|
CYSTOSCOPY
|
Facility
|
OP
|
$1,566.00
|
|
| Hospital Charge Code |
2959977
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.02 |
| Max. Negotiated Rate |
$1,498.35 |
| Rate for Payer: Aetna Commercial |
$1,465.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.63
|
| Rate for Payer: Aetna Managed Medicare |
$456.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,058.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$814.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$781.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.18
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,498.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$911.41
|
| Rate for Payer: Health EOS Commercial |
$1,449.49
|
| Rate for Payer: HFN Commercial |
$1,498.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,221.48
|
| Rate for Payer: Multiplan Commercial |
$1,302.91
|
| Rate for Payer: NAPHCARE Commercial |
$977.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.35
|
| Rate for Payer: Quartz Beloit One Network |
$798.03
|
| Rate for Payer: Quartz Commercial |
$1,058.62
|
| Rate for Payer: Quartz Medicare Advantage |
$977.18
|
| Rate for Payer: The Alliance Commercial |
$814.32
|
| Rate for Payer: WEA Trust Commercial |
$895.75
|
| Rate for Payer: WPS Commercial |
$1,206.29
|
|
|
CYSTOSCOPY
|
Facility
|
IP
|
$1,566.00
|
|
| Hospital Charge Code |
2959977
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$798.03 |
| Max. Negotiated Rate |
$1,498.35 |
| Rate for Payer: Aetna Commercial |
$1,465.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.18
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,498.35
|
| Rate for Payer: Health EOS Commercial |
$1,449.49
|
| Rate for Payer: HFN Commercial |
$1,498.35
|
| Rate for Payer: Multiplan Commercial |
$1,302.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.35
|
| Rate for Payer: Quartz Beloit One Network |
$798.03
|
| Rate for Payer: Quartz Commercial |
$977.18
|
| Rate for Payer: WEA Trust Commercial |
$895.75
|
| Rate for Payer: WPS Commercial |
$1,206.29
|
|
|
Cystoscopy 5200022
|
Professional
|
Both
|
$1,075.00
|
|
|
Service Code
|
CPT 52000 22
|
| Hospital Charge Code |
5388760
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$147.17 |
| Max. Negotiated Rate |
$1,062.10 |
| Rate for Payer: Aetna Commercial |
$1,062.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$961.48
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cash Price |
$322.50
|
| Rate for Payer: Cigna Commercial |
$1,062.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$147.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$670.80
|
| Rate for Payer: Health EOS Commercial |
$1,017.38
|
| Rate for Payer: HFN Commercial |
$1,062.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$278.46
|
| Rate for Payer: Multiplan Commercial |
$894.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,062.10
|
| Rate for Payer: Quartz Beloit One Network |
$491.92
|
| Rate for Payer: Quartz Commercial |
$637.26
|
| Rate for Payer: The Alliance Commercial |
$559.00
|
| Rate for Payer: United Healthcare Medicaid |
$147.17
|
| Rate for Payer: WEA Trust Commercial |
$614.90
|
| Rate for Payer: WPS Commercial |
$828.07
|
|
|
CYSTOSCOPY AND TREATMENT 52214
|
Professional
|
Both
|
$889.00
|
|
|
Service Code
|
CPT 52214
|
| Hospital Charge Code |
3014984
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$146.68 |
| Max. Negotiated Rate |
$878.33 |
| Rate for Payer: Aetna Commercial |
$878.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$795.12
|
| Rate for Payer: Aetna Managed Medicare |
$146.68
|
| Rate for Payer: Anthem Medicare Advantage |
$146.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$146.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$146.68
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cash Price |
$266.70
|
| Rate for Payer: Cigna Commercial |
$878.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$146.68
|
| Rate for Payer: Health EOS Commercial |
$841.35
|
| Rate for Payer: HFN Commercial |
$878.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$609.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$609.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$146.68
|
| Rate for Payer: Multiplan Commercial |
$739.65
|
| Rate for Payer: NAPHCARE Commercial |
$220.02
|
| Rate for Payer: Preferred Network Access Commercial |
$878.33
|
| Rate for Payer: Quartz Beloit One Network |
$406.81
|
