|
CYSTOGRAM
|
Facility
OP
|
$720.00
|
|
| Hospital Charge Code |
2959978
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$201.60 |
| Max. Negotiated Rate |
$2,880.00 |
| Rate for Payer: Aetna Commercial |
$648.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$619.20
|
| Rate for Payer: Aetna Managed Medicare |
$201.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$468.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$360.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$345.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$381.60
|
| Rate for Payer: Cash Price |
$216.00
|
| Rate for Payer: Cigna Commercial |
$662.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$402.91
|
| Rate for Payer: Health EOS Commercial |
$640.80
|
| Rate for Payer: HFN Commercial |
$662.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$540.00
|
| Rate for Payer: Multiplan Commercial |
$576.00
|
| Rate for Payer: NAPHCARE Commercial |
$432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$662.40
|
| Rate for Payer: Quartz Beloit One Network |
$352.80
|
| Rate for Payer: Quartz Commercial |
$468.00
|
| Rate for Payer: Quartz Medicare Advantage |
$432.00
|
| Rate for Payer: The Alliance Commercial |
$2,880.00
|
| Rate for Payer: WEA Trust Commercial |
$396.00
|
| Rate for Payer: WPS Commercial |
$533.30
|
|
|
CYSTOLITHOTOMY
|
Facility
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959980
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
CYSTOLITHOTOMY
|
Facility
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959980
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
CYSTO RECTOCELE REPAIR
|
Facility
OP
|
$4,721.00
|
|
| Hospital Charge Code |
2959981
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,321.88 |
| Max. Negotiated Rate |
$18,884.00 |
| Rate for Payer: Aetna Commercial |
$4,248.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,060.06
|
| Rate for Payer: Aetna Managed Medicare |
$1,321.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,068.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,360.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,266.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,502.13
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,343.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,641.87
|
| Rate for Payer: Health EOS Commercial |
$4,201.69
|
| Rate for Payer: HFN Commercial |
$4,343.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,540.75
|
| Rate for Payer: Multiplan Commercial |
$3,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,832.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,313.29
|
| Rate for Payer: Quartz Commercial |
$3,068.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,832.60
|
| Rate for Payer: The Alliance Commercial |
$18,884.00
|
| Rate for Payer: WEA Trust Commercial |
$2,596.55
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
|
CYSTO RECTOCELE REPAIR
|
Facility
IP
|
$4,721.00
|
|
| Hospital Charge Code |
2959981
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,313.29 |
| Max. Negotiated Rate |
$4,343.32 |
| Rate for Payer: Aetna Commercial |
$4,248.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,502.13
|
| Rate for Payer: Cash Price |
$1,416.30
|
| Rate for Payer: Cigna Commercial |
$4,343.32
|
| Rate for Payer: Health EOS Commercial |
$4,201.69
|
| Rate for Payer: HFN Commercial |
$4,343.32
|
| Rate for Payer: Multiplan Commercial |
$3,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,832.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,343.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,313.29
|
| Rate for Payer: Quartz Commercial |
$2,832.60
|
| Rate for Payer: WEA Trust Commercial |
$2,596.55
|
| Rate for Payer: WPS Commercial |
$3,496.84
|
|
|
CYSTORRHAPHY
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959983
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CYSTORRHAPHY
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959983
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
CYSTOSCOPY
|
Facility
OP
|
$1,566.00
|
|
| Hospital Charge Code |
2959977
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$438.48 |
| Max. Negotiated Rate |
$6,264.00 |
| Rate for Payer: Aetna Commercial |
$1,409.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,346.76
|
| Rate for Payer: Aetna Managed Medicare |
$438.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,017.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$783.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$751.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$829.98
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,440.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$876.33
|
| Rate for Payer: Health EOS Commercial |
$1,393.74
|
| Rate for Payer: HFN Commercial |
$1,440.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,174.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$939.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,440.72
