|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
$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
|
$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
|
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 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
|
|
|
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 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 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
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
|
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
|
|
