|
TRANSLUMINAL BALLOON ANGIOPLASTY (EXCEPT DIALYSIS CIRCUIT), OPEN OR PERCUTANEOUS, INCLUDING ALL IMAGING AND RADIOLOGICAL SUPERVISION AND INTERPRETATION NECESSARY TO PERFORM THE ANGIOPLASTY WITHIN THE SAME VEIN; INITIAL VEIN
|
Facility
|
OP
|
$23,958.98
|
|
|
Service Code
|
CPT 37248
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,989.74 |
| Max. Negotiated Rate |
$23,958.98 |
| Rate for Payer: Aetna Managed Medicare |
$5,989.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,989.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,989.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,989.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,281.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,989.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,989.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,989.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,989.74
|
| Rate for Payer: NAPHCARE Commercial |
$8,984.62
|
| Rate for Payer: Quartz Medicare Advantage |
$5,989.74
|
| Rate for Payer: The Alliance Commercial |
$23,958.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,989.74
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: Wellcare Medicare |
$5,989.74
|
|
|
Transparent dressing charge
|
Facility
|
IP
|
$51.00
|
|
| Hospital Charge Code |
2844902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$25.99 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$31.82
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
Transparent dressing charge
|
Facility
|
OP
|
$51.00
|
|
| Hospital Charge Code |
2844902
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$14.85 |
| Max. Negotiated Rate |
$48.80 |
| Rate for Payer: Aetna Commercial |
$47.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45.61
|
| Rate for Payer: Aetna Managed Medicare |
$14.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28.11
|
| Rate for Payer: Cash Price |
$15.30
|
| Rate for Payer: Cigna Commercial |
$48.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29.68
|
| Rate for Payer: Health EOS Commercial |
$47.21
|
| Rate for Payer: HFN Commercial |
$48.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39.78
|
| Rate for Payer: Multiplan Commercial |
$42.43
|
| Rate for Payer: NAPHCARE Commercial |
$31.82
|
| Rate for Payer: Preferred Network Access Commercial |
$48.80
|
| Rate for Payer: Quartz Beloit One Network |
$25.99
|
| Rate for Payer: Quartz Commercial |
$34.48
|
| Rate for Payer: Quartz Medicare Advantage |
$31.82
|
| Rate for Payer: The Alliance Commercial |
$26.52
|
| Rate for Payer: WEA Trust Commercial |
$29.17
|
| Rate for Payer: WPS Commercial |
$39.29
|
|
|
TRANSPERINEAL PLACEMENT SPACEOAR INJECTION W/IMAGE GUIDANCE
|
Facility
|
IP
|
$1,186.00
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
5454805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$604.39 |
| Max. Negotiated Rate |
$1,134.76 |
| Rate for Payer: Aetna Commercial |
$1,110.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.72
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$1,134.76
|
| Rate for Payer: Health EOS Commercial |
$1,097.76
|
| Rate for Payer: HFN Commercial |
$1,134.76
|
| Rate for Payer: Multiplan Commercial |
$986.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.76
|
| Rate for Payer: Quartz Beloit One Network |
$604.39
|
| Rate for Payer: Quartz Commercial |
$740.06
|
| Rate for Payer: WEA Trust Commercial |
$678.39
|
| Rate for Payer: WPS Commercial |
$913.58
|
|
|
TRANSPERINEAL PLACEMENT SPACEOAR INJECTION W/IMAGE GUIDANCE
|
Facility
|
OP
|
$1,186.00
|
|
|
Service Code
|
CPT 55874
|
| Hospital Charge Code |
5454805
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$604.39 |
| Max. Negotiated Rate |
$22,570.79 |
| Rate for Payer: Aetna Commercial |
$1,110.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,060.76
|
| Rate for Payer: Aetna Managed Medicare |
$5,642.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,642.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$653.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,642.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,642.70
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cash Price |
$355.80
|
| Rate for Payer: Cigna Commercial |
$1,134.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,642.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,642.70
|
| Rate for Payer: Health EOS Commercial |
$1,097.76
|
| Rate for Payer: HFN Commercial |
$1,134.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,990.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,642.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,642.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,642.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,642.70
|
| Rate for Payer: Multiplan Commercial |
$986.75
|
| Rate for Payer: NAPHCARE Commercial |
$8,464.05
|
| Rate for Payer: Preferred Network Access Commercial |
$1,134.76
|
| Rate for Payer: Quartz Beloit One Network |
$604.39
|
| Rate for Payer: Quartz Commercial |
$801.74
|
| Rate for Payer: Quartz Medicare Advantage |