| Rate for Payer: Quartz Commercial |
$527.00
|
| Rate for Payer: Quartz Medicare Advantage |
$146.68
|
| Rate for Payer: The Alliance Commercial |
$623.40
|
| Rate for Payer: United Healthcare Medicaid |
$158.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$146.68
|
| Rate for Payer: WEA Trust Commercial |
$508.51
|
| Rate for Payer: WPS Commercial |
$660.07
|
|
|
CYSTOSCOPY AND TREATMENT 52224
|
Professional
|
Both
|
$1,724.00
|
|
|
Service Code
|
CPT 52224
|
| Hospital Charge Code |
3014985
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$158.07 |
| Max. Negotiated Rate |
$1,703.31 |
| Rate for Payer: Aetna Commercial |
$1,703.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,541.95
|
| Rate for Payer: Aetna Managed Medicare |
$169.74
|
| Rate for Payer: Anthem Medicare Advantage |
$169.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$169.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$169.74
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cash Price |
$517.20
|
| Rate for Payer: Cigna Commercial |
$1,703.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$158.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$169.74
|
| Rate for Payer: Health EOS Commercial |
$1,631.59
|
| Rate for Payer: HFN Commercial |
$1,703.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$703.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$703.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$169.74
|
| Rate for Payer: Multiplan Commercial |
$1,434.37
|
| Rate for Payer: NAPHCARE Commercial |
$254.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,703.31
|
| Rate for Payer: Quartz Beloit One Network |
$788.90
|
| Rate for Payer: Quartz Commercial |
$1,021.99
|
| Rate for Payer: Quartz Medicare Advantage |
$169.74
|
| Rate for Payer: The Alliance Commercial |
$721.39
|
| Rate for Payer: United Healthcare Medicaid |
$158.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$169.74
|
| Rate for Payer: WEA Trust Commercial |
$986.13
|
| Rate for Payer: WPS Commercial |
$763.82
|
|
|
Cystoscopy and Treatment 5231050
|
Professional
|
Both
|
$3,685.00
|
|
|
Service Code
|
CPT 52310 50
|
| Hospital Charge Code |
3898160
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$253.91 |
| Max. Negotiated Rate |
$3,640.78 |
| Rate for Payer: Aetna Commercial |
$3,640.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,295.86
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cash Price |
$1,105.50
|
| Rate for Payer: Cigna Commercial |
$3,640.78
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$253.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,299.44
|
| Rate for Payer: Health EOS Commercial |
$3,487.48
|
| Rate for Payer: HFN Commercial |
$3,640.78
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$522.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$522.12
|
| Rate for Payer: Multiplan Commercial |
$3,065.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,640.78
|
| Rate for Payer: Quartz Beloit One Network |
$1,686.26
|
| Rate for Payer: Quartz Commercial |
$2,184.47
|
| Rate for Payer: The Alliance Commercial |
$1,916.20
|
| Rate for Payer: United Healthcare Medicaid |
$253.91
|
| Rate for Payer: WEA Trust Commercial |
$2,107.82
|
| Rate for Payer: WPS Commercial |
$2,838.56
|
|
|
CYSTOSCOPY AND TREATMENT 52332
|
Professional
|
Both
|
$2,455.00
|
|
|
Service Code
|
CPT 52332
|
| Hospital Charge Code |
3014994
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$134.98 |
| Max. Negotiated Rate |
$2,425.54 |
| Rate for Payer: Aetna Commercial |
$2,425.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,195.75
|
| Rate for Payer: Aetna Managed Medicare |
$134.98
|
| Rate for Payer: Anthem Medicare Advantage |
$134.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$134.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$134.98
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cash Price |
$736.50
|
| Rate for Payer: Cigna Commercial |
$2,425.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134.98
|
| Rate for Payer: Health EOS Commercial |
$2,323.41
|
| Rate for Payer: HFN Commercial |
$2,425.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$536.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$536.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$134.98
|
| Rate for Payer: Multiplan Commercial |
$2,042.56
|
| Rate for Payer: NAPHCARE Commercial |
$202.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,425.54
|
