|
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) of trigone, bladder neck, prostatic fossa, urethra, or periurethral glands
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52214
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| 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 |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
Cystourethroscopy, with fulguration (including cryosurgery or laser surgery) or treatment of minor (less than 0.5 cm) lesion(s) with or without biopsy
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52224
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| 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 |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
CYSTOURETHROSCOPY, WITH INJECTION(S) FOR CHEMODENERVATION OF THE BLADDER
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 52287
|
|
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 |
$4,386.95
|
| 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 insertion of indwelling ureteral stent (e.g., Gibbons or double-J type)
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52332
|
|
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 WITH INSERTION OF URETERAL GUIDE WIRE THROUGH KIDNEY TO ESTABLISH A PERCUTANEOUS NEPHROSTOMY, RETROGRADE
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52334
|
|
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 INTERNAL URETHROTOMY; MALE
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 52275
|
|
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 irrigation and evacuation of multiple obstructing clots
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52001
|
|
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, WITH MECHANICAL URETHRAL DILATION AND URETHRAL THERAPEUTIC DRUG DELIVERY BY DRUG-COATED BALLOON CATHETER FOR URETHRAL STRICTURE OR STENOSIS, MALE, INCLUDING FLUOROSCOPY, WHEN PERFORMED
|
Facility
|
OP
|
$22,570.79
|
|
|
Service Code
|
CPT 52284
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,642.70 |
| Max. Negotiated Rate |
$22,570.79 |
| Rate for Payer: Aetna Managed Medicare |
$5,642.70
|
| 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 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: Wellcare Medicare |
$5,642.70
|
|
|
Cystourethroscopy, with removal of foreign body, calculus, or ureteral stent from urethra or bladder (separate procedure); simple
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 52310
|
|
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 Removal of Ureteral Stent 52310
|
Professional
|
Both
|
$1,780.00
|
|
|
Service Code
|
CPT 52310
|
| Hospital Charge Code |
2957665
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.98 |
| Max. Negotiated Rate |
$1,758.64 |
| Rate for Payer: Aetna Commercial |
$1,758.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,592.03
|
| Rate for Payer: Aetna Managed Medicare |
$129.98
|
| Rate for Payer: Anthem Medicare Advantage |
$129.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$129.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$129.98
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cash Price |
$534.00
|
| Rate for Payer: Cigna Commercial |
$1,758.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$253.91
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$129.98
|
| Rate for Payer: Health EOS Commercial |
$1,684.59
|
| Rate for Payer: HFN Commercial |
$1,758.64
|
| 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: Independent Care Health Plan Medicare |
$129.98
|
| Rate for Payer: Multiplan Commercial |
$1,480.96
|
| Rate for Payer: NAPHCARE Commercial |
$194.97
|
| Rate for Payer: Preferred Network Access Commercial |
$1,758.64
|
| Rate for Payer: Quartz Beloit One Network |
$814.53
|
| Rate for Payer: Quartz Commercial |
$1,055.18
|
| Rate for Payer: Quartz Medicare Advantage |
$129.98
|
| Rate for Payer: The Alliance Commercial |
$552.41
|
| Rate for Payer: United Healthcare Medicaid |
$253.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$129.98
|
| Rate for Payer: WEA Trust Commercial |
$1,018.16
|
| Rate for Payer: WPS Commercial |
$584.91
|
|
|
CYSTOURETHROSCOPY; WITH TREATMENT OF URETERAL STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 52341
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$14,838.60 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,709.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,799.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,709.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,709.65
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,709.65
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,709.65
|
| Rate for Payer: NAPHCARE Commercial |
$5,564.47
|
| Rate for Payer: Quartz Medicare Advantage |
$3,709.65
|
| Rate for Payer: The Alliance Commercial |
$14,838.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,709.65
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
Cystourethroscopy, with ureteral catheterization, with or without irrigation, instillation, or ureteropyelography, exclusive of radiologic service;
|
Facility
|
OP
|
$8,799.61
|
|
|
Service Code
|
CPT 52005
|
|
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 URETEROSCOPY AND/OR PYELOSCOPY; DIAGNOSTIC
|
Facility
|
OP
|
$13,799.89
|
|
|
Service Code
|
CPT 52351
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,799.89 |
| Rate for Payer: Aetna Managed Medicare |
$3,709.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,709.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,709.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,709.65
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$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 |
$6,306.40
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,709.65
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,709.65
|
|
|
Cystourethroscopy, with ureteroscopy and/or pyeloscopy; with biopsy and/or fulguration of ureteral or renal pelvic lesion
|
Facility
|
OP
|
$20,990.83
|
|
|
Service Code
|
CPT 52354
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$20,990.83 |
| 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 |
$8,107.14
|
| 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 |
$9,592.58
|
| 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 ureteroscopy and/or pyeloscopy; with lithotripsy including insertion of indwelling ureteral stent (e.g., Gibbons or double-J type)
|
Facility
|
OP
|
$20,990.83
|
|
|
Service Code
|
CPT 52356
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$20,990.83 |
| 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 |
$8,107.14
|
| 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 |
$9,592.58
|
| 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 ureteroscopy and/or pyeloscopy; with lithotripsy (ureteral catheterization is included)
|
Facility
|
OP
|
$20,990.83
|
|
