (LONG TERM 1-2YR) 5033877
|
Facility
|
OP
|
$4,433.00
|
|
|
Service Code
|
HCPCS L8607
|
| Hospital Charge Code |
5184695
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$219.69 |
| Max. Negotiated Rate |
$4,241.49 |
| Rate for Payer: Aetna Commercial |
$4,149.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,964.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,290.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,996.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,305.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,212.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,443.47
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cash Price |
$1,329.90
|
| Rate for Payer: Cigna Commercial |
$4,241.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,580.01
|
| Rate for Payer: Health EOS Commercial |
$4,103.18
|
| Rate for Payer: HFN Commercial |
$4,241.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,457.74
|
| Rate for Payer: Multiplan Commercial |
$3,688.26
|
| Rate for Payer: NAPHCARE Commercial |
$2,766.19
|
| Rate for Payer: Preferred Network Access Commercial |
$4,241.49
|
| Rate for Payer: Quartz Beloit One Network |
$2,259.06
|
| Rate for Payer: Quartz Commercial |
$2,996.71
|
| Rate for Payer: Quartz Medicare Advantage |
$2,766.19
|
| Rate for Payer: The Alliance Commercial |
$219.69
|
| Rate for Payer: WEA Trust Commercial |
$2,535.68
|
| Rate for Payer: WPS Commercial |
$3,414.74
|
|
|
Prolia/XGEVA 1 mg Charge
|
Professional
|
Both
|
$54.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
2958986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$24.71 |
| Max. Negotiated Rate |
$86.09 |
| Rate for Payer: Aetna Commercial |
$53.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$31.30
|
| Rate for Payer: Anthem Medicare Advantage |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.30
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$53.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26.20
|
| Rate for Payer: Health EOS Commercial |
$51.11
|
| Rate for Payer: HFN Commercial |
$53.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.30
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$46.96
|
| Rate for Payer: Preferred Network Access Commercial |
$53.35
|
| Rate for Payer: Quartz Beloit One Network |
$24.71
|
| Rate for Payer: Quartz Commercial |
$32.01
|
| Rate for Payer: Quartz Medicare Advantage |
$31.30
|
| Rate for Payer: The Alliance Commercial |
$86.09
|
| Rate for Payer: United Healthcare Medicaid |
$30.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.30
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$65.49
|
|
|
Prolia/XGEVA 1 mg Charge
|
Facility
|
OP
|
$54.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
2958986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$26.20 |
| Max. Negotiated Rate |
$125.22 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Aetna Managed Medicare |
$31.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26.20
|
| Rate for Payer: Anthem Medicare Advantage |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.30
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.66
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31.30
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$116.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31.30
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: NAPHCARE Commercial |
$46.96
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$36.50
|
| Rate for Payer: Quartz Medicare Advantage |
$31.30
|
| Rate for Payer: The Alliance Commercial |
$125.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.30
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: Wellcare Medicare |
$31.30
|
| Rate for Payer: WPS Commercial |
$65.49
|
|
|
Prolia/XGEVA 1 mg Charge
|
Facility
|
IP
|
$54.00
|
|
|
Service Code
|
HCPCS J0897
|
| Hospital Charge Code |
2958986
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$27.52 |
| Max. Negotiated Rate |
$51.67 |
| Rate for Payer: Aetna Commercial |
$50.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29.76
|
| Rate for Payer: Cash Price |
$16.20
|
| Rate for Payer: Cigna Commercial |
$51.67
|
| Rate for Payer: Health EOS Commercial |
$49.98
|
| Rate for Payer: HFN Commercial |
$51.67
|
| Rate for Payer: Multiplan Commercial |
$44.93
|
| Rate for Payer: Preferred Network Access Commercial |
$51.67
|
| Rate for Payer: Quartz Beloit One Network |
$27.52
|
| Rate for Payer: Quartz Commercial |
$33.70
|
| Rate for Payer: WEA Trust Commercial |
$30.89
|
| Rate for Payer: WPS Commercial |
$41.60
|
|
|
PROLONGED CARE IN ADDITION TO At-Home Care G0318
|
Professional
|
Both
|
$77.00
|
|
|
Service Code
|
HCPCS G0318
|
| Hospital Charge Code |
6196534
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.18 |
| Max. Negotiated Rate |
$76.08 |
| Rate for Payer: Aetna Commercial |
$76.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$68.87
|
| Rate for Payer: Aetna Managed Medicare |
$27.05
|
| Rate for Payer: Anthem Medicare Advantage |
$27.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.05
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cash Price |
$23.10
|
| Rate for Payer: Cigna Commercial |
$76.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27.05
|
| Rate for Payer: Health EOS Commercial |
$72.87
|
| Rate for Payer: HFN Commercial |
$76.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.05
|
| Rate for Payer: Multiplan Commercial |
$64.06
|
| Rate for Payer: NAPHCARE Commercial |
$40.58
|
| Rate for Payer: Preferred Network Access Commercial |
$76.08
|
| Rate for Payer: Quartz Beloit One Network |
$35.24
|
| Rate for Payer: Quartz Commercial |
$45.65
|
| Rate for Payer: Quartz Medicare Advantage |
$27.05
|
| Rate for Payer: The Alliance Commercial |
$74.39
|
| Rate for Payer: United Healthcare Medicaid |
$24.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.05
|
| Rate for Payer: WEA Trust Commercial |
$44.04
|
| Rate for Payer: WPS Commercial |
$47.34
|
|
|
Prolonged Evaluation and Management Service, First Hour
|
Professional
|
Both
|
$384.00
|
|
|
Service Code
|
CPT 99358
|
| Hospital Charge Code |
1122819
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$175.72 |
| Max. Negotiated Rate |
$389.33 |
| Rate for Payer: Aetna Commercial |
$379.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$343.45
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cash Price |
$115.20
|
| Rate for Payer: Cigna Commercial |
$379.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$199.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$239.62
|
| Rate for Payer: Health EOS Commercial |
$363.42
|
| Rate for Payer: HFN Commercial |
$379.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$389.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$389.33
|
| Rate for Payer: Multiplan Commercial |
$319.49
|
| Rate for Payer: Preferred Network Access Commercial |
$379.39
|
| Rate for Payer: Quartz Beloit One Network |
$175.72
|
| Rate for Payer: Quartz Commercial |
$227.64
|
| Rate for Payer: The Alliance Commercial |
$199.68
|
| Rate for Payer: WEA Trust Commercial |
$219.65
|
| Rate for Payer: WPS Commercial |
$295.80
|
|
|
PROLONGED SERV, W/O CONTACT 99359
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 99359
|
| Hospital Charge Code |
3015558
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$87.86 |
| Max. Negotiated Rate |
$189.70 |
| Rate for Payer: Aetna Commercial |
$189.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$189.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.81
|
| Rate for Payer: Health EOS Commercial |
$181.71
|
| Rate for Payer: HFN Commercial |
$189.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$187.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$187.09
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: Preferred Network Access Commercial |
$189.70
|
| Rate for Payer: Quartz Beloit One Network |
$87.86
|
| Rate for Payer: Quartz Commercial |
$113.82
|
| Rate for Payer: The Alliance Commercial |
$99.84
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$147.90
|
|
