|
Leptin
|
Facility
|
IP
|
$141.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
4163507
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$71.85 |
| Max. Negotiated Rate |
$134.91 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.72
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$134.91
|
| Rate for Payer: Health EOS Commercial |
$130.51
|
| Rate for Payer: HFN Commercial |
$134.91
|
| Rate for Payer: Multiplan Commercial |
$117.31
|
| Rate for Payer: Preferred Network Access Commercial |
$134.91
|
| Rate for Payer: Quartz Beloit One Network |
$71.85
|
| Rate for Payer: Quartz Commercial |
$87.98
|
| Rate for Payer: WEA Trust Commercial |
$80.65
|
| Rate for Payer: WPS Commercial |
$108.61
|
|
|
Leptin
|
Facility
|
OP
|
$141.00
|
|
|
Service Code
|
CPT 82397
|
| Hospital Charge Code |
4163507
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.68 |
| Max. Negotiated Rate |
$134.91 |
| Rate for Payer: Aetna Commercial |
$131.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$126.11
|
| Rate for Payer: Aetna Managed Medicare |
$14.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.07
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$77.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.68
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cash Price |
$42.30
|
| Rate for Payer: Cigna Commercial |
$134.91
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.06
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.68
|
| Rate for Payer: Health EOS Commercial |
$130.51
|
| Rate for Payer: HFN Commercial |
$134.91
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$54.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.68
|
| Rate for Payer: Multiplan Commercial |
$117.31
|
| Rate for Payer: NAPHCARE Commercial |
$22.03
|
| Rate for Payer: Preferred Network Access Commercial |
$134.91
|
| Rate for Payer: Quartz Beloit One Network |
$71.85
|
| Rate for Payer: Quartz Commercial |
$95.32
|
| Rate for Payer: Quartz Medicare Advantage |
$14.68
|
| Rate for Payer: The Alliance Commercial |
$58.74
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.68
|
| Rate for Payer: United Healthcare PPO |
$109.98
|
| Rate for Payer: WEA Trust Commercial |
$80.65
|
| Rate for Payer: Wellcare Medicare |
$14.68
|
| Rate for Payer: WPS Commercial |
$108.61
|
|
|
Leptospira PCR / 17875
|
Facility
|
IP
|
$234.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
978007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$119.25 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$146.02
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
Leptospira PCR / 17875
|
Facility
|
OP
|
$234.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
978007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$223.89 |
| Rate for Payer: Aetna Commercial |
$219.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$136.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$63.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.58
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$128.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$223.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$36.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$136.19
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$216.59
|
| Rate for Payer: HFN Commercial |
$223.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$135.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$36.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$36.49
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$223.89
|
| Rate for Payer: Quartz Beloit One Network |
$119.25
|
| Rate for Payer: Quartz Commercial |
$158.18
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$145.97
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: United Healthcare PPO |
$182.52
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: Wellcare Medicare |
$36.49
|
| Rate for Payer: WPS Commercial |
$180.25
|
|
|
Leptospira PCR / 17875
|
Professional
|
Both
|
$234.00
|
|
|
Service Code
|
CPT 87798
|
| Hospital Charge Code |
978007
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$36.49 |
| Max. Negotiated Rate |
$231.19 |
| Rate for Payer: Aetna Commercial |
$231.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$209.29
|
| Rate for Payer: Aetna Managed Medicare |
$36.49
|
| Rate for Payer: Anthem Medicare Advantage |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.49
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cash Price |
$70.20
|
| Rate for Payer: Cigna Commercial |
$231.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$121.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.49
|
| Rate for Payer: Health EOS Commercial |
$221.46
|
| Rate for Payer: HFN Commercial |
$231.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$128.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$128.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.49