| Rate for Payer: Quartz Beloit One Network |
$1,123.41
|
| Rate for Payer: Quartz Commercial |
$1,455.32
|
| Rate for Payer: Quartz Medicare Advantage |
$134.98
|
| Rate for Payer: The Alliance Commercial |
$573.67
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$134.98
|
| Rate for Payer: WEA Trust Commercial |
$1,404.26
|
| Rate for Payer: WPS Commercial |
$607.42
|
|
|
Cystoscopy and Treatment 5233222
|
Professional
|
Both
|
$2,886.00
|
|
|
Service Code
|
CPT 52332 22
|
| Hospital Charge Code |
3975037
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.36 |
| Max. Negotiated Rate |
$2,851.37 |
| Rate for Payer: Aetna Commercial |
$2,851.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,581.24
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cash Price |
$865.80
|
| Rate for Payer: Cigna Commercial |
$2,851.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,800.86
|
| Rate for Payer: Health EOS Commercial |
$2,731.31
|
| Rate for Payer: HFN Commercial |
$2,851.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$536.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$536.66
|
| Rate for Payer: Multiplan Commercial |
$2,401.15
|
| Rate for Payer: Preferred Network Access Commercial |
$2,851.37
|
| Rate for Payer: Quartz Beloit One Network |
$1,320.63
|
| Rate for Payer: Quartz Commercial |
$1,710.82
|
| Rate for Payer: The Alliance Commercial |
$1,500.72
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: WEA Trust Commercial |
$1,650.79
|
| Rate for Payer: WPS Commercial |
$2,223.09
|
|
|
Cystoscopy and Treatment 5233250
|
Professional
|
Both
|
$4,911.00
|
|
|
Service Code
|
CPT 52332 50
|
| Hospital Charge Code |
3493548
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.36 |
| Max. Negotiated Rate |
$4,852.07 |
| Rate for Payer: Aetna Commercial |
$4,852.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,392.40
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cash Price |
$1,473.30
|
| Rate for Payer: Cigna Commercial |
$4,852.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,064.46
|
| Rate for Payer: Health EOS Commercial |
$4,647.77
|
| Rate for Payer: HFN Commercial |
$4,852.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$536.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$536.66
|
| Rate for Payer: Multiplan Commercial |
$4,085.95
|
| Rate for Payer: Preferred Network Access Commercial |
$4,852.07
|
| Rate for Payer: Quartz Beloit One Network |
$2,247.27
|
| Rate for Payer: Quartz Commercial |
$2,911.24
|
| Rate for Payer: The Alliance Commercial |
$2,553.72
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: WEA Trust Commercial |
$2,809.09
|
| Rate for Payer: WPS Commercial |
$3,782.94
|
|
|
CYSTOSCOPY, REMOVAL OF CLOTS 52001
|
Professional
|
Both
|
$1,425.00
|
|
|
Service Code
|
CPT 52001
|
| Hospital Charge Code |
3014981
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.92 |
| Max. Negotiated Rate |
$1,407.90 |
| Rate for Payer: Aetna Commercial |
$1,407.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Aetna Managed Medicare |
$244.30
|
| Rate for Payer: Anthem Medicare Advantage |
$244.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.30
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,407.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.30
|
| Rate for Payer: Health EOS Commercial |
$1,348.62
|
| Rate for Payer: HFN Commercial |
$1,407.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$991.44
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$991.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.30
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$366.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,407.90
|
| Rate for Payer: Quartz Beloit One Network |
$652.08
|
| Rate for Payer: Quartz Commercial |
$844.74
|
| Rate for Payer: Quartz Medicare Advantage |
$244.30
|
| Rate for Payer: The Alliance Commercial |
$1,038.26
|
| Rate for Payer: United Healthcare Medicaid |
$135.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.30
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,099.33
|
|
|
CYSTOSCOPY & TREATMENT-BILATERAL 523322250
|
Professional
|
Both
|
$5,772.00
|
|
|
Service Code
|
CPT 52332 23,50
|
| Hospital Charge Code |
6172222
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$313.36 |
| Max. Negotiated Rate |
$5,702.74 |
| Rate for Payer: Aetna Commercial |
$5,702.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,162.48
|
| Rate for Payer: Cash Price |
