|
URETEROCOLONIC CONDUIT
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960471
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
URETEROCOLONIC CONDUIT
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960471
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
URETEROLITHOTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
URETEROLITHOTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960469
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
URETEROLYSIS
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960470
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
URETEROLYSIS
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960470
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
URETEROPLASTY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960474
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
URETEROPLASTY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960474
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
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 |
$3,614.59 |
| Max. Negotiated Rate |
$6,786.58 |
| Rate for Payer: Aetna Commercial |
$6,639.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,343.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.66
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,786.58
|
| Rate for Payer: Health EOS Commercial |
$6,565.28
|
| Rate for Payer: HFN Commercial |
$6,786.58
|
| Rate for Payer: Multiplan Commercial |
$5,901.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.59
|
| Rate for Payer: Quartz Commercial |
$4,426.03
|
| Rate for Payer: WEA Trust Commercial |
$4,057.20
|
| Rate for Payer: WPS Commercial |
$5,463.74
|
|
|
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 |
$2,065.48 |
| Max. Negotiated Rate |
$6,786.58 |
| Rate for Payer: Aetna Commercial |
$6,639.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,343.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,065.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,794.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,688.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,540.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.66
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,786.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,128.13
|
| Rate for Payer: Health EOS Commercial |
$6,565.28
|
| Rate for Payer: HFN Commercial |
$6,786.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,532.54
|
| Rate for Payer: Multiplan Commercial |
$5,901.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,426.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.59
|
| Rate for Payer: Quartz Commercial |
$4,794.87
|
| Rate for Payer: Quartz Medicare Advantage |
$4,426.03
|
| Rate for Payer: The Alliance Commercial |
$2,581.85
|
| Rate for Payer: WEA Trust Commercial |
$4,057.20
|
| Rate for Payer: WPS Commercial |
$5,463.74
|
|
|
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 |
$2,065.48 |
| Max. Negotiated Rate |
$6,786.58 |
| Rate for Payer: Aetna Commercial |
$6,639.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,343.98
|
| Rate for Payer: Aetna Managed Medicare |
$2,065.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,794.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,688.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,540.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.66
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,786.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,128.13
|
| Rate for Payer: Health EOS Commercial |
$6,565.28
|
| Rate for Payer: HFN Commercial |
$6,786.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,532.54
|
| Rate for Payer: Multiplan Commercial |
$5,901.38
|
| Rate for Payer: NAPHCARE Commercial |
$4,426.03
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.59
|
| Rate for Payer: Quartz Commercial |
$4,794.87
|
| Rate for Payer: Quartz Medicare Advantage |
$4,426.03
|
| Rate for Payer: The Alliance Commercial |
$2,581.85
|
| Rate for Payer: WEA Trust Commercial |
$4,057.20
|
| Rate for Payer: WPS Commercial |
$5,463.74
|
|
|
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 |
$3,614.59 |
| Max. Negotiated Rate |
$6,786.58 |
| Rate for Payer: Aetna Commercial |
$6,639.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,343.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,909.66
|
| Rate for Payer: Cash Price |
$2,127.90
|
| Rate for Payer: Cigna Commercial |
$6,786.58
|
| Rate for Payer: Health EOS Commercial |
$6,565.28
|
| Rate for Payer: HFN Commercial |
$6,786.58
|
| Rate for Payer: Multiplan Commercial |
$5,901.38
|
| Rate for Payer: Preferred Network Access Commercial |
$6,786.58
|
| Rate for Payer: Quartz Beloit One Network |
$3,614.59
|
| Rate for Payer: Quartz Commercial |
$4,426.03
|
| Rate for Payer: WEA Trust Commercial |
$4,057.20
|
| Rate for Payer: WPS Commercial |
$5,463.74
|
|
|
URETEROSCOPY
|
Facility
|
OP
|
$4,721.00
|
|
| Hospital Charge Code |
2960475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,374.76 |
| Max. Negotiated Rate |
$4,517.05 |
| Rate for Payer: Aetna Commercial |
$4,418.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,374.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,191.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,454.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,356.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,602.22
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,517.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,747.62
|
| Rate for Payer: Health EOS Commercial |
$4,369.76
|
| Rate for Payer: HFN Commercial |
$4,517.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,682.38
|
| Rate for Payer: Multiplan Commercial |
$3,927.87
|
| Rate for Payer: NAPHCARE Commercial |
$2,945.90
|
| Rate for Payer: Preferred Network Access Commercial |
$4,517.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,405.82
|
| Rate for Payer: Quartz Commercial |
$3,191.40
|
| Rate for Payer: Quartz Medicare Advantage |
$2,945.90
|
| Rate for Payer: The Alliance Commercial |
$2,454.92
|
| Rate for Payer: WEA Trust Commercial |
$2,700.41
|
| Rate for Payer: WPS Commercial |
$3,636.59
|
|
|
URETEROSCOPY
|
Facility
|
IP
|
$4,721.00
|
|
| Hospital Charge Code |
2960475
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,405.82 |
| Max. Negotiated Rate |
$4,517.05 |
| Rate for Payer: Aetna Commercial |
$4,418.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,222.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,602.22
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,517.05
|
| Rate for Payer: Health EOS Commercial |
$4,369.76
|
| Rate for Payer: HFN Commercial |
$4,517.05
|
| Rate for Payer: Multiplan Commercial |
$3,927.87
|
| Rate for Payer: Preferred Network Access Commercial |
$4,517.05
|
| Rate for Payer: Quartz Beloit One Network |
$2,405.82
|
| Rate for Payer: Quartz Commercial |
$2,945.90