$5,642.70
|
| Rate for Payer: The Alliance Commercial |
$22,570.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,642.70
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: WEA Trust Commercial |
$678.39
|
| Rate for Payer: Wellcare Medicare |
$5,642.70
|
| Rate for Payer: WPS Commercial |
$913.58
|
|
|
TRANSRECTAL ULTRASOUND
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
TRANSRECTAL ULTRASOUND
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
Transtelephonic Pacemaker Eval 90 day
|
Facility
|
OP
|
$450.00
|
|
|
Service Code
|
CPT 93293
|
| Hospital Charge Code |
2982420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$39.28 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Aetna Managed Medicare |
$39.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$304.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$234.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$224.64
|
| Rate for Payer: Anthem Medicare Advantage |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.28
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$261.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39.28
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$146.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39.28
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: NAPHCARE Commercial |
$58.92
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$304.20
|
| Rate for Payer: Quartz Medicare Advantage |
$39.28
|
| Rate for Payer: The Alliance Commercial |
$157.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.28
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: Wellcare Medicare |
$39.28
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
Transtelephonic Pacemaker Eval 90 day
|
Facility
|
IP
|
$450.00
|
|
|
Service Code
|
CPT 93293
|
| Hospital Charge Code |
2982420
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$229.32 |
| Max. Negotiated Rate |
$430.56 |
| Rate for Payer: Aetna Commercial |
$421.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$402.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$248.04
|
| Rate for Payer: Cash Price |
$135.00
|
| Rate for Payer: Cigna Commercial |
$430.56
|
| Rate for Payer: Health EOS Commercial |
$416.52
|
| Rate for Payer: HFN Commercial |
$430.56
|
| Rate for Payer: Multiplan Commercial |
$374.40
|
| Rate for Payer: Preferred Network Access Commercial |
$430.56
|
| Rate for Payer: Quartz Beloit One Network |
$229.32
|
| Rate for Payer: Quartz Commercial |
$280.80
|
| Rate for Payer: WEA Trust Commercial |
$257.40
|
| Rate for Payer: WPS Commercial |
$346.63
|
|
|
Transtel Pacer 93293
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
CPT 93293
|
| Hospital Charge Code |
3127518
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$39.58 |
| Max. Negotiated Rate |
$853.63 |
| Rate for Payer: Aetna Commercial |
$853.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Aetna Managed Medicare |
$39.58
|
| Rate for Payer: Anthem Medicare Advantage |
$39.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39.58
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$853.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$50.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39.58
|
| Rate for Payer: Health EOS Commercial |
$817.69
|
| Rate for Payer: HFN Commercial |
$853.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$179.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$179.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39.58
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: NAPHCARE Commercial |
$59.37
|
| Rate for Payer: Preferred Network Access Commercial |
$853.63
|
| Rate for Payer: Quartz Beloit One Network |
$395.37
|
| Rate for Payer: Quartz Commercial |
$512.18
|
| Rate for Payer: Quartz Medicare Advantage |
$39.58
|
| Rate for Payer: The Alliance Commercial |
$150.41
|
| Rate for Payer: United Healthcare Medicaid |
$50.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39.58
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$158.33
|
|
|
Transtel Pacer Interp 9329326
|
Professional
|
Both
|
$864.00
|
|
|
Service Code
|
CPT 93293 26
|
| Hospital Charge Code |
3127506
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$13.52 |
| Max. Negotiated Rate |
$853.63 |
| Rate for Payer: Aetna Commercial |
$853.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$772.76
|
| Rate for Payer: Aetna Managed Medicare |
$13.52
|
| Rate for Payer: Anthem Medicare Advantage |
$13.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.52
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cash Price |
$259.20
|
| Rate for Payer: Cigna Commercial |
$853.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.52
|
| Rate for Payer: Health EOS Commercial |
$817.69
|
| Rate for Payer: HFN Commercial |
$853.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$53.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$53.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.52
|
| Rate for Payer: Multiplan Commercial |
$718.85
|
