|
Dihydrotestosterone, LC/MS/MS
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
3400168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$59.64 |
| Max. Negotiated Rate |
$852.00 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Aetna Managed Medicare |
$59.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$138.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$106.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$102.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119.19
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$159.75
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$138.45
|
| Rate for Payer: Quartz Medicare Advantage |
$127.80
|
| Rate for Payer: The Alliance Commercial |
$852.00
|
| Rate for Payer: United Healthcare PPO |
$159.75
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Dihydrotestosterone, LC/MS/MS
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
3400168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$80.06 |
| Max. Negotiated Rate |
$202.35 |
| Rate for Payer: Aetna Commercial |
$202.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$202.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$106.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.80
|
| Rate for Payer: Health EOS Commercial |
$193.83
|
| Rate for Payer: HFN Commercial |
$202.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$80.06
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: Preferred Network Access Commercial |
$202.35
|
| Rate for Payer: Quartz Beloit One Network |
$93.72
|
| Rate for Payer: Quartz Commercial |
$121.41
|
| Rate for Payer: The Alliance Commercial |
$106.50
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Dihydrotestosterone, LC/MS/MS
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
3400168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$104.37 |
| Max. Negotiated Rate |
$195.96 |
| Rate for Payer: Aetna Commercial |
$191.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$183.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$112.89
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$195.96
|
| Rate for Payer: Health EOS Commercial |
$189.57
|
| Rate for Payer: HFN Commercial |
$195.96
|
| Rate for Payer: Multiplan Commercial |
$170.40
|
| Rate for Payer: NAPHCARE Commercial |
$127.80
|
| Rate for Payer: Preferred Network Access Commercial |
$195.96
|
| Rate for Payer: Quartz Beloit One Network |
$104.37
|
| Rate for Payer: Quartz Commercial |
$127.80
|
| Rate for Payer: WEA Trust Commercial |
$117.15
|
| Rate for Payer: WPS Commercial |
$157.77
|
|
|
Dilate Tear Duct Opening 6880150
|
Professional
|
Both
|
$525.00
|
|
|
Service Code
|
CPT 68801 50
|
| Hospital Charge Code |
3798683
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$498.75 |
| Rate for Payer: Aetna Commercial |
$498.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$451.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$498.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$315.00
|
| Rate for Payer: Health EOS Commercial |
$477.75
|
| Rate for Payer: HFN Commercial |
$498.75
|
| Rate for Payer: Multiplan Commercial |
$420.00
|
| Rate for Payer: Preferred Network Access Commercial |
$498.75
|
| Rate for Payer: Quartz Beloit One Network |
$231.00
|
| Rate for Payer: Quartz Commercial |
$299.25
|
| Rate for Payer: The Alliance Commercial |
$262.50
|
| Rate for Payer: United Healthcare Medicaid |
$43.75
|
| Rate for Payer: WEA Trust Commercial |
$288.75
|
| Rate for Payer: WPS Commercial |
$388.87
|
|
|
DILATION AND CURETTAGE 58120
|
Professional
|
Both
|
$1,648.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
3015096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$229.84 |
| Max. Negotiated Rate |
$1,565.60 |
| Rate for Payer: Aetna Commercial |
$1,565.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,417.28
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cigna Commercial |
$1,565.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$229.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$988.80
|
| Rate for Payer: Health EOS Commercial |
$1,499.68
|
| Rate for Payer: HFN Commercial |
$1,565.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$770.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$770.81
|
| Rate for Payer: Multiplan Commercial |
$1,318.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,565.60
|
| Rate for Payer: Quartz Beloit One Network |
$725.12
|
| Rate for Payer: Quartz Commercial |
$939.36
|
| Rate for Payer: The Alliance Commercial |
$824.00
|
| Rate for Payer: United Healthcare Medicaid |
$229.84
|