|
| Rate for Payer: Multiplan Commercial |
$194.69
|
| Rate for Payer: NAPHCARE Commercial |
$54.74
|
| Rate for Payer: Preferred Network Access Commercial |
$231.19
|
| Rate for Payer: Quartz Beloit One Network |
$107.08
|
| Rate for Payer: Quartz Commercial |
$138.72
|
| Rate for Payer: Quartz Medicare Advantage |
$36.49
|
| Rate for Payer: The Alliance Commercial |
$144.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.49
|
| Rate for Payer: WEA Trust Commercial |
$133.85
|
| Rate for Payer: WPS Commercial |
$160.57
|
|
|
Leqvio (Inclisiran) 1mg J1306
|
Professional
|
Both
|
$25.00
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
6178255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$11.44 |
| Max. Negotiated Rate |
$36.29 |
| Rate for Payer: Aetna Commercial |
$24.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$13.20
|
| Rate for Payer: Anthem Medicare Advantage |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.20
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$24.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.60
|
| Rate for Payer: Health EOS Commercial |
$23.66
|
| Rate for Payer: HFN Commercial |
$24.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.80
|
| Rate for Payer: Preferred Network Access Commercial |
$24.70
|
| Rate for Payer: Quartz Beloit One Network |
$11.44
|
| Rate for Payer: Quartz Commercial |
$14.82
|
| Rate for Payer: Quartz Medicare Advantage |
$13.20
|
| Rate for Payer: The Alliance Commercial |
$36.29
|
| Rate for Payer: United Healthcare Medicaid |
$13.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.20
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$31.51
|
|
|
Leqvio (Inclisiran) 1mg J1306
|
Facility
|
IP
|
$25.00
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
6178255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.74 |
| Max. Negotiated Rate |
$23.92 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$15.60
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: WPS Commercial |
$19.26
|
|
|
Leqvio (Inclisiran) 1mg J1306
|
Facility
|
OP
|
$25.00
|
|
|
Service Code
|
HCPCS J1306
|
| Hospital Charge Code |
6178255
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$12.48 |
| Max. Negotiated Rate |
$52.79 |
| Rate for Payer: Aetna Commercial |
$23.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$22.36
|
| Rate for Payer: Aetna Managed Medicare |
$13.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12.48
|
| Rate for Payer: Anthem Medicare Advantage |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.20
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cash Price |
$7.50
|
| Rate for Payer: Cigna Commercial |
$23.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.20
|
| Rate for Payer: Health EOS Commercial |
$23.14
|
| Rate for Payer: HFN Commercial |
$23.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.20
|
| Rate for Payer: Multiplan Commercial |
$20.80
|
| Rate for Payer: NAPHCARE Commercial |
$19.80
|
| Rate for Payer: Preferred Network Access Commercial |
$23.92
|
| Rate for Payer: Quartz Beloit One Network |
$12.74
|
| Rate for Payer: Quartz Commercial |
$16.90
|
| Rate for Payer: Quartz Medicare Advantage |
$13.20
|
| Rate for Payer: The Alliance Commercial |
$52.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.20
|
| Rate for Payer: WEA Trust Commercial |
$14.30
|
| Rate for Payer: Wellcare Medicare |
$13.20
|
| Rate for Payer: WPS Commercial |
$31.51
|
|
|
LESION REMOVAL VIA A COLONOSCOPY 45385
|
Professional
|
Both
|
$2,777.00
|
|
|
Service Code
|
CPT 45385
|
| Hospital Charge Code |
3014811
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$217.62 |
| Max. Negotiated Rate |
$2,743.68 |
| Rate for Payer: Aetna Commercial |
$2,743.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,483.75
|
| Rate for Payer: Aetna Managed Medicare |
$217.62
|
| Rate for Payer: Anthem Medicare Advantage |
$217.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$217.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$217.62
|
| Rate for Payer: Cash Price |
$833.10
|
| Rate for Payer: Cash Price |
$833.10
|
| Rate for Payer: Cash Price |
$833.10
|
| Rate for Payer: Cigna Commercial |
$2,743.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$486.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$217.62
|
| Rate for Payer: Health EOS Commercial |
$2,628.15
|
| Rate for Payer: HFN Commercial |
$2,743.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$883.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$883.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$217.62
|
| Rate for Payer: Multiplan Commercial |
$2,310.46
|
| Rate for Payer: NAPHCARE Commercial |
$326.43
|
| Rate for Payer: Preferred Network Access Commercial |
$2,743.68
|
| Rate for Payer: Quartz Beloit One Network |
$1,270.76
|
| Rate for Payer: Quartz Commercial |
$1,646.21
|
| Rate for Payer: Quartz Medicare Advantage |
