|
URETEROLITHOTOMY
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
URETEROLYSIS
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960470
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
URETEROLYSIS
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960470
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
URETEROPLASTY
|
Facility
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960474
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
URETEROPLASTY
|
Facility
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960474
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
URETEROSCOPE LITHOVUE REVERSE DEFLECTING DIGITAL FLEXIBLE SINGLE-USE M0067913600
|
Facility
OP
|
$7,093.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
6211021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,986.04 |
| Max. Negotiated Rate |
$6,525.56 |
| Rate for Payer: Aetna Commercial |
$6,383.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,099.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,986.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,610.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,546.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,404.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,759.29
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,525.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,969.24
|
| Rate for Payer: Health EOS Commercial |
$6,312.77
|
| Rate for Payer: HFN Commercial |
$6,525.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,319.75
|
| Rate for Payer: Multiplan Commercial |
$5,674.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,255.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,525.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,475.57
|
| Rate for Payer: Quartz Commercial |
$4,610.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,255.80
|
| Rate for Payer: The Alliance Commercial |
$2,482.55
|
| Rate for Payer: WEA Trust Commercial |
$3,901.15
|
| Rate for Payer: WPS Commercial |
$5,253.79
|
|
|
URETEROSCOPE LITHOVUE REVERSE DEFLECTING DIGITAL FLEXIBLE SINGLE-USE M0067913600
|
Facility
IP
|
$7,093.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
6211021
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,475.57 |
| Max. Negotiated Rate |
$6,525.56 |
| Rate for Payer: Aetna Commercial |
$6,383.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,759.29
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,525.56
|
| Rate for Payer: Health EOS Commercial |
$6,312.77
|
| Rate for Payer: HFN Commercial |
$6,525.56
|
| Rate for Payer: Multiplan Commercial |
$5,674.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,255.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,525.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,475.57
|
| Rate for Payer: Quartz Commercial |
$4,255.80
|
| Rate for Payer: WEA Trust Commercial |
$3,901.15
|
| Rate for Payer: WPS Commercial |
$5,253.79
|
|
|
URETEROSCOPE LITHOVUE STD DEFLECTING DIGITAL FLEXIBLE SINGLE-USE M0067913500
|
Facility
OP
|
$7,093.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
6207073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,986.04 |
| Max. Negotiated Rate |
$6,525.56 |
| Rate for Payer: Aetna Commercial |
$6,383.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,099.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,986.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,610.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,546.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,404.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,759.29
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,525.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,969.24
|
| Rate for Payer: Health EOS Commercial |
$6,312.77
|
| Rate for Payer: HFN Commercial |
$6,525.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,319.75
|
| Rate for Payer: Multiplan Commercial |
$5,674.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,255.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,525.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,475.57
|
| Rate for Payer: Quartz Commercial |
$4,610.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,255.80
|
| Rate for Payer: The Alliance Commercial |
$2,482.55
|
| Rate for Payer: WEA Trust Commercial |
$3,901.15
|
| Rate for Payer: WPS Commercial |
$5,253.79
|
|
|
URETEROSCOPE LITHOVUE STD DEFLECTING DIGITAL FLEXIBLE SINGLE-USE M0067913500
|
Facility
IP
|
$7,093.00
|
|
|
Service Code
|
HCPCS C1747
|
| Hospital Charge Code |
6207073
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$3,475.57 |
| Max. Negotiated Rate |
$6,525.56 |
| Rate for Payer: Aetna Commercial |
$6,383.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,759.29
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,525.56
|
| Rate for Payer: Health EOS Commercial |
$6,312.77
|
| Rate for Payer: HFN Commercial |
$6,525.56
|
| Rate for Payer: Multiplan Commercial |