|
| Rate for Payer: WEA Trust Commercial |
$2,700.41
|
| Rate for Payer: WPS Commercial |
$3,636.59
|
|
|
URETEROSCOPY, FLEXIBLE
|
Facility
|
OP
|
$6,450.00
|
|
| Hospital Charge Code |
2975774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,878.24 |
| Max. Negotiated Rate |
$6,171.36 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Aetna Managed Medicare |
$1,878.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,360.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,354.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,219.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$1,935.00
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,753.90
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,031.00
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,024.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,360.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4,024.80
|
| Rate for Payer: The Alliance Commercial |
$3,354.00
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.44
|
|
|
URETEROSCOPY, FLEXIBLE
|
Facility
|
IP
|
$6,450.00
|
|
| Hospital Charge Code |
2975774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,286.92 |
| Max. Negotiated Rate |
$6,171.36 |
| Rate for Payer: Aetna Commercial |
$6,037.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,768.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,555.24
|
| Rate for Payer: Cash Price |
$1,935.00
|
| Rate for Payer: Cigna Commercial |
$6,171.36
|
| Rate for Payer: Health EOS Commercial |
$5,970.12
|
| Rate for Payer: HFN Commercial |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$5,366.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,171.36
|
| Rate for Payer: Quartz Beloit One Network |
$3,286.92
|
| Rate for Payer: Quartz Commercial |
$4,024.80
|
| Rate for Payer: WEA Trust Commercial |
$3,689.40
|
| Rate for Payer: WPS Commercial |
$4,968.44
|
|
|
URETEROSIGMOIDOSTOMY
|
Facility
|
IP
|
$4,256.00
|
|
| Hospital Charge Code |
2960482
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,168.86 |
| Max. Negotiated Rate |
$4,072.14 |
| Rate for Payer: Aetna Commercial |
$3,983.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.91
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,072.14
|
| Rate for Payer: Health EOS Commercial |
$3,939.35
|
| Rate for Payer: HFN Commercial |
$4,072.14
|
| Rate for Payer: Multiplan Commercial |
$3,540.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,072.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.86
|
| Rate for Payer: Quartz Commercial |
$2,655.74
|
| Rate for Payer: WEA Trust Commercial |
$2,434.43
|
| Rate for Payer: WPS Commercial |
$3,278.40
|
|
|
URETEROSIGMOIDOSTOMY
|
Facility
|
OP
|
$4,256.00
|
|
| Hospital Charge Code |
2960482
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,239.35 |
| Max. Negotiated Rate |
$4,072.14 |
| Rate for Payer: Aetna Commercial |
$3,983.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,877.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,213.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.91
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,072.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.99
|
| Rate for Payer: Health EOS Commercial |
$3,939.35
|
| Rate for Payer: HFN Commercial |
$4,072.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,319.68
|
| Rate for Payer: Multiplan Commercial |
$3,540.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,072.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.86
|
| Rate for Payer: Quartz Commercial |
$2,877.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.74
|
| Rate for Payer: The Alliance Commercial |
$2,213.12
|
| Rate for Payer: WEA Trust Commercial |
$2,434.43
|
| Rate for Payer: WPS Commercial |
$3,278.40
|
|
|
URETEROSTOMY/URETEROTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
URETEROSTOMY/URETEROTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960476
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$26,041.88
|
|
|
Service Code
|
APR-DRG 4464
|
| Min. Negotiated Rate |
$23,132.02 |
| Max. Negotiated Rate |
$26,041.88 |
| Rate for Payer: Anthem Medicaid |
$24,936.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$24,936.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24,936.54
|
| Rate for Payer: Dean Health Medicaid |
$24,936.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$23,132.02
|
| Rate for Payer: Managed Health Services Medicaid |
$26,041.88
|
| Rate for Payer: Molina Healthcare Medicaid |
$24,936.54
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$24,936.54
|
| Rate for Payer: United Healthcare Medicaid |
$24,936.54
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$8,329.89
|
|
|
Service Code
|
APR-DRG 4461
|
| Min. Negotiated Rate |
$7,399.13 |
| Max. Negotiated Rate |
$8,329.89 |
| Rate for Payer: Anthem Medicaid |
$7,976.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,976.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,976.33
|
| Rate for Payer: Dean Health Medicaid |
$7,976.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,399.13
|
| Rate for Payer: Managed Health Services Medicaid |
$8,329.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,976.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,976.33
|
| Rate for Payer: United Healthcare Medicaid |
$7,976.33
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$10,872.70
|
|
|
Service Code
|
APR-DRG 4462
|
| Min. Negotiated Rate |
$9,657.81 |
| Max. Negotiated Rate |
$10,872.70 |
| Rate for Payer: Anthem Medicaid |
$10,411.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,411.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,411.21
|
| Rate for Payer: Dean Health Medicaid |
$10,411.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,657.81
|
| Rate for Payer: Managed Health Services Medicaid |
$10,872.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,411.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,411.21
|
| Rate for Payer: United Healthcare Medicaid |
$10,411.21
|
|
|
URETHRAL AND TRANSURETHRAL PROCEDURES
|
Facility
|
IP
|
$16,309.06
|
|
|
Service Code
|
APR-DRG 4463
|
| Min. Negotiated Rate |
$14,486.72 |
| Max. Negotiated Rate |
$16,309.06 |
| Rate for Payer: Anthem Medicaid |
$15,616.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$15,616.82
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15,616.82
|
| Rate for Payer: Dean Health Medicaid |
$15,616.82
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$14,486.72
|
| Rate for Payer: Managed Health Services Medicaid |
$16,309.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$15,616.82
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$15,616.82
|
| Rate for Payer: United Healthcare Medicaid |
$15,616.82
|
|
|
URETHRAL DILATION
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960478
|
|
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
|
|
