|
Established minor dressing charge
|
Facility
|
IP
|
$94.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3165537
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$46.06 |
| Max. Negotiated Rate |
$86.48 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$56.40
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
Established minor dressing charge
|
Facility
|
OP
|
$94.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3165537
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$26.32 |
| Max. Negotiated Rate |
$376.00 |
| Rate for Payer: Aetna Commercial |
$84.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$80.84
|
| Rate for Payer: Aetna Managed Medicare |
$26.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$61.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.82
|
| Rate for Payer: Cash Price |
$28.20
|
| Rate for Payer: Cigna Commercial |
$86.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.60
|
| Rate for Payer: Health EOS Commercial |
$83.66
|
| Rate for Payer: HFN Commercial |
$86.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.50
|
| Rate for Payer: Multiplan Commercial |
$75.20
|
| Rate for Payer: NAPHCARE Commercial |
$56.40
|
| Rate for Payer: Preferred Network Access Commercial |
$86.48
|
| Rate for Payer: Quartz Beloit One Network |
$46.06
|
| Rate for Payer: Quartz Commercial |
$61.10
|
| Rate for Payer: Quartz Medicare Advantage |
$56.40
|
| Rate for Payer: The Alliance Commercial |
$376.00
|
| Rate for Payer: WEA Trust Commercial |
$51.70
|
| Rate for Payer: WPS Commercial |
$69.63
|
|
|
Established Patient Home Visit 40 Minutes
|
Professional
|
Both
|
$467.00
|
|
|
Service Code
|
CPT 99349
|
| Hospital Charge Code |
1122862
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.45 |
| Max. Negotiated Rate |
$443.65 |
| Rate for Payer: Aetna Commercial |
$443.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$401.62
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cash Price |
$140.10
|
| Rate for Payer: Cigna Commercial |
$443.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$98.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.20
|
| Rate for Payer: Health EOS Commercial |
$424.97
|
| Rate for Payer: HFN Commercial |
$443.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$434.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$434.01
|
| Rate for Payer: Multiplan Commercial |
$373.60
|
| Rate for Payer: Preferred Network Access Commercial |
$443.65
|
| Rate for Payer: Quartz Beloit One Network |
$205.48
|
| Rate for Payer: Quartz Commercial |
$266.19
|
| Rate for Payer: The Alliance Commercial |
$233.50
|
| Rate for Payer: United Healthcare Medicaid |
$98.45
|
| Rate for Payer: WEA Trust Commercial |
$256.85
|
| Rate for Payer: WPS Commercial |
$345.91
|
|
|
Established Pt Consult Level 2
|
Facility
|
OP
|
$274.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
3040420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.72 |
| Max. Negotiated Rate |
$1,096.00 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Aetna Managed Medicare |
$76.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$178.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$137.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$131.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$153.33
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$205.50
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$178.10
|
| Rate for Payer: Quartz Medicare Advantage |
$164.40
|
| Rate for Payer: The Alliance Commercial |
$1,096.00
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
Established Pt Consult Level 2
|
Facility
|
IP
|
$274.00
|
|
|
Service Code
|
CPT 99242
|
| Hospital Charge Code |
3040420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.26 |
| Max. Negotiated Rate |
$252.08 |
| Rate for Payer: Aetna Commercial |
$246.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$235.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$145.22
|
| Rate for Payer: Cash Price |
$82.20
|
| Rate for Payer: Cigna Commercial |
$252.08
|
| Rate for Payer: Health EOS Commercial |
$243.86
|
| Rate for Payer: HFN Commercial |
$252.08
|
| Rate for Payer: Multiplan Commercial |
$219.20
|
| Rate for Payer: NAPHCARE Commercial |
$164.40
|
| Rate for Payer: Preferred Network Access Commercial |
$252.08
|
| Rate for Payer: Quartz Beloit One Network |
$134.26
|
| Rate for Payer: Quartz Commercial |
$164.40
|
| Rate for Payer: WEA Trust Commercial |
$150.70
|
| Rate for Payer: WPS Commercial |
$202.95
|
|
|
Established Pt Consult Level 3
|
Facility
|
IP
|
$350.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3040421
