|
PSA only, No Rfx
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3457521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.43 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
PSA only, No Rfx
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3457521
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| 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 |
$168.12
|
| 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 |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| 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 |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$206.18
|
| 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 |
$237.90
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: Wellcare Medicare |
$19.13
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
PSA, Quest Free
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
1124799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$301.34 |
| Rate for Payer: Aetna Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| 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 |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$301.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$288.65
|
| Rate for Payer: HFN Commercial |
$301.34
|
| 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 |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$301.34
|
| Rate for Payer: Quartz Beloit One Network |
$139.57
|
| Rate for Payer: Quartz Commercial |
$180.80
|
| 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 |
$174.46
|
| Rate for Payer: WPS Commercial |
$84.15
|
|
|
PSA, Quest Free
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
1124799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| 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 |
$168.12
|
| 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 |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| 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 |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$206.18
|
| 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 |
$237.90
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: Wellcare Medicare |
$19.13
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
PSA, Quest Free
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
1124799
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.43 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
PSA, Total to Quest w/ Reflex Free PSA
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3249473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| 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 |
$168.12
|
| 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 |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| 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 |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$206.18
|
| 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 |
$237.90
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: Wellcare Medicare |
$19.13
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
PSA, Total to Quest w/ Reflex Free PSA
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3249473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$301.34 |
| Rate for Payer: Aetna Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| 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 |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$301.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$288.65
|
| Rate for Payer: HFN Commercial |
$301.34
|
| 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 |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$301.34
|
| Rate for Payer: Quartz Beloit One Network |
$139.57
|
| Rate for Payer: Quartz Commercial |
$180.80
|
| 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 |
$174.46
|
| Rate for Payer: WPS Commercial |
$84.15
|
|
|
PSA, Total to Quest w/ Reflex Free PSA
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
3249473
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.43 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
PSA w/ Rfx Free PSA
|
Facility
|
OP
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
633810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| 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 |
$168.12
|
| 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 |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$19.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$177.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| 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 |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$206.18
|
| 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 |
$237.90
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: Wellcare Medicare |
$19.13
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
PSA w/ Rfx Free PSA
|
Facility
|
IP
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
633810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$155.43 |
| Max. Negotiated Rate |
$291.82 |
| Rate for Payer: Aetna Commercial |
$285.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$168.12