| Rate for Payer: WEA Trust Commercial |
$906.40
|
| Rate for Payer: WPS Commercial |
$1,220.67
|
|
|
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
|
Facility
|
OP
|
$12,360.48
|
|
|
Service Code
|
CPT 58120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$12,360.48 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$12,360.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
|
DILATION CATHETER & NEPHROSTOMY BALLOON 10MM X 15CM X-FORCE 995101
|
Facility
|
IP
|
$2,771.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5520790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,357.79 |
| Max. Negotiated Rate |
$2,549.32 |
| Rate for Payer: Aetna Commercial |
$2,493.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,383.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,468.63
|
| Rate for Payer: Cash Price |
$831.30
|
| Rate for Payer: Cigna Commercial |
$2,549.32
|
| Rate for Payer: Health EOS Commercial |
$2,466.19
|
| Rate for Payer: HFN Commercial |
$2,549.32
|
| Rate for Payer: Multiplan Commercial |
$2,216.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,662.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,549.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,357.79
|
| Rate for Payer: Quartz Commercial |
$1,662.60
|
| Rate for Payer: WEA Trust Commercial |
$1,524.05
|
| Rate for Payer: WPS Commercial |
$2,052.48
|
|
|
DILATION CATHETER & NEPHROSTOMY BALLOON 10MM X 15CM X-FORCE 995101
|
Facility
|
OP
|
$2,771.00
|
|
|
Service Code
|
HCPCS C1726
|
| Hospital Charge Code |
5520790
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$775.88 |
| Max. Negotiated Rate |
$11,084.00 |
| Rate for Payer: Aetna Commercial |
$2,493.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,383.06
|
| Rate for Payer: Aetna Managed Medicare |
$775.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,801.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,385.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,330.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,468.63
|
| Rate for Payer: Cash Price |
$831.30
|
| Rate for Payer: Cigna Commercial |
$2,549.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,550.65
|
| Rate for Payer: Health EOS Commercial |
$2,466.19
|
| Rate for Payer: HFN Commercial |
$2,549.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,078.25
|
| Rate for Payer: Multiplan Commercial |
$2,216.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,662.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,549.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,357.79
|
| Rate for Payer: Quartz Commercial |
$1,801.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,662.60
|
| Rate for Payer: The Alliance Commercial |
$11,084.00
|
| Rate for Payer: WEA Trust Commercial |
$1,524.05
|
| Rate for Payer: WPS Commercial |
$2,052.48
|
|
|
DILATION & CURETTAGE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959988
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$303.52 |
| Max. Negotiated Rate |
$4,336.00 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Aetna Managed Medicare |
$303.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$704.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$542.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$520.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$606.61
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$813.00
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$704.60
|
| Rate for Payer: Quartz Medicare Advantage |
$650.40
|
| Rate for Payer: The Alliance Commercial |
$4,336.00
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
DILATION & CURETTAGE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959988
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$531.16 |
| Max. Negotiated Rate |
$997.28 |
| Rate for Payer: Aetna Commercial |
$975.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$932.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$574.52
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$997.28
|
| Rate for Payer: Health EOS Commercial |
$964.76
|
| Rate for Payer: HFN Commercial |
$997.28
|
| Rate for Payer: Multiplan Commercial |
$867.20
|
| Rate for Payer: NAPHCARE Commercial |
$650.40
|
| Rate for Payer: Preferred Network Access Commercial |
$997.28
|
| Rate for Payer: Quartz Beloit One Network |
$531.16
|
| Rate for Payer: Quartz Commercial |
$650.40
|
| Rate for Payer: WEA Trust Commercial |
$596.20
|
| Rate for Payer: WPS Commercial |
$802.92
|
|
|
DILATION & EVACUATION
|
Facility
|
OP
|
$1,153.00
|
|
| Hospital Charge Code |
2959990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$322.84 |