$1,731.60
|
| Rate for Payer: Cash Price |
$1,731.60
|
| Rate for Payer: Cash Price |
$1,731.60
|
| Rate for Payer: Cigna Commercial |
$5,702.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$313.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,601.73
|
| Rate for Payer: Health EOS Commercial |
$5,462.62
|
| Rate for Payer: HFN Commercial |
$5,702.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$536.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$536.66
|
| Rate for Payer: Multiplan Commercial |
$4,802.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,702.74
|
| Rate for Payer: Quartz Beloit One Network |
$2,641.27
|
| Rate for Payer: Quartz Commercial |
$3,421.64
|
| Rate for Payer: The Alliance Commercial |
$3,001.44
|
| Rate for Payer: United Healthcare Medicaid |
$313.36
|
| Rate for Payer: WEA Trust Commercial |
$3,301.58
|
| Rate for Payer: WPS Commercial |
$4,446.17
|
|
|
CYSTOSCOPY & URETER CATHETER 52005
|
Professional
|
Both
|
$1,406.00
|
|
|
Service Code
|
CPT 52005
|
| Hospital Charge Code |
3014982
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$115.96 |
| Max. Negotiated Rate |
$1,389.13 |
| Rate for Payer: Aetna Commercial |
$1,389.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,257.53
|
| Rate for Payer: Aetna Managed Medicare |
$115.96
|
| Rate for Payer: Anthem Medicare Advantage |
$115.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$115.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$115.96
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cash Price |
$421.80
|
| Rate for Payer: Cigna Commercial |
$1,389.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.96
|
| Rate for Payer: Health EOS Commercial |
$1,330.64
|
| Rate for Payer: HFN Commercial |
$1,389.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$458.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$458.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$115.96
|
| Rate for Payer: Multiplan Commercial |
$1,169.79
|
| Rate for Payer: NAPHCARE Commercial |
$173.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,389.13
|
| Rate for Payer: Quartz Beloit One Network |
$643.39
|
| Rate for Payer: Quartz Commercial |
$833.48
|
| Rate for Payer: Quartz Medicare Advantage |
$115.96
|
| Rate for Payer: The Alliance Commercial |
$492.83
|
| Rate for Payer: United Healthcare Medicaid |
$203.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$115.96
|
| Rate for Payer: WEA Trust Commercial |
$804.23
|
| Rate for Payer: WPS Commercial |
$521.82
|
|
|
Cystoscopy & Ureter Catheter 5200522
|
Professional
|
Both
|
$1,688.00
|
|
|
Service Code
|
CPT 52005 22
|
| Hospital Charge Code |
4356591
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$203.09 |
| Max. Negotiated Rate |
$1,667.74 |
| Rate for Payer: Aetna Commercial |
$1,667.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,509.75
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cash Price |
$506.40
|
| Rate for Payer: Cigna Commercial |
$1,667.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,053.31
|
| Rate for Payer: Health EOS Commercial |
$1,597.52
|
| Rate for Payer: HFN Commercial |
$1,667.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$458.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$458.64
|
| Rate for Payer: Multiplan Commercial |
$1,404.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.74
|
| Rate for Payer: Quartz Beloit One Network |
$772.43
|
| Rate for Payer: Quartz Commercial |
$1,000.65
|
| Rate for Payer: The Alliance Commercial |
$877.76
|
| Rate for Payer: United Healthcare Medicaid |
$203.09
|
| Rate for Payer: WEA Trust Commercial |
$965.54
|
| Rate for Payer: WPS Commercial |
$1,300.27
|
|
|
Cystoscopy & Ureter Catheter 5200550
|
Professional
|
Both
|
$2,812.00
|
|
|
Service Code
|
CPT 52005 50
|
| Hospital Charge Code |
3493546
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$203.09 |
| Max. Negotiated Rate |
$2,778.26 |
| Rate for Payer: Aetna Commercial |
$2,778.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,515.05
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cash Price |
$843.60
|
| Rate for Payer: Cigna Commercial |
$2,778.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$203.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,754.69
|
| Rate for Payer: Health EOS Commercial |
$2,661.28
|
| Rate for Payer: HFN Commercial |
$2,778.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$458.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$458.64