|
| Rate for Payer: Quartz Beloit One Network |
$767.34
|
| Rate for Payer: Quartz Commercial |
$1,017.90
|
| Rate for Payer: Quartz Medicare Advantage |
$939.60
|
| Rate for Payer: The Alliance Commercial |
$6,264.00
|
| Rate for Payer: WEA Trust Commercial |
$861.30
|
| Rate for Payer: WPS Commercial |
$1,159.94
|
|
|
CYSTOSCOPY
|
Facility
IP
|
$1,566.00
|
|
| Hospital Charge Code |
2959977
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$767.34 |
| Max. Negotiated Rate |
$1,440.72 |
| Rate for Payer: Aetna Commercial |
$1,409.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$829.98
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,440.72
|
| Rate for Payer: Health EOS Commercial |
$1,393.74
|
| Rate for Payer: HFN Commercial |
$1,440.72
|
| Rate for Payer: Multiplan Commercial |
$1,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$939.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,440.72
|
| Rate for Payer: Quartz Beloit One Network |
$767.34
|
| Rate for Payer: Quartz Commercial |
$939.60
|
| Rate for Payer: WEA Trust Commercial |
$861.30
|
| Rate for Payer: WPS Commercial |
$1,159.94
|
|
|
Cystoscopy 5200022
|
Professional
|
$1,075.00
|
|
|
Service Code
|
CPT 52000 22
|
| Hospital Charge Code |
5388760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$473.00 |
| Max. Negotiated Rate |
$1,021.25 |
| Rate for Payer: Aetna Commercial |
$1,021.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$924.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$1,021.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$537.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$645.00
|
| Rate for Payer: Health EOS Commercial |
$978.25
|
| Rate for Payer: Multiplan Commercial |
$860.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,021.25
|
| Rate for Payer: Quartz Beloit One Network |
$473.00
|
| Rate for Payer: Quartz Commercial |
$612.75
|
| Rate for Payer: The Alliance Commercial |
$537.50
|
| Rate for Payer: WEA Trust Commercial |
$591.25
|
| Rate for Payer: WPS Commercial |
$796.25
|
|
|
CYSTOSCOPY AND TREATMENT 52214
|
Professional
|
$889.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
3014984
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.99 |
| Max. Negotiated Rate |
$844.55 |
| Rate for Payer: Aetna Commercial |
$844.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.54
|
| Rate for Payer: Aetna Managed Medicare |
$161.71
|
| Rate for Payer: Anthem Medicare Advantage |
$161.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$161.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$161.71
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cigna Commercial |
$844.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$444.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$161.71
|
| Rate for Payer: Health EOS Commercial |
$808.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$585.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$585.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$161.71
|
| Rate for Payer: Multiplan Commercial |
$711.20
|
| Rate for Payer: Preferred Network Access Commercial |
$844.55
|
| Rate for Payer: Quartz Beloit One Network |
$391.16
|
| Rate for Payer: Quartz Commercial |
$506.73
|
| Rate for Payer: Quartz Medicare Advantage |
$161.71
|
| Rate for Payer: The Alliance Commercial |
$687.27
|
| Rate for Payer: United Healthcare Medicaid |
$151.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$161.71
|
| Rate for Payer: WEA Trust Commercial |
$488.95
|
| Rate for Payer: WPS Commercial |
$727.70
|
|
|
CYSTOSCOPY AND TREATMENT 52224
|
Professional
|
$1,724.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
3014985
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$151.99 |
| Max. Negotiated Rate |
$1,637.80 |
| Rate for Payer: Aetna Commercial |
$1,637.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,482.64
|
| Rate for Payer: Aetna Managed Medicare |
$187.21
|
| Rate for Payer: Anthem Medicare Advantage |
$187.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$187.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$187.21
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cigna Commercial |
$1,637.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$862.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$187.21
|
| Rate for Payer: Health EOS Commercial |
$1,568.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$676.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$676.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$187.21
|
| Rate for Payer: Multiplan Commercial |
$1,379.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,637.80
|
| Rate for Payer: Quartz Beloit One Network |
$758.56
|
| Rate for Payer: Quartz Commercial |
$982.68
|
| Rate for Payer: Quartz Medicare Advantage |
$187.21
|
| Rate for Payer: The Alliance Commercial |
$795.64
|
| Rate for Payer: United Healthcare Medicaid |
$151.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$187.21