$217.62
|
| Rate for Payer: The Alliance Commercial |
$924.88
|
| Rate for Payer: United Healthcare Medicaid |
$486.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$217.62
|
| Rate for Payer: WEA Trust Commercial |
$1,588.44
|
| Rate for Payer: WPS Commercial |
$979.29
|
|
|
LESION REMOVE COLONOSCOPY 45384
|
Professional
|
Both
|
$3,571.00
|
|
|
Service Code
|
CPT 45384
|
| Hospital Charge Code |
3014810
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.68 |
| Max. Negotiated Rate |
$3,528.15 |
| Rate for Payer: Aetna Commercial |
$3,528.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,193.90
|
| Rate for Payer: Aetna Managed Medicare |
$194.68
|
| Rate for Payer: Anthem Medicare Advantage |
$194.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$194.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$194.68
|
| Rate for Payer: Cash Price |
$1,071.30
|
| Rate for Payer: Cash Price |
$1,071.30
|
| Rate for Payer: Cash Price |
$1,071.30
|
| Rate for Payer: Cigna Commercial |
$3,528.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$420.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.68
|
| Rate for Payer: Health EOS Commercial |
$3,379.59
|
| Rate for Payer: HFN Commercial |
$3,528.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$785.16
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$785.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$194.68
|
| Rate for Payer: Multiplan Commercial |
$2,971.07
|
| Rate for Payer: NAPHCARE Commercial |
$292.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,528.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,634.09
|
| Rate for Payer: Quartz Commercial |
$2,116.89
|
| Rate for Payer: Quartz Medicare Advantage |
$194.68
|
| Rate for Payer: The Alliance Commercial |
$827.38
|
| Rate for Payer: United Healthcare Medicaid |
$420.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.68
|
| Rate for Payer: WEA Trust Commercial |
$2,042.61
|
| Rate for Payer: WPS Commercial |
$876.05
|
|
|
Leucovorin 50 mg Charge
|
Facility
|
OP
|
$10.00
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
2958829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2.91 |
| Max. Negotiated Rate |
$15.97 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Aetna Managed Medicare |
$2.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7.07
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7.80
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: NAPHCARE Commercial |
$6.24
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.76
|
| Rate for Payer: Quartz Medicare Advantage |
$6.24
|
| Rate for Payer: The Alliance Commercial |
$15.97
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$13.36
|
|
|
Leucovorin 50 mg Charge
|
Facility
|
IP
|
$10.00
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
2958829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$5.10 |
| Max. Negotiated Rate |
$9.57 |
| Rate for Payer: Aetna Commercial |
$9.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.51
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.57
|
| Rate for Payer: Health EOS Commercial |
$9.26
|
| Rate for Payer: HFN Commercial |
$9.57
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: Preferred Network Access Commercial |
$9.57
|
| Rate for Payer: Quartz Beloit One Network |
$5.10
|
| Rate for Payer: Quartz Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$7.70
|
|
|
Leucovorin 50 mg Charge
|
Professional
|
Both
|
$10.00
|
|
|
Service Code
|
HCPCS J0640
|
| Hospital Charge Code |
2958829
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.99 |
| Max. Negotiated Rate |
$13.36 |
| Rate for Payer: Aetna Commercial |
$9.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.94
|
| Rate for Payer: Aetna Managed Medicare |
$3.99
|
| Rate for Payer: Anthem Medicare Advantage |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3.99
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cash Price |
$3.00
|
| Rate for Payer: Cigna Commercial |
$9.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.34
|
| Rate for Payer: Health EOS Commercial |
$9.46
|
| Rate for Payer: HFN Commercial |
$9.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3.99
|
| Rate for Payer: Multiplan Commercial |
$8.32
|
| Rate for Payer: NAPHCARE Commercial |
$5.99
|
| Rate for Payer: Preferred Network Access Commercial |
$9.88
|
| Rate for Payer: Quartz Beloit One Network |
$4.58
|
| Rate for Payer: Quartz Commercial |
$5.93
|
| Rate for Payer: Quartz Medicare Advantage |
$3.99
|
| Rate for Payer: The Alliance Commercial |
$10.98
|
| Rate for Payer: United Healthcare Medicaid |
$3.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3.99
|
| Rate for Payer: WEA Trust Commercial |
$5.72
|
| Rate for Payer: WPS Commercial |
$13.36
|
|
|
Leukemia/Lymphoma Evaluation
|
Facility
|
OP
|
$115.00
|
|
|
Service Code
|
CPT 88189
|
| Hospital Charge Code |
983304