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$291.82
|
| Rate for Payer: Health EOS Commercial |
$282.31
|
| Rate for Payer: HFN Commercial |
$291.82
|
| Rate for Payer: Multiplan Commercial |
$253.76
|
| Rate for Payer: Preferred Network Access Commercial |
$291.82
|
| Rate for Payer: Quartz Beloit One Network |
$155.43
|
| Rate for Payer: Quartz Commercial |
$190.32
|
| Rate for Payer: WEA Trust Commercial |
$174.46
|
| Rate for Payer: WPS Commercial |
$234.94
|
|
|
PSA w/ Rfx Free PSA
|
Professional
|
Both
|
$305.00
|
|
|
Service Code
|
CPT 84153
|
| Hospital Charge Code |
633810
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$19.13 |
| Max. Negotiated Rate |
$301.34 |
| Rate for Payer: Aetna Commercial |
$301.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$272.79
|
| 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 |
$91.50
|
| Rate for Payer: Cash Price |
$91.50
|
| Rate for Payer: Cigna Commercial |
$301.34
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19.13
|
| Rate for Payer: Health EOS Commercial |
$288.65
|
| Rate for Payer: HFN Commercial |
$301.34
|
| 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 |
$253.76
|
| Rate for Payer: NAPHCARE Commercial |
$28.69
|
| Rate for Payer: Preferred Network Access Commercial |
$301.34
|
| Rate for Payer: Quartz Beloit One Network |
$139.57
|
| Rate for Payer: Quartz Commercial |
$180.80
|
| 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 |
$174.46
|
| Rate for Payer: WPS Commercial |
$84.15
|
|
|
PSMA. 18F-DCFPyL
|
Facility
|
OP
|
$1,021.00
|
|
|
Service Code
|
HCPCS A9595
|
| Hospital Charge Code |
6101629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$360.35 |
| Max. Negotiated Rate |
$1,441.40 |
| Rate for Payer: Aetna Commercial |
$955.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Aetna Managed Medicare |
$360.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$690.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$530.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$509.68
|
| Rate for Payer: Anthem Medicare Advantage |
$360.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$360.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$360.35
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$976.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$360.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$594.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$360.35
|
| Rate for Payer: Health EOS Commercial |
$945.04
|
| Rate for Payer: HFN Commercial |
$976.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,340.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$360.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$360.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$360.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$360.35
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: NAPHCARE Commercial |
$540.52
|
| Rate for Payer: Preferred Network Access Commercial |
$976.89
|
| Rate for Payer: Quartz Beloit One Network |
$520.30
|
| Rate for Payer: Quartz Commercial |
$690.20
|
| Rate for Payer: Quartz Medicare Advantage |
$360.35
|
| Rate for Payer: The Alliance Commercial |
$1,441.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$360.35
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: Wellcare Medicare |
$360.35
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
PSMA. 18F-DCFPyL
|
Professional
|
Both
|
$1,021.00
|
|
|
Service Code
|
HCPCS A9595
|
| Hospital Charge Code |
6101629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$467.21 |
| Max. Negotiated Rate |
$1,008.75 |
| Rate for Payer: Aetna Commercial |
$1,008.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$1,008.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$884.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$637.10
|
| Rate for Payer: Health EOS Commercial |
$966.27
|
| Rate for Payer: HFN Commercial |
$1,008.75
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,008.75
|
| Rate for Payer: Quartz Beloit One Network |
$467.21
|
| Rate for Payer: Quartz Commercial |
$605.25
|
| Rate for Payer: The Alliance Commercial |
$530.92
|
| Rate for Payer: United Healthcare Medicaid |
$884.00
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
PSMA. 18F-DCFPyL
|
Facility
|
IP
|
$1,021.00
|
|
|
Service Code
|
HCPCS A9595
|
| Hospital Charge Code |
6101629
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$520.30 |
| Max. Negotiated Rate |
$976.89 |
| Rate for Payer: Aetna Commercial |
$955.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$913.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$562.78
|
| Rate for Payer: Cash Price |
$306.30
|
| Rate for Payer: Cigna Commercial |
$976.89
|
| Rate for Payer: Health EOS Commercial |
$945.04
|
| Rate for Payer: HFN Commercial |
$976.89
|
| Rate for Payer: Multiplan Commercial |
$849.47
|
| Rate for Payer: Preferred Network Access Commercial |
$976.89
|
| Rate for Payer: Quartz Beloit One Network |
$520.30
|
| Rate for Payer: Quartz Commercial |
$637.10
|
| Rate for Payer: WEA Trust Commercial |
$584.01
|
| Rate for Payer: WPS Commercial |
$786.48
|
|
|
