|
URETHRAL DILATION
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960478
|
|
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
|
|
|
URETHRAL DIVERTICULECTOMY
|
Facility
|
OP
|
$4,383.00
|
|
| Hospital Charge Code |
2959996
|
|
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
|
|
|
URETHRAL DIVERTICULECTOMY
|
Facility
|
IP
|
$4,383.00
|
|
| Hospital Charge Code |
2959996
|
|
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
|
|
|
Urethral Pressure Profile Upp
|
Facility
|
IP
|
$664.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
3005556
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$338.37 |
| Max. Negotiated Rate |
$635.32 |
| Rate for Payer: Aetna Commercial |
$621.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.00
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$635.32
|
| Rate for Payer: Health EOS Commercial |
$614.60
|
| Rate for Payer: HFN Commercial |
$635.32
|
| Rate for Payer: Multiplan Commercial |
$552.45
|
| Rate for Payer: Preferred Network Access Commercial |
$635.32
|
| Rate for Payer: Quartz Beloit One Network |
$338.37
|
| Rate for Payer: Quartz Commercial |
$414.34
|
| Rate for Payer: WEA Trust Commercial |
$379.81
|
| Rate for Payer: WPS Commercial |
$511.48
|
|
|
Urethral Pressure Profile Upp
|
Facility
|
OP
|
$664.00
|
|
|
Service Code
|
CPT 51729
|
| Hospital Charge Code |
3005556
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$331.47 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$621.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$593.88
|
| Rate for Payer: Aetna Managed Medicare |
$733.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$448.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$345.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$331.47
|
| Rate for Payer: Anthem Medicare Advantage |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$366.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$733.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$733.82
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cash Price |
$199.20
|
| Rate for Payer: Cigna Commercial |
$635.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$733.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$733.82
|
| Rate for Payer: Health EOS Commercial |
$614.60
|
| Rate for Payer: HFN Commercial |
$635.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,729.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$733.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$733.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$733.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$733.82
|
| Rate for Payer: Multiplan Commercial |
$552.45
|
| Rate for Payer: NAPHCARE Commercial |
$1,100.74
|
| Rate for Payer: Preferred Network Access Commercial |
$635.32
|
| Rate for Payer: Quartz Beloit One Network |
$338.37
|
| Rate for Payer: Quartz Commercial |
$448.86
|
| Rate for Payer: Quartz Medicare Advantage |
$733.82
|
| Rate for Payer: The Alliance Commercial |
$2,935.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$733.82
|
| Rate for Payer: United Healthcare PPO |
$517.92
|
| Rate for Payer: WEA Trust Commercial |
$379.81
|
| Rate for Payer: Wellcare Medicare |
$733.82
|
| Rate for Payer: WPS Commercial |
$511.48
|
|
|
URETHRAL PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$47,666.32
|
|
|
Service Code
|
MSDRG 671
|
| Min. Negotiated Rate |
$14,253.25 |
| Max. Negotiated Rate |
$47,666.32 |
| Rate for Payer: Aetna Managed Medicare |
$14,253.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,165.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,020.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,520.97
|
| Rate for Payer: Anthem Medicare Advantage |
$14,253.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,253.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,253.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,253.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,660.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,253.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,717.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,253.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,253.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,253.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,253.25
|
| Rate for Payer: NAPHCARE Commercial |
$21,379.88
|
| Rate for Payer: Quartz Medicare Advantage |
$14,253.25
|
| Rate for Payer: The Alliance Commercial |
$47,666.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,253.25
|
| Rate for Payer: United Healthcare PPO |
$27,027.88
|
| Rate for Payer: Wellcare Medicare |
$14,253.25
|
|
|
URETHRAL PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$26,254.80
|
|
|
Service Code
|
MSDRG 672
|
| Min. Negotiated Rate |
$8,773.80 |
| Max. Negotiated Rate |
$26,254.80 |
| Rate for Payer: Aetna Managed Medicare |
$8,773.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,553.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,053.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,152.31
|
| Rate for Payer: Anthem Medicare Advantage |
$8,773.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,773.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,773.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,773.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,040.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,773.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,712.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,773.80
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,773.80