|
| Rate for Payer: WEA Trust Commercial |
$948.20
|
| Rate for Payer: WPS Commercial |
$842.44
|
|
|
Cystoscopy and Treatment 5231050
|
Professional
|
$3,685.00
|
|
|
Service Code
|
CPT 52310 50
|
| Hospital Charge Code |
3898160
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,621.40 |
| Max. Negotiated Rate |
$3,500.75 |
| Rate for Payer: Aetna Commercial |
$3,500.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,169.10
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cigna Commercial |
$3,500.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,842.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,211.00
|
| Rate for Payer: Health EOS Commercial |
$3,353.35
|
| Rate for Payer: Multiplan Commercial |
$2,948.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,500.75
|
| Rate for Payer: Quartz Beloit One Network |
$1,621.40
|
| Rate for Payer: Quartz Commercial |
$2,100.45
|
| Rate for Payer: The Alliance Commercial |
$1,842.50
|
| Rate for Payer: WEA Trust Commercial |
$2,026.75
|
| Rate for Payer: WPS Commercial |
$2,729.48
|
|
|
CYSTOSCOPY AND TREATMENT 52332
|
Professional
|
$2,455.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
3014994
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$143.71 |
| Max. Negotiated Rate |
$2,332.25 |
| Rate for Payer: Aetna Commercial |
$2,332.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,111.30
|
| Rate for Payer: Aetna Managed Medicare |
$143.71
|
| Rate for Payer: Anthem Medicare Advantage |
$143.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$143.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$143.71
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cigna Commercial |
$2,332.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,227.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.71
|
| Rate for Payer: Health EOS Commercial |
$2,234.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$516.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$516.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$143.71
|
| Rate for Payer: Multiplan Commercial |
$1,964.00
|
| Rate for Payer: Preferred Network Access Commercial |
$2,332.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,080.20
|
| Rate for Payer: Quartz Commercial |
$1,399.35
|
| Rate for Payer: Quartz Medicare Advantage |
$143.71
|
| Rate for Payer: The Alliance Commercial |
$610.77
|
| Rate for Payer: United Healthcare Medicaid |
$301.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$143.71
|
| Rate for Payer: WEA Trust Commercial |
$1,350.25
|
| Rate for Payer: WPS Commercial |
$646.70
|
|
|
Cystoscopy and Treatment 5233222
|
Professional
|
$2,886.00
|
|
|
Service Code
|
CPT 52332 22
|
| Hospital Charge Code |
3975037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,269.84 |
| Max. Negotiated Rate |
$2,741.70 |
| Rate for Payer: Aetna Commercial |
$2,741.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,481.96
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cigna Commercial |
$2,741.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,443.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,731.60
|
| Rate for Payer: Health EOS Commercial |
$2,626.26
|
| Rate for Payer: Multiplan Commercial |
$2,308.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,741.70
|
| Rate for Payer: Quartz Beloit One Network |
$1,269.84
|
| Rate for Payer: Quartz Commercial |
$1,645.02
|
| Rate for Payer: The Alliance Commercial |
$1,443.00
|
| Rate for Payer: WEA Trust Commercial |
$1,587.30
|
| Rate for Payer: WPS Commercial |
$2,137.66
|
|
|
Cystoscopy and Treatment 5233250
|
Professional
|
$4,911.00
|
|
|
Service Code
|
CPT 52332 50
|
| Hospital Charge Code |
3493548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,160.84 |
| Max. Negotiated Rate |
$4,665.45 |
| Rate for Payer: Aetna Commercial |
$4,665.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,223.46
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cigna Commercial |
$4,665.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,455.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,946.60
|
| Rate for Payer: Health EOS Commercial |
$4,469.01
|
| Rate for Payer: Multiplan Commercial |
$3,928.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,665.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,160.84
|
| Rate for Payer: Quartz Commercial |
$2,799.27
|
| Rate for Payer: The Alliance Commercial |
$2,455.50
|
| Rate for Payer: WEA Trust Commercial |
$2,701.05
|
| Rate for Payer: WPS Commercial |
$3,637.58
|
|
|
CYSTOSCOPY, REMOVAL OF CLOTS 52001
|
Professional
|
$1,425.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
3014981
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.69 |
| Max. Negotiated Rate |
$1,353.75 |
| Rate for Payer: Aetna Commercial |
$1,353.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.50
|
| Rate for Payer: Aetna Managed Medicare |
$264.98
|
| Rate for Payer: Anthem Medicare Advantage |