PSN FEMUR CR CMT CCR STD SZ 10 RT 42-5026-068-02
|
Facility
|
OP
|
$20,886.00
|
|
| Hospital Charge Code |
3901351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,082.00 |
| Max. Negotiated Rate |
$19,983.72 |
| Rate for Payer: Aetna Commercial |
$19,549.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,680.44
|
| Rate for Payer: Aetna Managed Medicare |
$6,082.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,118.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,860.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,426.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,512.36
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,983.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,155.65
|
| Rate for Payer: Health EOS Commercial |
$19,332.08
|
| Rate for Payer: HFN Commercial |
$19,983.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,291.08
|
| Rate for Payer: Multiplan Commercial |
$17,377.15
|
| Rate for Payer: NAPHCARE Commercial |
$13,032.86
|
| Rate for Payer: Preferred Network Access Commercial |
$19,983.72
|
| Rate for Payer: Quartz Beloit One Network |
$10,643.51
|
| Rate for Payer: Quartz Commercial |
$14,118.94
|
| Rate for Payer: Quartz Medicare Advantage |
$13,032.86
|
| Rate for Payer: The Alliance Commercial |
$10,860.72
|
| Rate for Payer: WEA Trust Commercial |
$11,946.79
|
| Rate for Payer: WPS Commercial |
$16,088.49
|
|
|
PSN FEMUR CR CMT CCR STD SZ 10 RT 42-5026-068-02
|
Facility
|
IP
|
$20,886.00
|
|
| Hospital Charge Code |
3901351
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,643.51 |
| Max. Negotiated Rate |
$19,983.72 |
| Rate for Payer: Aetna Commercial |
$19,549.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,680.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,512.36
|
| Rate for Payer: Cash Price |
$6,265.80
|
| Rate for Payer: Cigna Commercial |
$19,983.72
|
| Rate for Payer: Health EOS Commercial |
$19,332.08
|
| Rate for Payer: HFN Commercial |
$19,983.72
|
| Rate for Payer: Multiplan Commercial |
$17,377.15
|
| Rate for Payer: Preferred Network Access Commercial |
$19,983.72
|
| Rate for Payer: Quartz Beloit One Network |
$10,643.51
|
| Rate for Payer: Quartz Commercial |
$13,032.86
|
| Rate for Payer: WEA Trust Commercial |
$11,946.79
|
| Rate for Payer: WPS Commercial |
$16,088.49
|
|
|
P.S.T. W/Allergenic Extracts, Immediate Reaction 95004
|
Professional
|
Both
|
$23.00
|
|
|
Service Code
|
CPT 95004
|
| Hospital Charge Code |
1188807
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2.26 |
| Max. Negotiated Rate |
$22.72 |
| Rate for Payer: Aetna Commercial |
$22.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20.57
|
| Rate for Payer: Aetna Managed Medicare |
$3.45
|
| Rate for Payer: Anthem Medicare Advantage |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.45
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cash Price |
$6.90
|
| Rate for Payer: Cigna Commercial |
$22.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.45
|
| Rate for Payer: Health EOS Commercial |
$21.77
|
| Rate for Payer: HFN Commercial |
$22.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.45
|
| Rate for Payer: Multiplan Commercial |
$19.14
|
| Rate for Payer: NAPHCARE Commercial |
$5.18
|
| Rate for Payer: Preferred Network Access Commercial |
$22.72
|
| Rate for Payer: Quartz Beloit One Network |
$10.52
|
| Rate for Payer: Quartz Commercial |
$13.63
|
| Rate for Payer: Quartz Medicare Advantage |
$3.45
|
| Rate for Payer: The Alliance Commercial |
$8.63
|
| Rate for Payer: United Healthcare Medicaid |
$2.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.45
|
| Rate for Payer: WEA Trust Commercial |
$13.16
|
| Rate for Payer: WPS Commercial |
$13.81
|
|
|
Psych and neuropsych test & scoring by physician; each add 30 min 96137
|
Professional
|
Both
|
$172.00
|
|
|
Service Code
|
CPT 96137
|
| Hospital Charge Code |
5454801
|
| Min. Negotiated Rate |
$16.97 |
| Max. Negotiated Rate |
$169.94 |
| Rate for Payer: Aetna Commercial |
$169.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$153.84
|
| Rate for Payer: Aetna Managed Medicare |
$16.97
|
| Rate for Payer: Anthem Medicare Advantage |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16.97
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cash Price |
$51.60
|
| Rate for Payer: Cigna Commercial |
$169.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$51.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.97
|
| Rate for Payer: Health EOS Commercial |
$162.78
|
| Rate for Payer: HFN Commercial |
$169.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.92
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16.97
|
| Rate for Payer: Multiplan Commercial |
$143.10
|
| Rate for Payer: NAPHCARE Commercial |
$25.46
|
| Rate for Payer: Preferred Network Access Commercial |
$169.94
|
| Rate for Payer: Quartz Beloit One Network |
$78.71
|
| Rate for Payer: Quartz Commercial |
$101.96
|
| Rate for Payer: Quartz Medicare Advantage |
$16.97
|
| Rate for Payer: The Alliance Commercial |
$42.43
|
| Rate for Payer: United Healthcare Medicaid |
$51.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16.97
|