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,773.80
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,773.80
|
| Rate for Payer: NAPHCARE Commercial |
$13,160.71
|
| Rate for Payer: Quartz Medicare Advantage |
$8,773.80
|
| Rate for Payer: The Alliance Commercial |
$26,254.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,773.80
|
| Rate for Payer: United Healthcare PPO |
$14,567.81
|
| Rate for Payer: Wellcare Medicare |
$8,773.80
|
|
|
URETHRAL STRICTURE
|
Facility
|
IP
|
$31,109.52
|
|
|
Service Code
|
MSDRG 697
|
| Min. Negotiated Rate |
$8,760.78 |
| Max. Negotiated Rate |
$31,109.52 |
| Rate for Payer: Aetna Managed Medicare |
$8,760.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,516.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,025.39
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,125.29
|
| Rate for Payer: Anthem Medicare Advantage |
$8,760.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,760.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,760.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,760.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,010.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,760.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,573.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,760.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,760.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,760.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,760.78
|
| Rate for Payer: NAPHCARE Commercial |
$13,141.17
|
| Rate for Payer: Quartz Medicare Advantage |
$8,760.78
|
| Rate for Payer: The Alliance Commercial |
$31,109.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,760.78
|
| Rate for Payer: United Healthcare PPO |
$17,573.89
|
| Rate for Payer: Wellcare Medicare |
$8,760.78
|
|
|
URETHROMEATOPLASTY, WITH MUCOSAL ADVANCEMENT
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 53450
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| 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 |
$4,386.95
|
| 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 |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
URETHROPLASTY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960480
|
|
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
|
|
|
URETHROPLASTY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960480
|
|
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
|
|
|
URETHROSCOPY
|
Facility
|
IP
|
$4,383.00
|
|
| Hospital Charge Code |
2960481
|
|
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
|
|
|
URETHROSCOPY
|
Facility
|
OP
|
$4,383.00
|
|
| Hospital Charge Code |
2960481
|
|
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
|
|
|
URETHROTOMY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960479
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
URETHROTOMY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960479
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
Uric Acid
|
Facility
|
IP
|
$82.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
633858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.79 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$51.17
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Uric Acid
|
Facility
|
OP
|
$82.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
633858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$78.46 |
| Rate for Payer: Aetna Commercial |
$76.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$4.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.80
|
| Rate for Payer: Anthem Medicare Advantage |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.70
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$78.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.72
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.70
|
| Rate for Payer: Health EOS Commercial |
$75.90
|
| Rate for Payer: HFN Commercial |
$78.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$7.05
|
| Rate for Payer: Preferred Network Access Commercial |
$78.46
|
| Rate for Payer: Quartz Beloit One Network |
$41.79
|
| Rate for Payer: Quartz Commercial |
$55.43
|
| Rate for Payer: Quartz Medicare Advantage |
$4.70
|
| Rate for Payer: The Alliance Commercial |
$18.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.70
|
| Rate for Payer: United Healthcare PPO |
$63.96
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: Wellcare Medicare |
$4.70
|
| Rate for Payer: WPS Commercial |
$63.16
|
|
|
Uric Acid
|
Professional
|
Both
|
$82.00
|
|
|
Service Code
|
CPT 84550
|
| Hospital Charge Code |
633858
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.70 |
| Max. Negotiated Rate |
$81.02 |
| Rate for Payer: Aetna Commercial |
$81.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.34
|
| Rate for Payer: Aetna Managed Medicare |
$4.70
|
| Rate for Payer: Anthem Medicare Advantage |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.70
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cash Price |
$24.60
|
| Rate for Payer: Cigna Commercial |
$81.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.70
|
| Rate for Payer: Health EOS Commercial |
$77.60
|
| Rate for Payer: HFN Commercial |
$81.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.70
|
| Rate for Payer: Multiplan Commercial |
$68.22
|
| Rate for Payer: NAPHCARE Commercial |
$7.05
|
| Rate for Payer: Preferred Network Access Commercial |
$81.02
|
| Rate for Payer: Quartz Beloit One Network |
$37.52
|
| Rate for Payer: Quartz Commercial |
$48.61
|
| Rate for Payer: Quartz Medicare Advantage |