$5,674.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,255.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,525.56
|
| Rate for Payer: Quartz Beloit One Network |
$3,475.57
|
| Rate for Payer: Quartz Commercial |
$4,255.80
|
| Rate for Payer: WEA Trust Commercial |
$3,901.15
|
| Rate for Payer: WPS Commercial |
$5,253.79
|
|
|
URETEROSCOPY
|
Facility
IP
|
$4,721.00
|
|
| Hospital Charge Code |
2960475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,313.29 |
| Max. Negotiated Rate |
$4,343.32 |
| Rate for Payer: Aetna Commercial |
$4,248.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,502.13
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,343.32
|
| Rate for Payer: Health EOS Commercial |
$4,201.69
|
| Rate for Payer: HFN Commercial |
$4,343.32
|
| Rate for Payer: Multiplan Commercial |
$3,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,832.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,313.29
|
| Rate for Payer: Quartz Commercial |
$2,832.60
|
| Rate for Payer: WEA Trust Commercial |
$2,596.55
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
|
URETEROSCOPY
|
Facility
OP
|
$4,721.00
|
|
| Hospital Charge Code |
2960475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,321.88 |
| Max. Negotiated Rate |
$18,884.00 |
| Rate for Payer: Aetna Commercial |
$4,248.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,060.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,321.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,068.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,266.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,502.13
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,343.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,641.87
|
| Rate for Payer: Health EOS Commercial |
$4,201.69
|
| Rate for Payer: HFN Commercial |
$4,343.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,540.75
|
| Rate for Payer: Multiplan Commercial |
$3,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,832.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,313.29
|
| Rate for Payer: Quartz Commercial |
$3,068.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,832.60
|
| Rate for Payer: The Alliance Commercial |
$18,884.00
|
| Rate for Payer: WEA Trust Commercial |
$2,596.55
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
|
URETEROSCOPY, FLEXIBLE
|
Facility
IP
|
$6,450.00
|
|
| Hospital Charge Code |
2975774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,160.50 |
| Max. Negotiated Rate |
$5,934.00 |
| Rate for Payer: Aetna Commercial |
$5,805.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,418.50
|
| Rate for Payer: Cash Price |
$1,935.00
|
| Rate for Payer: Cigna Commercial |
$5,934.00
|
| Rate for Payer: Health EOS Commercial |
$5,740.50
|
| Rate for Payer: HFN Commercial |
$5,934.00
|
| Rate for Payer: Multiplan Commercial |
$5,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,870.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,934.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,160.50
|
| Rate for Payer: Quartz Commercial |
$3,870.00
|
| Rate for Payer: WEA Trust Commercial |
$3,547.50
|
| Rate for Payer: WPS Commercial |
$4,777.52
|
|
|
URETEROSCOPY, FLEXIBLE
|
Facility
OP
|
$6,450.00
|
|
| Hospital Charge Code |
2975774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,806.00 |
| Max. Negotiated Rate |
$25,800.00 |
| Rate for Payer: Aetna Commercial |
$5,805.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,547.00
|
| Rate for Payer: Aetna Managed Medicare |
$1,806.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,192.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,225.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,096.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,418.50
|
| Rate for Payer: Cash Price |
$1,935.00
|
| Rate for Payer: Cigna Commercial |
$5,934.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,609.42
|
| Rate for Payer: Health EOS Commercial |
$5,740.50
|
| Rate for Payer: HFN Commercial |
$5,934.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,837.50
|
| Rate for Payer: Multiplan Commercial |
$5,160.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,870.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,934.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,160.50
|
| Rate for Payer: Quartz Commercial |
$4,192.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,870.00
|
| Rate for Payer: The Alliance Commercial |
$25,800.00
|
| Rate for Payer: WEA Trust Commercial |
$3,547.50
|
| Rate for Payer: WPS Commercial |
$4,777.52
|
|
|
URETEROSIGMOIDOSTOMY
|
Facility
OP
|
$4,256.00
|
|
| Hospital Charge Code |
2960482
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,191.68 |
| Max. Negotiated Rate |
$17,024.00 |
| Rate for Payer: Aetna Commercial |
$3,830.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,660.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,191.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,766.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,128.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,042.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,255.68