| Rate for Payer: WEA Trust Commercial |
$98.38
|
| Rate for Payer: WPS Commercial |
$67.89
|
|
|
Psych and neuropsych test & scoring by physician; first 30 min 96136
|
Professional
|
Both
|
$186.00
|
|
|
Service Code
|
CPT 96136
|
| Hospital Charge Code |
5454802
|
| Min. Negotiated Rate |
$21.65 |
| Max. Negotiated Rate |
$183.77 |
| Rate for Payer: Aetna Commercial |
$183.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$166.36
|
| Rate for Payer: Aetna Managed Medicare |
$21.65
|
| Rate for Payer: Anthem Medicare Advantage |
$21.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.65
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cash Price |
$55.80
|
| Rate for Payer: Cigna Commercial |
$183.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$55.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.65
|
| Rate for Payer: Health EOS Commercial |
$176.03
|
| Rate for Payer: HFN Commercial |
$183.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$85.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$85.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.65
|
| Rate for Payer: Multiplan Commercial |
$154.75
|
| Rate for Payer: NAPHCARE Commercial |
$32.48
|
| Rate for Payer: Preferred Network Access Commercial |
$183.77
|
| Rate for Payer: Quartz Beloit One Network |
$85.11
|
| Rate for Payer: Quartz Commercial |
$110.26
|
| Rate for Payer: Quartz Medicare Advantage |
$21.65
|
| Rate for Payer: The Alliance Commercial |
$54.13
|
| Rate for Payer: United Healthcare Medicaid |
$55.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.65
|
| Rate for Payer: WEA Trust Commercial |
$106.39
|
| Rate for Payer: WPS Commercial |
$86.61
|
|
|
Psych and neuropsych test & scoring by technician; each add 30 min 96139
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 96139
|
| Hospital Charge Code |
5454803
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$35.28 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$152.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Aetna Managed Medicare |
$35.28
|
| Rate for Payer: Anthem Medicare Advantage |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.28
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.28
|
| Rate for Payer: Health EOS Commercial |
$145.75
|
| Rate for Payer: HFN Commercial |
$152.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.28
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: NAPHCARE Commercial |
$52.92
|
| Rate for Payer: Preferred Network Access Commercial |
$152.15
|
| Rate for Payer: Quartz Beloit One Network |
$70.47
|
| Rate for Payer: Quartz Commercial |
$91.29
|
| Rate for Payer: Quartz Medicare Advantage |
$35.28
|
| Rate for Payer: The Alliance Commercial |
$88.19
|
| Rate for Payer: United Healthcare Medicaid |
$44.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.28
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$141.11
|
|
|
Psych and neuropsych test & scoring by technician; first 30 min 96138
|
Professional
|
Both
|
$154.00
|
|
|
Service Code
|
CPT 96138
|
| Hospital Charge Code |
5454804
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$37.38 |
| Max. Negotiated Rate |
$152.15 |
| Rate for Payer: Aetna Commercial |
$152.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$137.74
|
| Rate for Payer: Aetna Managed Medicare |
$37.38
|
| Rate for Payer: Anthem Medicare Advantage |
$37.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37.38
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cash Price |
$46.20
|
| Rate for Payer: Cigna Commercial |
$152.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37.38
|
| Rate for Payer: Health EOS Commercial |
$145.75
|
| Rate for Payer: HFN Commercial |
$152.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.27
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.27
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37.38
|
| Rate for Payer: Multiplan Commercial |
$128.13
|
| Rate for Payer: NAPHCARE Commercial |
$56.07
|
| Rate for Payer: Preferred Network Access Commercial |
$152.15
|
| Rate for Payer: Quartz Beloit One Network |
$70.47
|
| Rate for Payer: Quartz Commercial |
$91.29
|
| Rate for Payer: Quartz Medicare Advantage |
$37.38
|
| Rate for Payer: The Alliance Commercial |
$93.44
|
| Rate for Payer: United Healthcare Medicaid |
$44.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37.38
|
| Rate for Payer: WEA Trust Commercial |
$88.09
|
| Rate for Payer: WPS Commercial |
$149.51
|
|
|
Psychiatric Diagnostic Eval/No Medical Services 90791
|
Professional
|
Both
|
$560.00
|
|
|
Service Code
|
CPT 90791
|
| Hospital Charge Code |
2990618
|
|
Hospital Revenue Code
|
513
|
| Min. Negotiated Rate |
$141.92 |
| Max. Negotiated Rate |
$567.67 |
| Rate for Payer: Aetna Commercial |
$553.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$500.86
|
| Rate for Payer: Aetna Managed Medicare |
$141.92
|
| Rate for Payer: Anthem Medicare Advantage |
$141.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.92
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cash Price |
$168.00
|
| Rate for Payer: Cigna Commercial |