|
| Rate for Payer: Multiplan Commercial |
$2,339.58
|
| Rate for Payer: Preferred Network Access Commercial |
$2,778.26
|
| Rate for Payer: Quartz Beloit One Network |
$1,286.77
|
| Rate for Payer: Quartz Commercial |
$1,666.95
|
| Rate for Payer: The Alliance Commercial |
$1,462.24
|
| Rate for Payer: United Healthcare Medicaid |
$203.09
|
| Rate for Payer: WEA Trust Commercial |
$1,608.46
|
| Rate for Payer: WPS Commercial |
$2,166.08
|
|
|
CYSTOSCOPY W/BIOPSY(S) 52204
|
Professional
|
Both
|
$2,592.00
|
|
|
Service Code
|
CPT 52204
|
| Hospital Charge Code |
3014983
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$122.47 |
| Max. Negotiated Rate |
$2,560.90 |
| Rate for Payer: Aetna Commercial |
$2,560.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,318.28
|
| Rate for Payer: Aetna Managed Medicare |
$122.47
|
| Rate for Payer: Anthem Medicare Advantage |
$122.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$122.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$122.47
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cash Price |
$777.60
|
| Rate for Payer: Cigna Commercial |
$2,560.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$237.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$122.47
|
| Rate for Payer: Health EOS Commercial |
$2,453.07
|
| Rate for Payer: HFN Commercial |
$2,560.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$487.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$487.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$122.47
|
| Rate for Payer: Multiplan Commercial |
$2,156.54
|
| Rate for Payer: NAPHCARE Commercial |
$183.71
|
| Rate for Payer: Preferred Network Access Commercial |
$2,560.90
|
| Rate for Payer: Quartz Beloit One Network |
$1,186.10
|
| Rate for Payer: Quartz Commercial |
$1,536.54
|
| Rate for Payer: Quartz Medicare Advantage |
$122.47
|
| Rate for Payer: The Alliance Commercial |
$520.50
|
| Rate for Payer: United Healthcare Medicaid |
$237.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$122.47
|
| Rate for Payer: WEA Trust Commercial |
$1,482.62
|
| Rate for Payer: WPS Commercial |
$551.12
|
|
|
CYSTOSCOPY WITH HYDRODISTENSION
|
Facility
|
IP
|
$1,566.00
|
|
| Hospital Charge Code |
2959979
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$798.03 |
| Max. Negotiated Rate |
$1,498.35 |
| Rate for Payer: Aetna Commercial |
$1,465.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.18
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,498.35
|
| Rate for Payer: Health EOS Commercial |
$1,449.49
|
| Rate for Payer: HFN Commercial |
$1,498.35
|
| Rate for Payer: Multiplan Commercial |
$1,302.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.35
|
| Rate for Payer: Quartz Beloit One Network |
$798.03
|
| Rate for Payer: Quartz Commercial |
$977.18
|
| Rate for Payer: WEA Trust Commercial |
$895.75
|
| Rate for Payer: WPS Commercial |
$1,206.29
|
|
|
CYSTOSCOPY WITH HYDRODISTENSION
|
Facility
|
OP
|
$1,566.00
|
|
| Hospital Charge Code |
2959979
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.02 |
| Max. Negotiated Rate |
$1,498.35 |
| Rate for Payer: Aetna Commercial |
$1,465.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.63
|
| Rate for Payer: Aetna Managed Medicare |
$456.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,058.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$814.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$781.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.18
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,498.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$911.41
|
| Rate for Payer: Health EOS Commercial |
$1,449.49
|
| Rate for Payer: HFN Commercial |
$1,498.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,221.48
|
| Rate for Payer: Multiplan Commercial |
$1,302.91
|
| Rate for Payer: NAPHCARE Commercial |
$977.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.35
|
| Rate for Payer: Quartz Beloit One Network |
$798.03
|
| Rate for Payer: Quartz Commercial |
$1,058.62
|
| Rate for Payer: Quartz Medicare Advantage |
$977.18
|
| Rate for Payer: The Alliance Commercial |
$814.32
|
| Rate for Payer: WEA Trust Commercial |
$895.75
|
| Rate for Payer: WPS Commercial |
$1,206.29
|
|
|
CYSTOSCOPY WITH RETROGRADE PYELOGRAM
|
Facility
|
IP
|
$1,566.00
|
|
| Hospital Charge Code |
2959982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$798.03 |