| Max. Negotiated Rate |
$4,612.00 |
| Rate for Payer: Aetna Commercial |
$1,037.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.58
|
| Rate for Payer: Aetna Managed Medicare |
$322.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$749.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$576.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$553.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.09
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,060.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$645.22
|
| Rate for Payer: Health EOS Commercial |
$1,026.17
|
| Rate for Payer: HFN Commercial |
$1,060.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$864.75
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: NAPHCARE Commercial |
$691.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,060.76
|
| Rate for Payer: Quartz Beloit One Network |
$564.97
|
| Rate for Payer: Quartz Commercial |
$749.45
|
| Rate for Payer: Quartz Medicare Advantage |
$691.80
|
| Rate for Payer: The Alliance Commercial |
$4,612.00
|
| Rate for Payer: WEA Trust Commercial |
$634.15
|
| Rate for Payer: WPS Commercial |
$854.03
|
|
|
DILATION & EVACUATION
|
Facility
|
IP
|
$1,153.00
|
|
| Hospital Charge Code |
2959990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$564.97 |
| Max. Negotiated Rate |
$1,060.76 |
| Rate for Payer: Aetna Commercial |
$1,037.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$991.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$611.09
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,060.76
|
| Rate for Payer: Health EOS Commercial |
$1,026.17
|
| Rate for Payer: HFN Commercial |
$1,060.76
|
| Rate for Payer: Multiplan Commercial |
$922.40
|
| Rate for Payer: NAPHCARE Commercial |
$691.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,060.76
|
| Rate for Payer: Quartz Beloit One Network |
$564.97
|
| Rate for Payer: Quartz Commercial |
$691.80
|
| Rate for Payer: WEA Trust Commercial |
$634.15
|
| Rate for Payer: WPS Commercial |
$854.03
|
|
|
Dilation Of Cervical Canal 57800
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
1190836
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.87 |
| Max. Negotiated Rate |
$182.40 |
| Rate for Payer: Aetna Commercial |
$182.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$165.12
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$182.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$41.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$115.20
|
| Rate for Payer: Health EOS Commercial |
$174.72
|
| Rate for Payer: HFN Commercial |
$182.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$158.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$158.74
|
| Rate for Payer: Multiplan Commercial |
$153.60
|
| Rate for Payer: Preferred Network Access Commercial |
$182.40
|
| Rate for Payer: Quartz Beloit One Network |
$84.48
|
| Rate for Payer: Quartz Commercial |
$109.44
|
| Rate for Payer: The Alliance Commercial |
$96.00
|
| Rate for Payer: United Healthcare Medicaid |
$41.87
|
| Rate for Payer: WEA Trust Commercial |
$105.60
|
| Rate for Payer: WPS Commercial |
$142.21
|
|
|
Dilation of Female Urethra, Initial 53660
|
Professional
|
Both
|
$277.00
|
|
|
Service Code
|
CPT 53660
|
| Hospital Charge Code |
1188977
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$20.21 |
| Max. Negotiated Rate |
$263.15 |
| Rate for Payer: Aetna Commercial |
$263.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$238.22
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$263.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$166.20
|
| Rate for Payer: Health EOS Commercial |
$252.07
|
| Rate for Payer: HFN Commercial |
$263.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$138.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$138.31
|
| Rate for Payer: Multiplan Commercial |
$221.60
|
| Rate for Payer: Preferred Network Access Commercial |
$263.15
|
| Rate for Payer: Quartz Beloit One Network |
$121.88
|
| Rate for Payer: Quartz Commercial |
$157.89
|
| Rate for Payer: The Alliance Commercial |
$138.50
|
| Rate for Payer: United Healthcare Medicaid |
$20.21
|
| Rate for Payer: WEA Trust Commercial |
$152.35
|
| Rate for Payer: WPS Commercial |
$205.17
|
|
|
Dilation of Female Urethra, Subsequent 53661
|
Professional
|
Both
|
$288.00
|
|
|
Service Code
|
CPT 53661
|
| Hospital Charge Code |
1188978
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$18.87 |
| Max. Negotiated Rate |
$273.60 |
| Rate for Payer: Aetna Commercial |
$273.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.68