$553.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$291.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.92
|
| Rate for Payer: Health EOS Commercial |
$529.98
|
| Rate for Payer: HFN Commercial |
$553.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$557.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$557.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.92
|
| Rate for Payer: Multiplan Commercial |
$465.92
|
| Rate for Payer: NAPHCARE Commercial |
$212.88
|
| Rate for Payer: Preferred Network Access Commercial |
$553.28
|
| Rate for Payer: Quartz Beloit One Network |
$256.26
|
| Rate for Payer: Quartz Commercial |
$331.97
|
| Rate for Payer: Quartz Medicare Advantage |
$141.92
|
| Rate for Payer: The Alliance Commercial |
$354.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.92
|
| Rate for Payer: WEA Trust Commercial |
$320.32
|
| Rate for Payer: WPS Commercial |
$567.67
|
|
|
Psychological Testing Evaluation: each add hour 96131
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 96131
|
| Hospital Charge Code |
5454798
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$324.06 |
| Rate for Payer: Aetna Commercial |
$324.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$293.36
|
| Rate for Payer: Aetna Managed Medicare |
$72.52
|
| Rate for Payer: Anthem Medicare Advantage |
$72.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$72.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$72.52
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$324.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$105.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$72.52
|
| Rate for Payer: Health EOS Commercial |
$310.42
|
| Rate for Payer: HFN Commercial |
$324.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$289.47
|
| Rate for Payer: Independent Care Health Plan Medicare |
$72.52
|
| Rate for Payer: Multiplan Commercial |
$272.90
|
| Rate for Payer: NAPHCARE Commercial |
$108.78
|
| Rate for Payer: Preferred Network Access Commercial |
$324.06
|
| Rate for Payer: Quartz Beloit One Network |
$150.09
|
| Rate for Payer: Quartz Commercial |
$194.44
|
| Rate for Payer: Quartz Medicare Advantage |
$72.52
|
| Rate for Payer: The Alliance Commercial |
$181.30
|
| Rate for Payer: United Healthcare Medicaid |
$105.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$72.52
|
| Rate for Payer: WEA Trust Commercial |
$187.62
|
| Rate for Payer: WPS Commercial |
$290.08
|
|
|
Psychological Testing Evaluation; first hour 96130
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 96130
|
| Hospital Charge Code |
5454797
|
| Min. Negotiated Rate |
$100.87 |
| Max. Negotiated Rate |
$414.96 |
| Rate for Payer: Aetna Commercial |
$414.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$100.87
|
| Rate for Payer: Anthem Medicare Advantage |
$100.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$100.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$100.87
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$414.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$138.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.87
|
| Rate for Payer: Health EOS Commercial |
$397.49
|
| Rate for Payer: HFN Commercial |
$414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$385.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$385.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$100.87
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$151.30
|
| Rate for Payer: Preferred Network Access Commercial |
$414.96
|
| Rate for Payer: Quartz Beloit One Network |
$192.19
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: Quartz Medicare Advantage |
$100.87
|
| Rate for Payer: The Alliance Commercial |
$252.17
|
| Rate for Payer: United Healthcare Medicaid |
$138.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$100.87
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$403.48
|
|
|
PSYCHOSES
|
Facility
|
IP
|
$38,112.88
|
|
|
Service Code
|
MSDRG 885
|
| Min. Negotiated Rate |
$11,203.75 |
| Max. Negotiated Rate |
$38,112.88 |
| Rate for Payer: Aetna Managed Medicare |
$11,203.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,477.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,360.42
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,193.92
|
| Rate for Payer: Anthem Medicare Advantage |
$11,203.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,203.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,203.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,203.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,637.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,203.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,203.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,203.75
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,203.75
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,203.75
|
| Rate for Payer: NAPHCARE Commercial |
$16,805.63
|
| Rate for Payer: Quartz Medicare Advantage |
$11,203.75
|
| Rate for Payer: The Alliance Commercial |
$38,112.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,203.75
|
| Rate for Payer: United Healthcare PPO |
$21,573.05
|
| Rate for Payer: Wellcare Medicare |
$11,203.75
|
|