| Max. Negotiated Rate |
$1,498.35 |
| Rate for Payer: Aetna Commercial |
$1,465.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.18
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,498.35
|
| Rate for Payer: Health EOS Commercial |
$1,449.49
|
| Rate for Payer: HFN Commercial |
$1,498.35
|
| Rate for Payer: Multiplan Commercial |
$1,302.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.35
|
| Rate for Payer: Quartz Beloit One Network |
$798.03
|
| Rate for Payer: Quartz Commercial |
$977.18
|
| Rate for Payer: WEA Trust Commercial |
$895.75
|
| Rate for Payer: WPS Commercial |
$1,206.29
|
|
|
CYSTOSCOPY WITH RETROGRADE PYELOGRAM
|
Facility
|
OP
|
$1,566.00
|
|
| Hospital Charge Code |
2959982
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.02 |
| Max. Negotiated Rate |
$1,498.35 |
| Rate for Payer: Aetna Commercial |
$1,465.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.63
|
| Rate for Payer: Aetna Managed Medicare |
$456.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,058.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$814.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$781.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.18
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,498.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$911.41
|
| Rate for Payer: Health EOS Commercial |
$1,449.49
|
| Rate for Payer: HFN Commercial |
$1,498.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,221.48
|
| Rate for Payer: Multiplan Commercial |
$1,302.91
|
| Rate for Payer: NAPHCARE Commercial |
$977.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.35
|
| Rate for Payer: Quartz Beloit One Network |
$798.03
|
| Rate for Payer: Quartz Commercial |
$1,058.62
|
| Rate for Payer: Quartz Medicare Advantage |
$977.18
|
| Rate for Payer: The Alliance Commercial |
$814.32
|
| Rate for Payer: WEA Trust Commercial |
$895.75
|
| Rate for Payer: WPS Commercial |
$1,206.29
|
|
|
CYSTOSTOMY
|
Facility
|
OP
|
$7,836.00
|
|
| Hospital Charge Code |
2959984
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,281.84 |
| Max. Negotiated Rate |
$7,497.48 |
| Rate for Payer: Aetna Commercial |
$7,334.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,008.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,281.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,297.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,074.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,911.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,319.20
|
| Rate for Payer: Cash Price |
$2,350.80
|
| Rate for Payer: Cigna Commercial |
$7,497.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,560.55
|
| Rate for Payer: Health EOS Commercial |
$7,253.00
|
| Rate for Payer: HFN Commercial |
$7,497.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,112.08
|
| Rate for Payer: Multiplan Commercial |
$6,519.55
|
| Rate for Payer: NAPHCARE Commercial |
$4,889.66
|
| Rate for Payer: Preferred Network Access Commercial |
$7,497.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,993.23
|
| Rate for Payer: Quartz Commercial |
$5,297.14
|
| Rate for Payer: Quartz Medicare Advantage |
$4,889.66
|
| Rate for Payer: The Alliance Commercial |
$4,074.72
|
| Rate for Payer: WEA Trust Commercial |
$4,482.19
|
| Rate for Payer: WPS Commercial |
$6,036.07
|
|
|
CYSTOSTOMY
|
Facility
|
IP
|
$7,836.00
|
|
| Hospital Charge Code |
2959984
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,993.23 |
| Max. Negotiated Rate |
$7,497.48 |
| Rate for Payer: Aetna Commercial |
$7,334.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,008.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,319.20
|
| Rate for Payer: Cash Price |
$2,350.80
|
| Rate for Payer: Cigna Commercial |
$7,497.48
|
| Rate for Payer: Health EOS Commercial |
$7,253.00
|
| Rate for Payer: HFN Commercial |
$7,497.48
|
| Rate for Payer: Multiplan Commercial |
$6,519.55
|
| Rate for Payer: Preferred Network Access Commercial |
$7,497.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,993.23
|
| Rate for Payer: Quartz Commercial |
$4,889.66
|
| Rate for Payer: WEA Trust Commercial |
$4,482.19
|
| Rate for Payer: WPS Commercial |
$6,036.07
|
|
|
CYSTOSTOMY, CYSTOTOMY WITH DRAINAGE
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 51040
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,199.90 |
| Max. Negotiated Rate |
$8,799.61 |
| Rate for Payer: Aetna Managed Medicare |
$2,199.90
|