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$3,915.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,381.66
|
| Rate for Payer: Health EOS Commercial |
$3,787.84
|
| Rate for Payer: HFN Commercial |
$3,915.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,192.00
|
| Rate for Payer: Multiplan Commercial |
$3,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,553.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,915.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,085.44
|
| Rate for Payer: Quartz Commercial |
$2,766.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,553.60
|
| Rate for Payer: The Alliance Commercial |
$17,024.00
|
| Rate for Payer: WEA Trust Commercial |
$2,340.80
|
| Rate for Payer: WPS Commercial |
$3,152.42
|
|
|
URETEROSIGMOIDOSTOMY
|
Facility
IP
|
$4,256.00
|
|
| Hospital Charge Code |
2960482
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,085.44 |
| Max. Negotiated Rate |
$3,915.52 |
| Rate for Payer: Aetna Commercial |
$3,830.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,255.68
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$3,915.52
|
| Rate for Payer: Health EOS Commercial |
$3,787.84
|
| Rate for Payer: HFN Commercial |
$3,915.52
|
| Rate for Payer: Multiplan Commercial |
$3,404.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,553.60
|
| Rate for Payer: Preferred Network Access Commercial |
$3,915.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,085.44
|
| Rate for Payer: Quartz Commercial |
$2,553.60
|
| Rate for Payer: WEA Trust Commercial |
$2,340.80
|
| Rate for Payer: WPS Commercial |
$3,152.42
|
|
|
URETEROSTOMY/URETEROTOMY
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
URETEROSTOMY/URETEROTOMY
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
URETHRAL DILATION
|
Facility
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960478
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
URETHRAL DILATION
|
Facility
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960478
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
URETHRAL DIVERTICULECTOMY
|
Facility
OP
|
$4,383.00
|
|
| Hospital Charge Code |
2959996
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,227.24 |
| Max. Negotiated Rate |
$17,532.00 |
| Rate for Payer: Aetna Commercial |
$3,944.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,769.38
|
| Rate for Payer: Aetna Managed Medicare |
$1,227.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,848.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,191.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,103.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,322.99
|
| Rate for Payer: Cash Price |
$1,314.90
|
| Rate for Payer: Cigna Commercial |
$4,032.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,452.73
|
| Rate for Payer: Health EOS Commercial |
$3,900.87
|
| Rate for Payer: HFN Commercial |
$4,032.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,287.25
|
| Rate for Payer: Multiplan Commercial |
$3,506.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,629.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,032.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,147.67
|
| Rate for Payer: Quartz Commercial |
$2,848.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,629.80
|
| Rate for Payer: The Alliance Commercial |
$17,532.00
|
| Rate for Payer: WEA Trust Commercial |
$2,410.65
|
| Rate for Payer: WPS Commercial |
$3,246.49
|
|
|
URETHRAL DIVERTICULECTOMY
|
Facility
IP
|
$4,383.00
|
|
| Hospital Charge Code |
2959996
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,147.67 |
| Max. Negotiated Rate |
$4,032.36 |
| Rate for Payer: Aetna Commercial |
$3,944.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,322.99
|
| Rate for Payer: Cash Price |
$1,314.90
|
| Rate for Payer: Cigna Commercial |
$4,032.36
|
| Rate for Payer: Health EOS Commercial |
$3,900.87
|
| Rate for Payer: HFN Commercial |
$4,032.36
|
| Rate for Payer: Multiplan Commercial |
$3,506.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,629.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,032.36
|
| Rate for Payer: Quartz Beloit One Network |
$2,147.67
|
| Rate for Payer: Quartz Commercial |
$2,629.80
|
| Rate for Payer: WEA Trust Commercial |
$2,410.65
|
| Rate for Payer: WPS Commercial |
$3,246.49
|
|
|
Urethral Pressure Profile Upp
|
Facility
IP
|
$664.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
3005556
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$325.36 |
| Max. Negotiated Rate |
$610.88 |
| Rate for Payer: Aetna Commercial |
$597.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.92
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$610.88
|
| Rate for Payer: Health EOS Commercial |
$590.96
|
| Rate for Payer: HFN Commercial |
$610.88
|
| Rate for Payer: Multiplan Commercial |
$531.20
|
| Rate for Payer: NAPHCARE Commercial |
$398.40
|