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$273.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$172.80
|
| Rate for Payer: Health EOS Commercial |
$262.08
|
| Rate for Payer: HFN Commercial |
$273.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$133.75
|
| Rate for Payer: Multiplan Commercial |
$230.40
|
| Rate for Payer: Preferred Network Access Commercial |
$273.60
|
| Rate for Payer: Quartz Beloit One Network |
$126.72
|
| Rate for Payer: Quartz Commercial |
$164.16
|
| Rate for Payer: The Alliance Commercial |
$144.00
|
| Rate for Payer: United Healthcare Medicaid |
$18.87
|
| Rate for Payer: WEA Trust Commercial |
$158.40
|
| Rate for Payer: WPS Commercial |
$213.32
|
|
|
Dilation Of Lacrimal Punctum 68801
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
1190820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$43.75 |
| Max. Negotiated Rate |
$336.30 |
| Rate for Payer: Aetna Commercial |
$336.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$304.44
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$336.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$212.40
|
| Rate for Payer: Health EOS Commercial |
$322.14
|
| Rate for Payer: HFN Commercial |
$336.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$264.11
|
| Rate for Payer: Multiplan Commercial |
$283.20
|
| Rate for Payer: Preferred Network Access Commercial |
$336.30
|
| Rate for Payer: Quartz Beloit One Network |
$155.76
|
| Rate for Payer: Quartz Commercial |
$201.78
|
| Rate for Payer: The Alliance Commercial |
$177.00
|
| Rate for Payer: United Healthcare Medicaid |
$43.75
|
| Rate for Payer: WEA Trust Commercial |
$194.70
|
| Rate for Payer: WPS Commercial |
$262.21
|
|
|
Dilation of Urethral Stric Male Subsequent 53601PP
|
Professional
|
Both
|
$491.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
3605561
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$466.45 |
| Rate for Payer: Aetna Commercial |
$466.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$422.26
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$466.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$294.60
|
| Rate for Payer: Health EOS Commercial |
$446.81
|
| Rate for Payer: HFN Commercial |
$466.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.66
|
| Rate for Payer: Multiplan Commercial |
$392.80
|
| Rate for Payer: Preferred Network Access Commercial |
$466.45
|
| Rate for Payer: Quartz Beloit One Network |
$216.04
|
| Rate for Payer: Quartz Commercial |
$279.87
|
| Rate for Payer: The Alliance Commercial |
$245.50
|
| Rate for Payer: United Healthcare Medicaid |
$22.22
|
| Rate for Payer: WEA Trust Commercial |
$270.05
|
| Rate for Payer: WPS Commercial |
$363.68
|
|
|
Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator, Male Initial 53600
|
Professional
|
Both
|
$364.00
|
|
|
Service Code
|
CPT 53600
|
| Hospital Charge Code |
1188975
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$24.26 |
| Max. Negotiated Rate |
$345.80 |
| Rate for Payer: Aetna Commercial |
$345.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$313.04
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cash Price |
$109.20
|
| Rate for Payer: Cigna Commercial |
$345.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$24.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$218.40
|
| Rate for Payer: Health EOS Commercial |
$331.24
|
| Rate for Payer: HFN Commercial |
$345.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$212.15
|
| Rate for Payer: Multiplan Commercial |
$291.20
|
| Rate for Payer: Preferred Network Access Commercial |
$345.80
|
| Rate for Payer: Quartz Beloit One Network |
$160.16
|
| Rate for Payer: Quartz Commercial |
$207.48
|
| Rate for Payer: The Alliance Commercial |
$182.00
|
| Rate for Payer: United Healthcare Medicaid |
$24.26
|
| Rate for Payer: WEA Trust Commercial |
$200.20
|
| Rate for Payer: WPS Commercial |
$269.61
|
|
|
Dilation of Urethral Stricture by Passage of Sound or Urethral Dilator; Male Subsequent 53601
|
Professional
|
Both
|
$328.00
|
|
|
Service Code
|
CPT 53601
|
| Hospital Charge Code |
1188976
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$22.22 |
| Max. Negotiated Rate |
$311.60 |
| Rate for Payer: Aetna Commercial |
$311.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$282.08
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cash Price |
$98.40
|
| Rate for Payer: Cigna Commercial |
$311.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$196.80
|
| Rate for Payer: Health EOS Commercial |
$298.48
|
| Rate for Payer: HFN Commercial |