$4.70
|
| Rate for Payer: The Alliance Commercial |
$18.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.70
|
| Rate for Payer: WEA Trust Commercial |
$46.90
|
| Rate for Payer: WPS Commercial |
$20.68
|
|
|
Uric Acid 24 Hour Urine
|
Professional
|
Both
|
$56.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
633859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$55.33 |
| Rate for Payer: Aetna Commercial |
$55.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$55.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.28
|
| Rate for Payer: Health EOS Commercial |
$53.00
|
| Rate for Payer: HFN Commercial |
$55.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$55.33
|
| Rate for Payer: Quartz Beloit One Network |
$25.63
|
| Rate for Payer: Quartz Commercial |
$33.20
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$20.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$23.25
|
|
|
Uric Acid 24 Hour Urine
|
Facility
|
OP
|
$56.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
633859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.77
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.28
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$37.86
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$21.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: United Healthcare PPO |
$43.68
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: Wellcare Medicare |
$5.28
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Uric Acid 24 Hour Urine
|
Facility
|
IP
|
$56.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
633859
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$28.54 |
| Max. Negotiated Rate |
$53.58 |
| Rate for Payer: Aetna Commercial |
$52.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30.87
|
| Rate for Payer: Cash Price |
$16.80
|
| Rate for Payer: Cigna Commercial |
$53.58
|
| Rate for Payer: Health EOS Commercial |
$51.83
|
| Rate for Payer: HFN Commercial |
$53.58
|
| Rate for Payer: Multiplan Commercial |
$46.59
|
| Rate for Payer: Preferred Network Access Commercial |
$53.58
|
| Rate for Payer: Quartz Beloit One Network |
$28.54
|
| Rate for Payer: Quartz Commercial |
$34.94
|
| Rate for Payer: WEA Trust Commercial |
$32.03
|
| Rate for Payer: WPS Commercial |
$43.14
|
|
|
Uric Acid Random Urine
|
Facility
|
IP
|
$18.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3304823
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$9.17 |
| Max. Negotiated Rate |
$17.22 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$11.23
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Uric Acid Random Urine
|
Professional
|
Both
|
$18.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3304823
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$23.25 |
| Rate for Payer: Aetna Commercial |
$17.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.28
|
| Rate for Payer: Health EOS Commercial |
$17.04
|
| Rate for Payer: HFN Commercial |
$17.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$17.78
|
| Rate for Payer: Quartz Beloit One Network |
$8.24
|
| Rate for Payer: Quartz Commercial |
$10.67
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$20.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: WPS Commercial |
$23.25
|
|
|
Uric Acid Random Urine
|
Facility
|
OP
|
$18.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3304823
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.28 |
| Max. Negotiated Rate |
$21.13 |
| Rate for Payer: Aetna Commercial |
$16.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16.10
|
| Rate for Payer: Aetna Managed Medicare |
$5.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.77
|
| Rate for Payer: Anthem Medicare Advantage |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.28
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cash Price |
$5.40
|
| Rate for Payer: Cigna Commercial |
$17.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.28
|
| Rate for Payer: Health EOS Commercial |
$16.66
|
| Rate for Payer: HFN Commercial |
$17.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.28
|
| Rate for Payer: Multiplan Commercial |
$14.98
|
| Rate for Payer: NAPHCARE Commercial |
$7.92
|
| Rate for Payer: Preferred Network Access Commercial |
$17.22
|
| Rate for Payer: Quartz Beloit One Network |
$9.17
|
| Rate for Payer: Quartz Commercial |
$12.17
|
| Rate for Payer: Quartz Medicare Advantage |
$5.28
|
| Rate for Payer: The Alliance Commercial |
$21.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.28
|
| Rate for Payer: United Healthcare PPO |
$14.04
|
| Rate for Payer: WEA Trust Commercial |
$10.30
|
| Rate for Payer: Wellcare Medicare |
$5.28
|
| Rate for Payer: WPS Commercial |
$13.87
|
|
|
Uric Acid, Synovial Fluid
|
Facility
|
IP
|
$46.00
|
|
|
Service Code
|
CPT 84560
|
| Hospital Charge Code |
3154855
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$23.44 |
| Max. Negotiated Rate |
$44.01 |
| Rate for Payer: Aetna Commercial |
$43.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$41.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25.36
|
| Rate for Payer: Cash Price |
$13.80
|
| Rate for Payer: Cigna Commercial |
$44.01
|
| Rate for Payer: Health EOS Commercial |
$42.58
|
| Rate for Payer: HFN Commercial |
$44.01
|
| Rate for Payer: Multiplan Commercial |
$38.27
|
| Rate for Payer: Preferred Network Access Commercial |
$44.01
|
| Rate for Payer: Quartz Beloit One Network |
$23.44
|
| Rate for Payer: Quartz Commercial |
$28.70
|
| Rate for Payer: WEA Trust Commercial |
$26.31
|
| Rate for Payer: WPS Commercial |
$35.43
|
|
