|
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
|
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
|
|
|
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
|
|
|
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
|
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, 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
|
|
|
CYSTOTOMY; FOR EXCISION OF BLADDER DIVERTICULUM, SINGLE OR MULTIPLE (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$12,349.86
|
|
|
Service Code
|
CPT 51525
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,988.63 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: The Alliance Commercial |
$2,988.63
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
|
|
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
|
|
|
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH MANIPULATION, WITHOUT REMOVAL OF URETERAL CALCULUS
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52330
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,709.65 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| 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 |
$4,947.89
|
| 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 |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
CYSTOURETHROSCOPY (INCLUDING URETERAL CATHETERIZATION); WITH REMOVAL OF URETERAL CALCULUS
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52320
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,709.65 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| 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 |
$8,673.35
|
| 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 |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
Cystourethroscopy (separate procedure)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 52000
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$733.82 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$733.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$733.82
|
| 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: 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: 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: NAPHCARE Commercial |
$1,100.74
|
| 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 |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$733.82
|
|
|
Cystourethroscopy, with biopsy(s)
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 52204
|
|
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 |
$4,947.89
|
| 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
|
|
|
Cystourethroscopy, with calibration and/or dilation of urethral stricture or stenosis, with or without meatotomy, with or without injection procedure for cystography, male or female
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 52281
|
|
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 |
$4,947.89
|
| 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
|
|
|
CYSTOURETHROSCOPY, WITH DILATION OF BLADDER FOR INTERSTITIAL CYSTITIS; GENERAL OR CONDUCTION (SPINAL) ANESTHESIA
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 52260
|
|
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 |
$4,947.89
|
| 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
|
|
|
Cystourethroscopy With Dilation Of Stricture 52281
|
Professional
|
Both
|
$1,644.00
|
|
|
Service Code
|
CPT 52281
|
| Hospital Charge Code |
2957666
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$131.89 |
| Max. Negotiated Rate |
$1,624.27 |
| Rate for Payer: Aetna Commercial |
$1,624.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,470.39
|
| Rate for Payer: Aetna Managed Medicare |
$131.89
|
| Rate for Payer: Anthem Medicare Advantage |
$131.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$131.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$131.89
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cash Price |
$493.20
|
| Rate for Payer: Cigna Commercial |
$1,624.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$190.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$131.89
|
| Rate for Payer: Health EOS Commercial |
$1,555.88
|
| Rate for Payer: HFN Commercial |
$1,624.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$524.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$524.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$131.89
|
| Rate for Payer: Multiplan Commercial |
$1,367.81
|
| Rate for Payer: NAPHCARE Commercial |
$197.84
|
| Rate for Payer: Preferred Network Access Commercial |
$1,624.27
|
| Rate for Payer: Quartz Beloit One Network |
$752.29
|
| Rate for Payer: Quartz Commercial |
$974.56
|
| Rate for Payer: Quartz Medicare Advantage |
$131.89
|
| Rate for Payer: The Alliance Commercial |
$560.54
|
| Rate for Payer: United Healthcare Medicaid |
$190.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$131.89
|
| Rate for Payer: WEA Trust Commercial |
$940.37
|
| Rate for Payer: WPS Commercial |
$593.52
|
|
|
Cystourethroscopy with direct vision internal urethrotomy
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 52276
|
|
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 |
$6,807.99
|
| 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
|
|
|
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; large bladder tumor(s)
|
Facility
|
OP
|
$22,570.79
|
|
|
Service Code
|
CPT 52240
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$22,570.79 |
| Rate for Payer: Aetna Managed Medicare |
$5,642.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,642.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,642.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,642.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,642.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,642.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,990.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,642.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,642.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,642.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,642.70
|
| Rate for Payer: NAPHCARE Commercial |
$8,464.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,642.70
|
| Rate for Payer: The Alliance Commercial |
$22,570.79
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,642.70
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,642.70
|
|
|
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) and/or resection of; medium bladder tumor(s) (2.0 to 5.0 cm)
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52235
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,709.65 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| 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 |
$6,807.99
|
| 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 |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
CYSTOURETHROSCOPY, WITH FULGURATION (INCLUDING CRYOSURGERY OR LASER SURGERY) AND/OR RESECTION OF; SMALL BLADDER TUMOR(S) (0.5 UP TO 2.0 CM)
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52234
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,709.65 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| 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 |
$4,947.89
|
| 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 |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