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.49 |
| Max. Negotiated Rate |
$318.82 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$33.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$57.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.93
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$89.70
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$71.76
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$77.74
|
| Rate for Payer: Quartz Medicare Advantage |
$71.76
|
| Rate for Payer: The Alliance Commercial |
$318.82
|
| Rate for Payer: United Healthcare PPO |
$89.70
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Leukemia/Lymphoma Evaluation
|
Facility
|
IP
|
$115.00
|
|
|
Service Code
|
CPT 88189
|
| Hospital Charge Code |
983304
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.60 |
| Max. Negotiated Rate |
$110.03 |
| Rate for Payer: Aetna Commercial |
$107.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.39
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$110.03
|
| Rate for Payer: Health EOS Commercial |
$106.44
|
| Rate for Payer: HFN Commercial |
$110.03
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: Preferred Network Access Commercial |
$110.03
|
| Rate for Payer: Quartz Beloit One Network |
$58.60
|
| Rate for Payer: Quartz Commercial |
$71.76
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$88.58
|
|
|
Leukemia/Lymphoma Evaluation
|
Professional
|
Both
|
$115.00
|
|
|
Service Code
|
CPT 88189
|
| Hospital Charge Code |
983304
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.62 |
| Max. Negotiated Rate |
$350.70 |
| Rate for Payer: Aetna Commercial |
$113.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.86
|
| Rate for Payer: Aetna Managed Medicare |
$79.71
|
| Rate for Payer: Anthem Commercial |
$116.67
|
| Rate for Payer: Anthem Medicare Advantage |
$79.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$79.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$79.71
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cash Price |
$34.50
|
| Rate for Payer: Cigna Commercial |
$113.62
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$79.71
|
| Rate for Payer: Health EOS Commercial |
$108.84
|
| Rate for Payer: HFN Commercial |
$113.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$299.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$299.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$79.71
|
| Rate for Payer: Multiplan Commercial |
$95.68
|
| Rate for Payer: NAPHCARE Commercial |
$119.56
|
| Rate for Payer: Preferred Network Access Commercial |
$113.62
|
| Rate for Payer: Quartz Beloit One Network |
$52.62
|
| Rate for Payer: Quartz Commercial |
$68.17
|
| Rate for Payer: Quartz Medicare Advantage |
$79.71
|
| Rate for Payer: The Alliance Commercial |
$314.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$79.71
|
| Rate for Payer: WEA Trust Commercial |
$65.78
|
| Rate for Payer: WPS Commercial |
$350.70
|
|
|
Leukotriene E4, Urine
|
Facility
|
IP
|
$1,106.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5841646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$563.62 |
| Max. Negotiated Rate |
$1,058.22 |
| Rate for Payer: Aetna Commercial |
$1,035.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$989.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$609.63
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$1,058.22
|
| Rate for Payer: Health EOS Commercial |
$1,023.71
|
| Rate for Payer: HFN Commercial |
$1,058.22
|
| Rate for Payer: Multiplan Commercial |
$920.19
|
| Rate for Payer: Preferred Network Access Commercial |
$1,058.22
|
| Rate for Payer: Quartz Beloit One Network |
$563.62
|
| Rate for Payer: Quartz Commercial |
$690.14
|
| Rate for Payer: WEA Trust Commercial |
$632.63
|
| Rate for Payer: WPS Commercial |
$851.95
|
|
|
Leukotriene E4, Urine
|
Professional
|
Both
|
$1,106.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5841646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$1,092.73 |
| Rate for Payer: Aetna Commercial |
$1,092.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$989.21
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$1,092.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$575.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$1,046.72
|
| Rate for Payer: HFN Commercial |
$1,092.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$88.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$88.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$920.19
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,092.73
|
| Rate for Payer: Quartz Beloit One Network |
$506.11
|
| Rate for Payer: Quartz Commercial |
$655.64
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$98.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: WEA Trust Commercial |
$632.63
|
| Rate for Payer: WPS Commercial |
$110.24
|
|
|
Leukotriene E4, Urine
|
Facility
|
OP
|