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.50 |
| Max. Negotiated Rate |
$322.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Established Pt Consult Level 3
|
Facility
|
OP
|
$350.00
|
|
|
Service Code
|
CPT 99204
|
| Hospital Charge Code |
3040421
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$98.00 |
| Max. Negotiated Rate |
$1,400.00 |
| Rate for Payer: Aetna Commercial |
$315.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$301.00
|
| Rate for Payer: Aetna Managed Medicare |
$98.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$227.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$175.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$168.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$185.50
|
| Rate for Payer: Cash Price |
$105.00
|
| Rate for Payer: Cigna Commercial |
$322.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$195.86
|
| Rate for Payer: Health EOS Commercial |
$311.50
|
| Rate for Payer: HFN Commercial |
$322.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$262.50
|
| Rate for Payer: Multiplan Commercial |
$280.00
|
| Rate for Payer: NAPHCARE Commercial |
$210.00
|
| Rate for Payer: Preferred Network Access Commercial |
$322.00
|
| Rate for Payer: Quartz Beloit One Network |
$171.50
|
| Rate for Payer: Quartz Commercial |
$227.50
|
| Rate for Payer: Quartz Medicare Advantage |
$210.00
|
| Rate for Payer: The Alliance Commercial |
$1,400.00
|
| Rate for Payer: WEA Trust Commercial |
$192.50
|
| Rate for Payer: WPS Commercial |
$259.24
|
|
|
Established Pt Consult Level 4
|
Facility
|
OP
|
$406.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
3040422
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.68 |
| Max. Negotiated Rate |
$1,624.00 |
| Rate for Payer: Aetna Commercial |
$365.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.16
|
| Rate for Payer: Aetna Managed Medicare |
$113.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$263.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$203.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$194.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.18
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$373.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$227.20
|
| Rate for Payer: Health EOS Commercial |
$361.34
|
| Rate for Payer: HFN Commercial |
$373.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$304.50
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: NAPHCARE Commercial |
$243.60
|
| Rate for Payer: Preferred Network Access Commercial |
$373.52
|
| Rate for Payer: Quartz Beloit One Network |
$198.94
|
| Rate for Payer: Quartz Commercial |
$263.90
|
| Rate for Payer: Quartz Medicare Advantage |
$243.60
|
| Rate for Payer: The Alliance Commercial |
$1,624.00
|
| Rate for Payer: WEA Trust Commercial |
$223.30
|
| Rate for Payer: WPS Commercial |
$300.72
|
|
|
Established Pt Consult Level 4
|
Facility
|
IP
|
$406.00
|
|
|
Service Code
|
CPT 99244
|
| Hospital Charge Code |
3040422
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$198.94 |
| Max. Negotiated Rate |
$373.52 |
| Rate for Payer: Aetna Commercial |
$365.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$349.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$215.18
|
| Rate for Payer: Cash Price |
$121.80
|
| Rate for Payer: Cigna Commercial |
$373.52
|
| Rate for Payer: Health EOS Commercial |
$361.34
|
| Rate for Payer: HFN Commercial |
$373.52
|
| Rate for Payer: Multiplan Commercial |
$324.80
|
| Rate for Payer: NAPHCARE Commercial |
$243.60
|
| Rate for Payer: Preferred Network Access Commercial |
$373.52
|
| Rate for Payer: Quartz Beloit One Network |
$198.94
|
| Rate for Payer: Quartz Commercial |
$243.60
|
| Rate for Payer: WEA Trust Commercial |
$223.30
|
| Rate for Payer: WPS Commercial |
$300.72
|
|
|
Est Office Visit Routine
|
Facility
|
IP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
3040417
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.89 |
| Max. Negotiated Rate |
$240.12 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$156.60
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
Est Office Visit Routine
|
Facility
|
OP
|
$261.00
|
|
|
Service Code
|
CPT 99213
|
| Hospital Charge Code |
3040417
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.08 |
| Max. Negotiated Rate |
$1,044.00 |
| Rate for Payer: Aetna Commercial |
$234.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$224.46
|
| Rate for Payer: Aetna Managed Medicare |
$73.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$125.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$138.33
|
| Rate for Payer: Cash Price |
$78.30
|