$264.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$264.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$264.98
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,353.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$712.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$264.98
|
| Rate for Payer: Health EOS Commercial |
$1,296.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$953.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$953.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$264.98
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,353.75
|
| Rate for Payer: Quartz Beloit One Network |
$627.00
|
| Rate for Payer: Quartz Commercial |
$812.25
|
| Rate for Payer: Quartz Medicare Advantage |
$264.98
|
| Rate for Payer: The Alliance Commercial |
$1,126.16
|
| Rate for Payer: United Healthcare Medicaid |
$130.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$264.98
|
| Rate for Payer: WEA Trust Commercial |
$783.75
|
| Rate for Payer: WPS Commercial |
$1,192.41
|
|
|
CYSTOSCOPY & TREATMENT-BILATERAL 523322250
|
Professional
|
$5,772.00
|
|
|
Service Code
|
CPT 52332 23,50
|
| Hospital Charge Code |
6172222
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$2,539.68 |
| Max. Negotiated Rate |
$5,483.40 |
| Rate for Payer: Aetna Commercial |
$5,483.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,963.92
|
| Rate for Payer: Cash Price |
$1,731.60
|
| Rate for Payer: Cash Price |
$1,731.60
|
| Rate for Payer: Cigna Commercial |
$5,483.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,886.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,463.20
|
| Rate for Payer: Health EOS Commercial |
$5,252.52
|
| Rate for Payer: Multiplan Commercial |
$4,617.60
|
| Rate for Payer: Preferred Network Access Commercial |
$5,483.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,539.68
|
| Rate for Payer: Quartz Commercial |
$3,290.04
|
| Rate for Payer: The Alliance Commercial |
$2,886.00
|
| Rate for Payer: WEA Trust Commercial |
$3,174.60
|
| Rate for Payer: WPS Commercial |
$4,275.32
|
|
|
CYSTOSCOPY & URETER CATHETER 52005
|
Professional
|
$1,406.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
3014982
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.78 |
| Max. Negotiated Rate |
$1,335.70 |
| Rate for Payer: Aetna Commercial |
$1,335.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,209.16
|
| Rate for Payer: Aetna Managed Medicare |
$122.78
|
| Rate for Payer: Anthem Medicare Advantage |
$122.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.78
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cigna Commercial |
$1,335.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$703.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.78
|
| Rate for Payer: Health EOS Commercial |
$1,279.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$441.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$441.00
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.78
|
| Rate for Payer: Multiplan Commercial |
$1,124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,335.70
|
| Rate for Payer: Quartz Beloit One Network |
$618.64
|
| Rate for Payer: Quartz Commercial |
$801.42
|
| Rate for Payer: Quartz Medicare Advantage |
$122.78
|
| Rate for Payer: The Alliance Commercial |
$521.82
|
| Rate for Payer: United Healthcare Medicaid |
$195.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.78
|
| Rate for Payer: WEA Trust Commercial |
$773.30
|
| Rate for Payer: WPS Commercial |
$552.51
|
|
|
Cystoscopy & Ureter Catheter 5200522
|
Professional
|
$1,688.00
|
|
|
Service Code
|
CPT 52005 22
|
| Hospital Charge Code |
4356591
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$742.72 |
| Max. Negotiated Rate |
$1,603.60 |
| Rate for Payer: Aetna Commercial |
$1,603.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,451.68
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$1,603.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$844.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,012.80
|
| Rate for Payer: Health EOS Commercial |
$1,536.08
|
| Rate for Payer: Multiplan Commercial |
$1,350.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,603.60
|
| Rate for Payer: Quartz Beloit One Network |
$742.72
|
| Rate for Payer: Quartz Commercial |
$962.16
|
| Rate for Payer: The Alliance Commercial |
$844.00
|
| Rate for Payer: WEA Trust Commercial |
$928.40
|
| Rate for Payer: WPS Commercial |
$1,250.30
|
|
|
Cystoscopy & Ureter Catheter 5200550
|
Professional
|
$2,812.00
|
|
|
Service Code
|
CPT 52005 50
|
| Hospital Charge Code |
3493546
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,237.28 |
| Max. Negotiated Rate |
$2,671.40 |
| Rate for Payer: Aetna Commercial |
$2,671.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,418.32
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$2,671.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,406.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,687.20