| Rate for Payer: NAPHCARE Commercial |
$20.28
|
| Rate for Payer: Preferred Network Access Commercial |
$853.63
|
| Rate for Payer: Quartz Beloit One Network |
$395.37
|
| Rate for Payer: Quartz Commercial |
$512.18
|
| Rate for Payer: Quartz Medicare Advantage |
$13.52
|
| Rate for Payer: The Alliance Commercial |
$51.38
|
| Rate for Payer: United Healthcare Medicaid |
$15.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.52
|
| Rate for Payer: WEA Trust Commercial |
$494.21
|
| Rate for Payer: WPS Commercial |
$54.08
|
|
|
TRANSTRACHEAL CATHETERS ADULT #C-11-2
|
Facility
|
IP
|
$1,892.00
|
|
| Hospital Charge Code |
2973305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$964.16 |
| Max. Negotiated Rate |
$1,810.27 |
| Rate for Payer: Aetna Commercial |
$1,770.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.87
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,810.27
|
| Rate for Payer: Health EOS Commercial |
$1,751.24
|
| Rate for Payer: HFN Commercial |
$1,810.27
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.27
|
| Rate for Payer: Quartz Beloit One Network |
$964.16
|
| Rate for Payer: Quartz Commercial |
$1,180.61
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
TRANSTRACHEAL CATHETERS ADULT #C-11-2
|
Facility
|
OP
|
$1,892.00
|
|
| Hospital Charge Code |
2973305
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$550.95 |
| Max. Negotiated Rate |
$1,810.27 |
| Rate for Payer: Aetna Commercial |
$1,770.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,692.20
|
| Rate for Payer: Aetna Managed Medicare |
$550.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,278.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$983.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$944.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,042.87
|
| Rate for Payer: Cash Price |
$567.60
|
| Rate for Payer: Cigna Commercial |
$1,810.27
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,101.14
|
| Rate for Payer: Health EOS Commercial |
$1,751.24
|
| Rate for Payer: HFN Commercial |
$1,810.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,475.76
|
| Rate for Payer: Multiplan Commercial |
$1,574.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,180.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,810.27
|
| Rate for Payer: Quartz Beloit One Network |
$964.16
|
| Rate for Payer: Quartz Commercial |
$1,278.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1,180.61
|
| Rate for Payer: The Alliance Commercial |
$983.84
|
| Rate for Payer: WEA Trust Commercial |
$1,082.22
|
| Rate for Payer: WPS Commercial |
$1,457.41
|
|
|
TRANSURETEROURETEROSTOMY
|
Facility
|
IP
|
$4,383.00
|
|
| Hospital Charge Code |
2960451
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,233.58 |
| Max. Negotiated Rate |
$4,193.65 |
| Rate for Payer: Aetna Commercial |
$4,102.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,920.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,415.91
|
| Rate for Payer: Cash Price |
$1,314.90
|
| Rate for Payer: Cigna Commercial |
$4,193.65
|
| Rate for Payer: Health EOS Commercial |
$4,056.90
|
| Rate for Payer: HFN Commercial |
$4,193.65
|
| Rate for Payer: Multiplan Commercial |
$3,646.66
|
| Rate for Payer: Preferred Network Access Commercial |
$4,193.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,233.58
|
| Rate for Payer: Quartz Commercial |
$2,734.99
|
| Rate for Payer: WEA Trust Commercial |
$2,507.08
|
| Rate for Payer: WPS Commercial |
$3,376.22
|
|
|
TRANSURETEROURETEROSTOMY
|
Facility
|
OP
|
$4,383.00
|
|
| Hospital Charge Code |
2960451
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.33 |
| Max. Negotiated Rate |
$4,193.65 |
| Rate for Payer: Aetna Commercial |
$4,102.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,920.16
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,962.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,279.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,187.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,415.91
|
| Rate for Payer: Cash Price |
$1,314.90
|
| Rate for Payer: Cigna Commercial |
$4,193.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,550.91
|
| Rate for Payer: Health EOS Commercial |
$4,056.90
|
| Rate for Payer: HFN Commercial |
$4,193.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,418.74
|
| Rate for Payer: Multiplan Commercial |
$3,646.66
|
| Rate for Payer: NAPHCARE Commercial |
$2,734.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,193.65
|
| Rate for Payer: Quartz Beloit One Network |
$2,233.58
|
| Rate for Payer: Quartz Commercial |
$2,962.91
|
| Rate for Payer: Quartz Medicare Advantage |
$2,734.99
|
| Rate for Payer: The Alliance Commercial |
$2,279.16
|
| Rate for Payer: WEA Trust Commercial |
$2,507.08
|
| Rate for Payer: WPS Commercial |
$3,376.22
|
|
|
TRANSURETHRAL ELECTROSURGICAL RESECTION OF PROSTATE, INCLUDING CONTROL OF POSTOPERATIVE BLEEDING, COMPLETE (VASECTOMY, MEATOTOMY, CYSTOURETHROSCOPY, URETHRAL CALIBRATION AND/OR DILATION, AND INTERNAL URETHROTOMY ARE INCLUDED)
|