$1,106.00
|
|
|
Service Code
|
CPT 82542
|
| Hospital Charge Code |
5841646
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$25.05 |
| Max. Negotiated Rate |
$1,058.22 |
| Rate for Payer: Aetna Commercial |
$1,035.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$989.21
|
| Rate for Payer: Aetna Managed Medicare |
$25.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$93.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.59
|
| Rate for Payer: Anthem Medicare Advantage |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$609.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25.05
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cash Price |
$331.80
|
| Rate for Payer: Cigna Commercial |
$1,058.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$643.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25.05
|
| Rate for Payer: Health EOS Commercial |
$1,023.71
|
| Rate for Payer: HFN Commercial |
$1,058.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25.05
|
| Rate for Payer: Multiplan Commercial |
$920.19
|
| Rate for Payer: NAPHCARE Commercial |
$37.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,058.22
|
| Rate for Payer: Quartz Beloit One Network |
$563.62
|
| Rate for Payer: Quartz Commercial |
$747.66
|
| Rate for Payer: Quartz Medicare Advantage |
$25.05
|
| Rate for Payer: The Alliance Commercial |
$100.21
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25.05
|
| Rate for Payer: United Healthcare PPO |
$862.68
|
| Rate for Payer: WEA Trust Commercial |
$632.63
|
| Rate for Payer: Wellcare Medicare |
$25.05
|
| Rate for Payer: WPS Commercial |
$851.95
|
|
|
Leuprolide acetate /3.75 mg J1950 man
|
Facility
|
OP
|
$2,412.00
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
3373657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,204.07 |
| Max. Negotiated Rate |
$7,337.70 |
| Rate for Payer: Aetna Commercial |
$2,257.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,834.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,630.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,254.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,204.07
|
| Rate for Payer: Anthem Medicare Advantage |
$1,834.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,329.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,834.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,834.42
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,307.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,834.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,168.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,834.42
|
| Rate for Payer: Health EOS Commercial |
$2,232.55
|
| Rate for Payer: HFN Commercial |
$2,307.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,824.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,834.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,834.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,834.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,834.42
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,751.64
|
| Rate for Payer: Preferred Network Access Commercial |
$2,307.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.16
|
| Rate for Payer: Quartz Commercial |
$1,630.51
|
| Rate for Payer: Quartz Medicare Advantage |
$1,834.42
|
| Rate for Payer: The Alliance Commercial |
$7,337.70
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,834.42
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: Wellcare Medicare |
$1,834.42
|
| Rate for Payer: WPS Commercial |
$4,097.91
|
|
|
Leuprolide acetate /3.75 mg J1950 man
|
Facility
|
IP
|
$2,412.00
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
3373657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,229.16 |
| Max. Negotiated Rate |
$2,307.80 |
| Rate for Payer: Aetna Commercial |
$2,257.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,329.49
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,307.80
|
| Rate for Payer: Health EOS Commercial |
$2,232.55
|
| Rate for Payer: HFN Commercial |
$2,307.80
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: Preferred Network Access Commercial |
$2,307.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,229.16
|
| Rate for Payer: Quartz Commercial |
$1,505.09
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: WPS Commercial |
$1,857.96
|
|
|
Leuprolide acetate /3.75 mg J1950 man
|
Professional
|
Both
|
$2,412.00
|
|
|
Service Code
|
HCPCS J1950
|
| Hospital Charge Code |
3373657
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$1,103.73 |
| Max. Negotiated Rate |
$5,044.67 |
| Rate for Payer: Aetna Commercial |
$2,383.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,157.29
|
| Rate for Payer: Aetna Managed Medicare |
$1,834.42
|
| Rate for Payer: Anthem Medicare Advantage |
$1,834.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,834.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,834.42