| Rate for Payer: Preferred Network Access Commercial |
$610.88
|
| Rate for Payer: Quartz Beloit One Network |
$325.36
|
| Rate for Payer: Quartz Commercial |
$398.40
|
| Rate for Payer: WEA Trust Commercial |
$365.20
|
| Rate for Payer: WPS Commercial |
$491.82
|
|
|
Urethral Pressure Profile Upp
|
Facility
OP
|
$664.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
3005556
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$318.72 |
| Max. Negotiated Rate |
$13,286.32 |
| Rate for Payer: Aetna Commercial |
$597.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$571.04
|
| Rate for Payer: Aetna Managed Medicare |
$675.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$431.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$332.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$318.72
|
| Rate for Payer: Anthem Medicare Advantage |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$351.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$675.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$675.19
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$610.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$675.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$675.19
|
| Rate for Payer: Health EOS Commercial |
$590.96
|
| Rate for Payer: HFN Commercial |
$610.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,511.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$675.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$675.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$675.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$675.19
|
| Rate for Payer: Multiplan Commercial |
$531.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.78
|
| Rate for Payer: Preferred Network Access Commercial |
$610.88
|
| Rate for Payer: Quartz Beloit One Network |
$325.36
|
| Rate for Payer: Quartz Commercial |
$431.60
|
| Rate for Payer: Quartz Medicare Advantage |
$675.19
|
| Rate for Payer: The Alliance Commercial |
$13,286.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$675.19
|
| Rate for Payer: United Healthcare PPO |
$498.00
|
| Rate for Payer: WEA Trust Commercial |
$365.20
|
| Rate for Payer: Wellcare Medicare |
$675.19
|
| Rate for Payer: WPS Commercial |
$491.82
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
IP
|
$45,833.00
|
|
|
Service Code
|
MS-DRG 671
|
| Min. Negotiated Rate |
$16,486.67 |
| Max. Negotiated Rate |
$45,833.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,486.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,875.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,498.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,125.38
|
| Rate for Payer: Anthem Medicare Advantage |
$16,486.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,486.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,486.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,486.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,001.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,486.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,382.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,486.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,486.67
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,486.67
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,486.67
|
| Rate for Payer: NAPHCARE Commercial |
$24,730.00
|
| Rate for Payer: Quartz Medicare Advantage |
$16,486.67
|
| Rate for Payer: The Alliance Commercial |
$45,833.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,486.67
|
| Rate for Payer: United Healthcare PPO |
$25,988.35
|
| Rate for Payer: Wellcare Medicare |
$16,486.67
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
IP
|
$25,245.00
|
|
|
Service Code
|
MS-DRG 672
|
| Min. Negotiated Rate |
$9,080.86 |
| Max. Negotiated Rate |
$25,245.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,080.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,301.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,794.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,055.76
|
| Rate for Payer: Anthem Medicare Advantage |
$9,080.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,080.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,080.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,080.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,603.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,080.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,992.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,080.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,080.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,080.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,080.86
|
| Rate for Payer: NAPHCARE Commercial |
$13,621.29
|
| Rate for Payer: Quartz Medicare Advantage |
$9,080.86
|
| Rate for Payer: The Alliance Commercial |
$25,245.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,080.86
|
| Rate for Payer: United Healthcare PPO |
$14,007.51
|
| Rate for Payer: Wellcare Medicare |
$9,080.86
|
|