| 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 |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,199.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,199.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,199.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,199.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,183.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,199.90
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,199.90
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,199.90
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,199.90
|
| Rate for Payer: NAPHCARE Commercial |
$3,299.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,199.90
|
| Rate for Payer: The Alliance Commercial |
$8,799.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,199.90
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,199.90
|
|
|
CYSTO URETHROGRAM, VOIDING (VCUG)
|
Facility
|
IP
|
$1,566.00
|
|
| Hospital Charge Code |
2950487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$798.03 |
| Max. Negotiated Rate |
$1,498.35 |
| Rate for Payer: Aetna Commercial |
$1,465.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.18
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,498.35
|
| Rate for Payer: Health EOS Commercial |
$1,449.49
|
| Rate for Payer: HFN Commercial |
$1,498.35
|
| Rate for Payer: Multiplan Commercial |
$1,302.91
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.35
|
| Rate for Payer: Quartz Beloit One Network |
$798.03
|
| Rate for Payer: Quartz Commercial |
$977.18
|
| Rate for Payer: WEA Trust Commercial |
$895.75
|
| Rate for Payer: WPS Commercial |
$1,206.29
|
|
|
CYSTO URETHROGRAM, VOIDING (VCUG)
|
Facility
|
OP
|
$1,566.00
|
|
| Hospital Charge Code |
2950487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$456.02 |
| Max. Negotiated Rate |
$1,498.35 |
| Rate for Payer: Aetna Commercial |
$1,465.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,400.63
|
| Rate for Payer: Aetna Managed Medicare |
$456.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,058.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$814.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$781.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.18
|
| Rate for Payer: Cash Price |
$469.80
|
| Rate for Payer: Cigna Commercial |
$1,498.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$911.41
|
| Rate for Payer: Health EOS Commercial |
$1,449.49
|
| Rate for Payer: HFN Commercial |
$1,498.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,221.48
|
| Rate for Payer: Multiplan Commercial |
$1,302.91
|
| Rate for Payer: NAPHCARE Commercial |
$977.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,498.35
|
| Rate for Payer: Quartz Beloit One Network |
$798.03
|
| Rate for Payer: Quartz Commercial |
$1,058.62
|
| Rate for Payer: Quartz Medicare Advantage |
$977.18
|
| Rate for Payer: The Alliance Commercial |
$814.32
|
| Rate for Payer: WEA Trust Commercial |
$895.75
|
| Rate for Payer: WPS Commercial |
$1,206.29
|
|
|
Cystourethroscopy 52000
|
Professional
|
Both
|
$896.00
|
|
|
Service Code
|
CPT 52000
|
| Hospital Charge Code |
2957664
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.54 |
| Max. Negotiated Rate |
$885.25 |
| Rate for Payer: Aetna Commercial |
$885.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Aetna Managed Medicare |
$68.54
|
| Rate for Payer: Anthem Medicare Advantage |
$68.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.54
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$885.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$147.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.54
|
| Rate for Payer: Health EOS Commercial |
$847.97
|
| Rate for Payer: HFN Commercial |
$885.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$278.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$278.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.54
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: NAPHCARE Commercial |
$102.80
|
| Rate for Payer: Preferred Network Access Commercial |
$885.25
|
| Rate for Payer: Quartz Beloit One Network |
$410.01
|
| Rate for Payer: Quartz Commercial |
$531.15
|
| Rate for Payer: Quartz Medicare Advantage |
$68.54
|
| Rate for Payer: The Alliance Commercial |
$291.28
|
| Rate for Payer: United Healthcare Medicaid |
$147.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.54
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$308.41
|
|