| Rate for Payer: Cigna Commercial |
$240.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.06
|
| Rate for Payer: Health EOS Commercial |
$232.29
|
| Rate for Payer: HFN Commercial |
$240.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.75
|
| Rate for Payer: Multiplan Commercial |
$208.80
|
| Rate for Payer: NAPHCARE Commercial |
$156.60
|
| Rate for Payer: Preferred Network Access Commercial |
$240.12
|
| Rate for Payer: Quartz Beloit One Network |
$127.89
|
| Rate for Payer: Quartz Commercial |
$169.65
|
| Rate for Payer: Quartz Medicare Advantage |
$156.60
|
| Rate for Payer: The Alliance Commercial |
$1,044.00
|
| Rate for Payer: WEA Trust Commercial |
$143.55
|
| Rate for Payer: WPS Commercial |
$193.32
|
|
|
Est Patient Office Visit Brief
|
Facility
|
IP
|
$231.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3040416
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$113.19 |
| Max. Negotiated Rate |
$212.52 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$138.60
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Est Patient Office Visit Brief
|
Facility
|
OP
|
$231.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3040416
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$64.68 |
| Max. Negotiated Rate |
$924.00 |
| Rate for Payer: Aetna Commercial |
$207.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$198.66
|
| Rate for Payer: Aetna Managed Medicare |
$64.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$150.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$115.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$110.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$122.43
|
| Rate for Payer: Cash Price |
$69.30
|
| Rate for Payer: Cigna Commercial |
$212.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.27
|
| Rate for Payer: Health EOS Commercial |
$205.59
|
| Rate for Payer: HFN Commercial |
$212.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.25
|
| Rate for Payer: Multiplan Commercial |
$184.80
|
| Rate for Payer: NAPHCARE Commercial |
$138.60
|
| Rate for Payer: Preferred Network Access Commercial |
$212.52
|
| Rate for Payer: Quartz Beloit One Network |
$113.19
|
| Rate for Payer: Quartz Commercial |
$150.15
|
| Rate for Payer: Quartz Medicare Advantage |
$138.60
|
| Rate for Payer: The Alliance Commercial |
$924.00
|
| Rate for Payer: WEA Trust Commercial |
$127.05
|
| Rate for Payer: WPS Commercial |
$171.10
|
|
|
Est Patient Office Visit Ext
|
Facility
|
OP
|
$448.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
3040418
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$125.44 |
| Max. Negotiated Rate |
$1,792.00 |
| Rate for Payer: Aetna Commercial |
$403.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.28
|
| Rate for Payer: Aetna Managed Medicare |
$125.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$291.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$224.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$215.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.44
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$412.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$250.70
|
| Rate for Payer: Health EOS Commercial |
$398.72
|
| Rate for Payer: HFN Commercial |
$412.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$336.00
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: NAPHCARE Commercial |
$268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$412.16
|
| Rate for Payer: Quartz Beloit One Network |
$219.52
|
| Rate for Payer: Quartz Commercial |
$291.20
|
| Rate for Payer: Quartz Medicare Advantage |
$268.80
|
| Rate for Payer: The Alliance Commercial |
$1,792.00
|
| Rate for Payer: WEA Trust Commercial |
$246.40
|
| Rate for Payer: WPS Commercial |
$331.83
|
|
|
Est Patient Office Visit Ext
|
Facility
|
IP
|
$448.00
|
|
|
Service Code
|
CPT 99214
|
| Hospital Charge Code |
3040418
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$219.52 |
| Max. Negotiated Rate |
$412.16 |
| Rate for Payer: Aetna Commercial |
$403.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$385.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$237.44
|
| Rate for Payer: Cash Price |
$134.40
|
| Rate for Payer: Cigna Commercial |
$412.16
|
| Rate for Payer: Health EOS Commercial |
$398.72
|
| Rate for Payer: HFN Commercial |
$412.16
|
| Rate for Payer: Multiplan Commercial |
$358.40
|
| Rate for Payer: NAPHCARE Commercial |
$268.80
|
| Rate for Payer: Preferred Network Access Commercial |
$412.16
|
| Rate for Payer: Quartz Beloit One Network |
$219.52
|
| Rate for Payer: Quartz Commercial |
$268.80
|
| Rate for Payer: WEA Trust Commercial |
$246.40
|