|
Service Code
|
CPT 52353
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$20,990.83 |
| 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 |
$8,107.14
|
| 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 |
$9,592.58
|
| 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 ureteroscopy and/or pyeloscopy; with removal or manipulation of calculus (ureteral catheterization is included)
|
Facility
|
OP
|
$13,799.89
|
|
|
Service Code
|
CPT 52352
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,709.65 |
| Max. Negotiated Rate |
$13,799.89 |
| 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 |
$8,107.14
|
| 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 |
$6,306.40
|
| 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 ureteroscopy; with treatment of ureteral stricture (e.g., balloon dilation, laser, electrocautery, and incision)
|
Facility
|
OP
|
$13,799.89
|
|
|
Service Code
|
CPT 52344
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,709.65 |
| Max. Negotiated Rate |
$13,799.89 |
| 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 |
$8,107.14
|
| 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 |
$6,306.40
|
| 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 URETEROSCOPY; WITH TREATMENT OF URETEROPELVIC JUNCTION STRICTURE (EG, BALLOON DILATION, LASER, ELECTROCAUTERY, AND INCISION)
|
Facility
|
OP
|
$13,799.89
|
|
|
Service Code
|
CPT 52345
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,709.65 |
| Max. Negotiated Rate |
$13,799.89 |
| 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 |
$8,107.14
|
| 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 |
$6,306.40
|
| 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
|
|
|
Cytogenetics and Molec Cyto
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2798802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.44 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$386.26
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
Cytogenetics and Molec Cyto
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2798802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.95 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$180.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$418.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$482.82
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$386.26
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$418.44
|
| Rate for Payer: Quartz Medicare Advantage |
$386.26
|
| Rate for Payer: The Alliance Commercial |
$132.95
|
| Rate for Payer: United Healthcare PPO |
$482.82
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
Cytogenetics and Molec Cyto
|
Professional
|
Both
|
$619.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2798802
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$611.57 |
| Rate for Payer: Aetna Commercial |
$611.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$33.24
|
| Rate for Payer: Anthem Commercial |
$5.89
|
| Rate for Payer: Anthem Medicare Advantage |
$33.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.24
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$611.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.24
|
| Rate for Payer: Health EOS Commercial |
$585.82
|
| Rate for Payer: HFN Commercial |
$611.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$49.86
|
| Rate for Payer: Preferred Network Access Commercial |
$611.57
|
| Rate for Payer: Quartz Beloit One Network |
$283.25
|
| Rate for Payer: Quartz Commercial |
$366.94
|
| Rate for Payer: Quartz Medicare Advantage |
$33.24
|
| Rate for Payer: The Alliance Commercial |
$131.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.24
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$146.25
|
|
|
Cytogenetics Interp & Report
|
Professional
|
Both
|
$619.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2798803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.89 |
| Max. Negotiated Rate |
$611.57 |
| Rate for Payer: Aetna Commercial |
$611.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$33.24
|
| Rate for Payer: Anthem Commercial |
$5.89
|
| Rate for Payer: Anthem Medicare Advantage |
$33.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$33.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$33.24
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$611.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$321.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.24
|
| Rate for Payer: Health EOS Commercial |
$585.82
|
| Rate for Payer: HFN Commercial |
$611.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$33.24
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$49.86
|
| Rate for Payer: Preferred Network Access Commercial |
$611.57
|
| Rate for Payer: Quartz Beloit One Network |
$283.25
|
| Rate for Payer: Quartz Commercial |
$366.94
|
| Rate for Payer: Quartz Medicare Advantage |
$33.24
|
| Rate for Payer: The Alliance Commercial |
$131.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$33.24
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$146.25
|
|
|
Cytogenetics Interp & Report
|
Facility
|
OP
|
$619.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2798803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$132.95 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Aetna Managed Medicare |
$180.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$418.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$321.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$309.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$360.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$482.82
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: NAPHCARE Commercial |
$386.26
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$418.44
|
| Rate for Payer: Quartz Medicare Advantage |
$386.26
|
| Rate for Payer: The Alliance Commercial |
$132.95
|
| Rate for Payer: United Healthcare PPO |
$482.82
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
|
Cytogenetics Interp & Report
|
Facility
|
IP
|
$619.00
|
|
|
Service Code
|
CPT 88291
|
| Hospital Charge Code |
2798803
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$315.44 |
| Max. Negotiated Rate |
$592.26 |
| Rate for Payer: Aetna Commercial |
$579.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$553.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$341.19
|
| Rate for Payer: Cash Price |
$185.70
|
| Rate for Payer: Cigna Commercial |
$592.26
|
| Rate for Payer: Health EOS Commercial |
$572.95
|
| Rate for Payer: HFN Commercial |
$592.26
|
| Rate for Payer: Multiplan Commercial |
$515.01
|
| Rate for Payer: Preferred Network Access Commercial |
$592.26
|
| Rate for Payer: Quartz Beloit One Network |
$315.44
|
| Rate for Payer: Quartz Commercial |
$386.26
|
| Rate for Payer: WEA Trust Commercial |
$354.07
|
| Rate for Payer: WPS Commercial |
$476.82
|
|