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cash Price |
$723.60
|
| Rate for Payer: Cigna Commercial |
$2,383.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,834.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,639.16
|
| Rate for Payer: Health EOS Commercial |
$2,282.72
|
| Rate for Payer: HFN Commercial |
$2,383.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,925.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,925.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,834.42
|
| Rate for Payer: Multiplan Commercial |
$2,006.78
|
| Rate for Payer: NAPHCARE Commercial |
$2,751.64
|
| Rate for Payer: Preferred Network Access Commercial |
$2,383.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,103.73
|
| Rate for Payer: Quartz Commercial |
$1,429.83
|
| Rate for Payer: Quartz Medicare Advantage |
$1,834.42
|
| Rate for Payer: The Alliance Commercial |
$5,044.67
|
| Rate for Payer: United Healthcare Medicaid |
$1,834.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,834.42
|
| Rate for Payer: WEA Trust Commercial |
$1,379.66
|
| Rate for Payer: WPS Commercial |
$4,097.91
|
|
|
Leuprolide acetate suspnsion 7.5 mg J9217 mans
|
Facility
|
OP
|
$383.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
3369607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$177.61 |
| Max. Negotiated Rate |
$710.44 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$177.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$258.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$199.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$191.19
|
| Rate for Payer: Anthem Medicare Advantage |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.61
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$255.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$177.61
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$660.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.61
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$177.61
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$177.61
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$266.42
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$258.91
|
| Rate for Payer: Quartz Medicare Advantage |
$177.61
|
| Rate for Payer: The Alliance Commercial |
$710.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.61
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: Wellcare Medicare |
$177.61
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Leuprolide acetate suspnsion 7.5 mg J9217 mans
|
Professional
|
Both
|
$383.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
3369607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$175.26 |
| Max. Negotiated Rate |
$488.43 |
| Rate for Payer: Aetna Commercial |
$378.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Aetna Managed Medicare |
$177.61
|
| Rate for Payer: Anthem Medicare Advantage |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$177.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$177.61
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$378.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$177.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.09
|
| Rate for Payer: Health EOS Commercial |
$362.47
|
| Rate for Payer: HFN Commercial |
$378.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$309.86
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$309.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$177.61
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: NAPHCARE Commercial |
$266.42
|
| Rate for Payer: Preferred Network Access Commercial |
$378.40
|
| Rate for Payer: Quartz Beloit One Network |
$175.26
|
| Rate for Payer: Quartz Commercial |
$227.04
|
| Rate for Payer: Quartz Medicare Advantage |
$177.61
|
| Rate for Payer: The Alliance Commercial |
$488.43
|
| Rate for Payer: United Healthcare Medicaid |
$177.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$177.61
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$482.72
|
|
|
Leuprolide acetate suspnsion 7.5 mg J9217 mans
|
Facility
|
IP
|
$383.00
|
|
|
Service Code
|
HCPCS J9217
|
| Hospital Charge Code |
3369607
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$195.18 |
| Max. Negotiated Rate |
$366.45 |
| Rate for Payer: Aetna Commercial |
$358.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$342.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$211.11
|
| Rate for Payer: Cash Price |
$114.90
|
| Rate for Payer: Cigna Commercial |
$366.45
|
| Rate for Payer: Health EOS Commercial |
$354.50
|
| Rate for Payer: HFN Commercial |
$366.45
|
| Rate for Payer: Multiplan Commercial |
$318.66
|
| Rate for Payer: Preferred Network Access Commercial |
$366.45
|
| Rate for Payer: Quartz Beloit One Network |
$195.18
|
| Rate for Payer: Quartz Commercial |
$238.99
|
| Rate for Payer: WEA Trust Commercial |
$219.08
|
| Rate for Payer: WPS Commercial |
$295.02
|
|