| Rate for Payer: WPS Commercial |
$331.83
|
|
|
Est/P Exam Min 99211PP
|
Professional
|
Both
|
$147.00
|
|
|
Service Code
|
CPT 99211
|
| Hospital Charge Code |
3133510
|
|
Hospital Revenue Code
|
500
|
| Min. Negotiated Rate |
$16.25 |
| Max. Negotiated Rate |
$139.65 |
| Rate for Payer: Aetna Commercial |
$139.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.42
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cash Price |
$44.10
|
| Rate for Payer: Cigna Commercial |
$139.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.20
|
| Rate for Payer: Health EOS Commercial |
$133.77
|
| Rate for Payer: HFN Commercial |
$139.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.64
|
| Rate for Payer: Multiplan Commercial |
$117.60
|
| Rate for Payer: Preferred Network Access Commercial |
$139.65
|
| Rate for Payer: Quartz Beloit One Network |
$64.68
|
| Rate for Payer: Quartz Commercial |
$83.79
|
| Rate for Payer: The Alliance Commercial |
$73.50
|
| Rate for Payer: United Healthcare Medicaid |
$16.25
|
| Rate for Payer: WEA Trust Commercial |
$80.85
|
| Rate for Payer: WPS Commercial |
$108.88
|
|
|
estradiol 10 mg Charge
|
Professional
|
Both
|
$22.00
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2958929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$8.66 |
| Max. Negotiated Rate |
$21.64 |
| Rate for Payer: Aetna Commercial |
$20.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$8.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.66
|
| Rate for Payer: Health EOS Commercial |
$20.02
|
| Rate for Payer: HFN Commercial |
$20.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.91
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: Preferred Network Access Commercial |
$20.90
|
| Rate for Payer: Quartz Beloit One Network |
$9.68
|
| Rate for Payer: Quartz Commercial |
$12.54
|
| Rate for Payer: The Alliance Commercial |
$11.00
|
| Rate for Payer: United Healthcare Medicaid |
$8.66
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$21.64
|
|
|
estradiol 10 mg Charge
|
Facility
|
IP
|
$22.00
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2958929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$13.20
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
estradiol 10 mg Charge
|
Facility
|
OP
|
$22.00
|
|
|
Service Code
|
HCPCS J1380
|
| Hospital Charge Code |
2958929
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Aetna Managed Medicare |
$6.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.45
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$14.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.20
|
| Rate for Payer: The Alliance Commercial |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$21.64
|
|
|
Estradiol Level
|
Facility
|
OP
|
$673.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
633723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$619.16 |
| Rate for Payer: Aetna Commercial |
$605.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.78
|
| Rate for Payer: Aetna Managed Medicare |
$27.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.38
|
| Rate for Payer: Anthem Medicaid |
$28.87
|
| Rate for Payer: Anthem Medicare Advantage |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.94
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$619.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$376.61
|
| Rate for Payer: Dean Health Medicaid |
$28.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$598.97
|
| Rate for Payer: HFN Commercial |
$619.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.94
|
| Rate for Payer: Managed Health Services Medicaid |
$30.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.94
|
| Rate for Payer: Multiplan Commercial |
$538.40
|
| Rate for Payer: NAPHCARE Commercial |
$41.91
|
| Rate for Payer: Preferred Network Access Commercial |
$619.16
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.87
|
| Rate for Payer: Quartz Beloit One Network |
$329.77
|
| Rate for Payer: Quartz Commercial |
$437.45
|
| Rate for Payer: Quartz Medicare Advantage |
$27.94
|
| Rate for Payer: The Alliance Commercial |
$111.76
|
| Rate for Payer: United Healthcare Medicaid |
$28.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.94
|
| Rate for Payer: United Healthcare PPO |
$504.75
|
| Rate for Payer: WEA Trust Commercial |
$370.15
|
| Rate for Payer: Wellcare Medicare |
$27.94
|
| Rate for Payer: WMAP Medicaid |
$28.87
|
| Rate for Payer: WPS Commercial |
$498.49
|
|
|
Estradiol Level
|
Professional
|
Both
|
$673.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
633723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$98.63 |
| Max. Negotiated Rate |
$639.35 |