Facility
|
OP
|
$22,570.79
|
|
|
Service Code
|
CPT 52601
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$22,570.79 |
| Rate for Payer: Aetna Managed Medicare |
$5,642.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,642.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,642.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,642.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,642.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,642.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,990.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,642.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,642.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,642.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,642.70
|
| Rate for Payer: NAPHCARE Commercial |
$8,464.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,642.70
|
| Rate for Payer: The Alliance Commercial |
$22,570.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,642.70
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,642.70
|
|
|
TRANSURETHRAL INCISION OF PROSTATE
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,709.65 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,709.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,799.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,709.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,709.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,709.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,709.65
|
| Rate for Payer: NAPHCARE Commercial |
$5,564.47
|
| Rate for Payer: Quartz Medicare Advantage |
$3,709.65
|
| Rate for Payer: The Alliance Commercial |
$14,838.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,709.65
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
TRANSURETHRAL PROCEDURES WITH CC
|
Facility
|
IP
|
$42,763.76
|
|
|
Service Code
|
MSDRG 669
|
| Min. Negotiated Rate |
$12,392.30 |
| Max. Negotiated Rate |
$42,763.76 |
| Rate for Payer: Aetna Managed Medicare |
$12,392.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,863.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,956.02
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,659.91
|
| Rate for Payer: Anthem Medicare Advantage |
$12,392.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,392.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,392.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,392.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,374.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,392.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,121.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,392.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,392.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,392.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,392.30
|
| Rate for Payer: NAPHCARE Commercial |
$18,588.45
|
| Rate for Payer: Quartz Medicare Advantage |
$12,392.30
|
| Rate for Payer: The Alliance Commercial |
$42,763.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,392.30
|
| Rate for Payer: United Healthcare PPO |
$24,228.63
|
| Rate for Payer: Wellcare Medicare |
$12,392.30
|
|
|
TRANSURETHRAL PROCEDURES WITH MCC
|
Facility
|
IP
|
$78,249.60
|
|
|
Service Code
|
MSDRG 668
|
| Min. Negotiated Rate |
$22,868.72 |
| Max. Negotiated Rate |
$78,249.60 |
| Rate for Payer: Aetna Managed Medicare |
$22,868.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63,712.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48,834.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46,396.23
|
| Rate for Payer: Anthem Medicare Advantage |
$22,868.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,868.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,868.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,868.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51,504.07
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,868.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57,149.04
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,868.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,868.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,868.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,868.72
|
| Rate for Payer: NAPHCARE Commercial |
$34,303.07
|
| Rate for Payer: Quartz Medicare Advantage |
$22,868.72
|
| Rate for Payer: The Alliance Commercial |
$78,249.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,868.72
|
| Rate for Payer: United Healthcare PPO |
$44,491.26
|
| Rate for Payer: Wellcare Medicare |
$22,868.72
|
|
|
TRANSURETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,948.48
|
|
|
Service Code
|
MSDRG 670
|
| Min. Negotiated Rate |
$7,991.14 |
| Max. Negotiated Rate |
$26,948.48 |
| Rate for Payer: Aetna Managed Medicare |
$7,991.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,323.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,344.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,528.44
|
| Rate for Payer: Anthem Medicare Advantage |