|
| Rate for Payer: Health EOS Commercial |
$2,558.92
|
| Rate for Payer: Multiplan Commercial |
$2,249.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,671.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,237.28
|
| Rate for Payer: Quartz Commercial |
$1,602.84
|
| Rate for Payer: The Alliance Commercial |
$1,406.00
|
| Rate for Payer: WEA Trust Commercial |
$1,546.60
|
| Rate for Payer: WPS Commercial |
$2,082.85
|
|
|
CYSTOSCOPY W/BIOPSY(S) 52204
|
Professional
|
$2,592.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
3014983
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$130.56 |
| Max. Negotiated Rate |
$2,462.40 |
| Rate for Payer: Aetna Commercial |
$2,462.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,229.12
|
| Rate for Payer: Aetna Managed Medicare |
$130.56
|
| Rate for Payer: Anthem Medicare Advantage |
$130.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$130.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$130.56
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$2,462.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,296.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$130.56
|
| Rate for Payer: Health EOS Commercial |
$2,358.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$469.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$469.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$130.56
|
| Rate for Payer: Multiplan Commercial |
$2,073.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,462.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,140.48
|
| Rate for Payer: Quartz Commercial |
$1,477.44
|
| Rate for Payer: Quartz Medicare Advantage |
$130.56
|
| Rate for Payer: The Alliance Commercial |
$554.88
|
| Rate for Payer: United Healthcare Medicaid |
$228.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$130.56
|
| Rate for Payer: WEA Trust Commercial |
$1,425.60
|
| Rate for Payer: WPS Commercial |
$587.52
|
|
|
CYSTOSCOPY WITH HYDRODISTENSION
|
Facility
IP
|
$1,566.00
|
|
| Hospital Charge Code |
2959979
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$767.34 |
| Max. Negotiated Rate |
$1,440.72 |
| Rate for Payer: Aetna Commercial |
$1,409.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$829.98
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,440.72
|
| Rate for Payer: Health EOS Commercial |
$1,393.74
|
| Rate for Payer: HFN Commercial |
$1,440.72
|
| Rate for Payer: Multiplan Commercial |
$1,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$939.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,440.72
|
| Rate for Payer: Quartz Beloit One Network |
$767.34
|
| Rate for Payer: Quartz Commercial |
$939.60
|
| Rate for Payer: WEA Trust Commercial |
$861.30
|
| Rate for Payer: WPS Commercial |
$1,159.94
|
|
|
CYSTOSCOPY WITH HYDRODISTENSION
|
Facility
OP
|
$1,566.00
|
|
| Hospital Charge Code |
2959979
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$438.48 |
| Max. Negotiated Rate |
$6,264.00 |
| Rate for Payer: Aetna Commercial |
$1,409.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,346.76
|
| Rate for Payer: Aetna Managed Medicare |
$438.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,017.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$783.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$751.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$829.98
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,440.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$876.33
|
| Rate for Payer: Health EOS Commercial |
$1,393.74
|
| Rate for Payer: HFN Commercial |
$1,440.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,174.50
|
| Rate for Payer: Multiplan Commercial |
$1,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$939.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,440.72
|
| Rate for Payer: Quartz Beloit One Network |
$767.34
|
| Rate for Payer: Quartz Commercial |
$1,017.90
|
| Rate for Payer: Quartz Medicare Advantage |
$939.60
|
| Rate for Payer: The Alliance Commercial |
$6,264.00
|
| Rate for Payer: WEA Trust Commercial |
$861.30
|
| Rate for Payer: WPS Commercial |
$1,159.94
|
|
|
CYSTOSCOPY WITH RETROGRADE PYELOGRAM
|
Facility
IP
|
$1,566.00
|
|
| Hospital Charge Code |
2959982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$767.34 |
| Max. Negotiated Rate |
$1,440.72 |
| Rate for Payer: Aetna Commercial |
$1,409.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$829.98
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,440.72
|
| Rate for Payer: Health EOS Commercial |
$1,393.74
|
| Rate for Payer: HFN Commercial |
$1,440.72
|
| Rate for Payer: Multiplan Commercial |
$1,252.80
|
| Rate for Payer: NAPHCARE Commercial |
$939.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,440.72
|
| Rate for Payer: Quartz Beloit One Network |
$767.34
|
| Rate for Payer: Quartz Commercial |
$939.60
|
| Rate for Payer: WEA Trust Commercial |
$861.30
|
| Rate for Payer: WPS Commercial |
$1,159.94
|
|