| Rate for Payer: Aetna Commercial |
$639.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.78
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$639.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$336.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$403.80
|
| Rate for Payer: Health EOS Commercial |
$612.43
|
| Rate for Payer: HFN Commercial |
$639.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.63
|
| Rate for Payer: Multiplan Commercial |
$538.40
|
| Rate for Payer: Preferred Network Access Commercial |
$639.35
|
| Rate for Payer: Quartz Beloit One Network |
$296.12
|
| Rate for Payer: Quartz Commercial |
$383.61
|
| Rate for Payer: The Alliance Commercial |
$336.50
|
| Rate for Payer: WEA Trust Commercial |
$370.15
|
| Rate for Payer: WPS Commercial |
$498.49
|
|
|
Estradiol Level
|
Facility
|
IP
|
$673.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
633723
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$329.77 |
| Max. Negotiated Rate |
$619.16 |
| Rate for Payer: Aetna Commercial |
$605.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$578.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$356.69
|
| Rate for Payer: Cash Price |
$201.90
|
| Rate for Payer: Cigna Commercial |
$619.16
|
| Rate for Payer: Health EOS Commercial |
$598.97
|
| Rate for Payer: HFN Commercial |
$619.16
|
| Rate for Payer: Multiplan Commercial |
$538.40
|
| Rate for Payer: NAPHCARE Commercial |
$403.80
|
| Rate for Payer: Preferred Network Access Commercial |
$619.16
|
| Rate for Payer: Quartz Beloit One Network |
$329.77
|
| Rate for Payer: Quartz Commercial |
$403.80
|
| Rate for Payer: WEA Trust Commercial |
$370.15
|
| Rate for Payer: WPS Commercial |
$498.49
|
|
|
Estradiol, Ultrasensitive, LC/MS/MS
|
Professional
|
Both
|
$107.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
4253736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.08 |
| Max. Negotiated Rate |
$101.65 |
| Rate for Payer: Aetna Commercial |
$101.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$101.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$53.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$64.20
|
| Rate for Payer: Health EOS Commercial |
$97.37
|
| Rate for Payer: HFN Commercial |
$101.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$98.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$98.63
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: Preferred Network Access Commercial |
$101.65
|
| Rate for Payer: Quartz Beloit One Network |
$47.08
|
| Rate for Payer: Quartz Commercial |
$60.99
|
| Rate for Payer: The Alliance Commercial |
$53.50
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Estradiol, Ultrasensitive, LC/MS/MS
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
4253736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$64.20
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Estradiol, Ultrasensitive, LC/MS/MS
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 82670
|
| Hospital Charge Code |
4253736
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$27.94 |
| Max. Negotiated Rate |
$111.76 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Aetna Managed Medicare |
$27.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$104.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.90
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.38
|
| Rate for Payer: Anthem Medicaid |
$28.87
|
| Rate for Payer: Anthem Medicare Advantage |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27.94
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$28.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.88
|
| Rate for Payer: Dean Health Medicaid |
$28.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27.94
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$103.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$28.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27.94
|
| Rate for Payer: Managed Health Services Medicaid |
$30.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27.94
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$41.91
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$28.87
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$69.55
|
| Rate for Payer: Quartz Medicare Advantage |
$27.94
|
| Rate for Payer: The Alliance Commercial |
$111.76
|
| Rate for Payer: United Healthcare Medicaid |
$28.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27.94
|
| Rate for Payer: United Healthcare PPO |
$80.25
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: Wellcare Medicare |
$27.94
|
| Rate for Payer: WMAP Medicaid |
$28.87
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