$7,991.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,991.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,991.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,991.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,237.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,991.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,521.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,991.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,991.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,991.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,991.14
|
| Rate for Payer: NAPHCARE Commercial |
$11,986.71
|
| Rate for Payer: Quartz Medicare Advantage |
$7,991.14
|
| Rate for Payer: The Alliance Commercial |
$26,948.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,991.14
|
| Rate for Payer: United Healthcare PPO |
$15,197.76
|
| Rate for Payer: Wellcare Medicare |
$7,991.14
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$10,346.61
|
|
|
Service Code
|
APR-DRG 4822
|
| Min. Negotiated Rate |
$9,190.50 |
| Max. Negotiated Rate |
$10,346.61 |
| Rate for Payer: Anthem Medicaid |
$9,907.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,907.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,907.45
|
| Rate for Payer: Dean Health Medicaid |
$9,907.45
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,190.50
|
| Rate for Payer: Managed Health Services Medicaid |
$10,346.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,907.45
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,907.45
|
| Rate for Payer: United Healthcare Medicaid |
$9,907.45
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$16,747.47
|
|
|
Service Code
|
APR-DRG 4823
|
| Min. Negotiated Rate |
$14,876.15 |
| Max. Negotiated Rate |
$16,747.47 |
| Rate for Payer: Anthem Medicaid |
$16,036.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,036.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,036.63
|
| Rate for Payer: Dean Health Medicaid |
$16,036.63
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,876.15
|
| Rate for Payer: Managed Health Services Medicaid |
$16,747.47
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,036.63
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,036.63
|
| Rate for Payer: United Healthcare Medicaid |
$16,036.63
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$7,277.70
|
|
|
Service Code
|
APR-DRG 4821
|
| Min. Negotiated Rate |
$6,464.50 |
| Max. Negotiated Rate |
$7,277.70 |
| Rate for Payer: Anthem Medicaid |
$6,968.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,968.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,968.80
|
| Rate for Payer: Dean Health Medicaid |
$6,968.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,464.50
|
| Rate for Payer: Managed Health Services Medicaid |
$7,277.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,968.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,968.80
|
| Rate for Payer: United Healthcare Medicaid |
$6,968.80
|
|
|
TRANSURETHRAL PROSTATECTOMY
|
Facility
|
IP
|
$22,972.97
|
|
|
Service Code
|
APR-DRG 4824
|
| Min. Negotiated Rate |
$20,406.03 |
| Max. Negotiated Rate |
$22,972.97 |
| Rate for Payer: Anthem Medicaid |
$21,997.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,997.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,997.89
|
| Rate for Payer: Dean Health Medicaid |
$21,997.89
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,406.03
|
| Rate for Payer: Managed Health Services Medicaid |
$22,972.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,997.89
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,997.89
|
| Rate for Payer: United Healthcare Medicaid |
$21,997.89
|
|
|
TRANSURETHRAL PROSTATECTOMY WITH CC/MCC
|
Facility
|
IP
|
$40,444.56
|
|
|
Service Code
|
MSDRG 713
|
| Min. Negotiated Rate |
$12,020.11 |
| Max. Negotiated Rate |
$40,444.56 |
| Rate for Payer: Aetna Managed Medicare |
$12,020.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,802.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,143.22
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,887.70
|
| Rate for Payer: Anthem Medicare Advantage |
$12,020.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,020.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,020.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,020.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,517.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,020.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,420.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,020.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,020.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,020.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,020.11
|
| Rate for Payer: NAPHCARE Commercial |
$18,030.17
|
| Rate for Payer: Quartz Medicare Advantage |
$12,020.11
|
| Rate for Payer: The Alliance Commercial |
$40,444.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,020.11
|
| Rate for Payer: United Healthcare PPO |
$22,904.00
|
| Rate for Payer: Wellcare Medicare |
$12,020.11
|
|