$311.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$177.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$177.66
|
| Rate for Payer: Multiplan Commercial |
$262.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.60
|
| Rate for Payer: Quartz Beloit One Network |
$144.32
|
| Rate for Payer: Quartz Commercial |
$186.96
|
| Rate for Payer: The Alliance Commercial |
$164.00
|
| Rate for Payer: United Healthcare Medicaid |
$22.22
|
| Rate for Payer: WEA Trust Commercial |
$180.40
|
| Rate for Payer: WPS Commercial |
$242.95
|
|
|
DILATOR 10fr
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
2970839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$72.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$156.00
|
| Rate for Payer: The Alliance Commercial |
$1,040.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
DILATOR 10fr
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
2970839
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
DILATOR 12-18FR NOTTINGHAM 230-115
|
Facility
|
IP
|
$1,148.00
|
|
| Hospital Charge Code |
2964808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$562.52 |
| Max. Negotiated Rate |
$1,056.16 |
| Rate for Payer: Aetna Commercial |
$1,033.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.44
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$1,056.16
|
| Rate for Payer: Health EOS Commercial |
$1,021.72
|
| Rate for Payer: HFN Commercial |
$1,056.16
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: NAPHCARE Commercial |
$688.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.16
|
| Rate for Payer: Quartz Beloit One Network |
$562.52
|
| Rate for Payer: Quartz Commercial |
$688.80
|
| Rate for Payer: WEA Trust Commercial |
$631.40
|
| Rate for Payer: WPS Commercial |
$850.32
|
|
|
DILATOR 12-18FR NOTTINGHAM 230-115
|
Facility
|
OP
|
$1,148.00
|
|
| Hospital Charge Code |
2964808
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$321.44 |
| Max. Negotiated Rate |
$4,592.00 |
| Rate for Payer: Aetna Commercial |
$1,033.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$987.28
|
| Rate for Payer: Aetna Managed Medicare |
$321.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$746.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$574.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$551.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$608.44
|
| Rate for Payer: Cash Price |
$344.40
|
| Rate for Payer: Cigna Commercial |
$1,056.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$642.42
|
| Rate for Payer: Health EOS Commercial |
$1,021.72
|
| Rate for Payer: HFN Commercial |
$1,056.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$861.00
|
| Rate for Payer: Multiplan Commercial |
$918.40
|
| Rate for Payer: NAPHCARE Commercial |
$688.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,056.16
|
| Rate for Payer: Quartz Beloit One Network |
$562.52
|
| Rate for Payer: Quartz Commercial |
$746.20
|
| Rate for Payer: Quartz Medicare Advantage |
$688.80
|
| Rate for Payer: The Alliance Commercial |
$4,592.00
|
| Rate for Payer: WEA Trust Commercial |
$631.40
|
| Rate for Payer: WPS Commercial |
$850.32
|
|
|
DILATOR 12fr
|
Facility
|
IP
|
$260.00
|
|
| Hospital Charge Code |
2970840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$127.40 |
| Max. Negotiated Rate |
$239.20 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$156.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
|
DILATOR 12fr
|
Facility
|
OP
|
$260.00
|
|
| Hospital Charge Code |
2970840
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$72.80 |
| Max. Negotiated Rate |
$1,040.00 |
| Rate for Payer: Aetna Commercial |
$234.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$223.60
|
| Rate for Payer: Aetna Managed Medicare |
$72.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$169.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$137.80
|
| Rate for Payer: Cash Price |
$78.00
|
| Rate for Payer: Cigna Commercial |
$239.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$145.50
|
| Rate for Payer: Health EOS Commercial |
$231.40
|
| Rate for Payer: HFN Commercial |
$239.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$195.00
|
| Rate for Payer: Multiplan Commercial |
$208.00
|
| Rate for Payer: NAPHCARE Commercial |
$156.00
|
| Rate for Payer: Preferred Network Access Commercial |
$239.20
|
| Rate for Payer: Quartz Beloit One Network |
$127.40
|
| Rate for Payer: Quartz Commercial |
$169.00
|
| Rate for Payer: Quartz Medicare Advantage |
$156.00
|
| Rate for Payer: The Alliance Commercial |
$1,040.00
|
| Rate for Payer: WEA Trust Commercial |
$143.00
|
| Rate for Payer: WPS Commercial |
$192.58
|
|
