|
Digoxin Level
|
Professional
|
Both
|
$224.00
|
|
|
Service Code
|
CPT 80162
|
| Hospital Charge Code |
633719
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.81 |
| Max. Negotiated Rate |
$221.31 |
| Rate for Payer: Aetna Commercial |
$221.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$200.35
|
| Rate for Payer: Aetna Managed Medicare |
$13.81
|
| Rate for Payer: Anthem Medicare Advantage |
$13.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.81
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cash Price |
$67.20
|
| Rate for Payer: Cigna Commercial |
$221.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.81
|
| Rate for Payer: Health EOS Commercial |
$211.99
|
| Rate for Payer: HFN Commercial |
$221.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.76
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.81
|
| Rate for Payer: Multiplan Commercial |
$186.37
|
| Rate for Payer: NAPHCARE Commercial |
$20.72
|
| Rate for Payer: Preferred Network Access Commercial |
$221.31
|
| Rate for Payer: Quartz Beloit One Network |
$102.50
|
| Rate for Payer: Quartz Commercial |
$132.79
|
| Rate for Payer: Quartz Medicare Advantage |
$13.81
|
| Rate for Payer: The Alliance Commercial |
$54.55
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.81
|
| Rate for Payer: WEA Trust Commercial |
$128.13
|
| Rate for Payer: WPS Commercial |
$60.77
|
|
|
Dihydrorhodamine Flow Cytometric Test
|
Facility
|
IP
|
$938.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
6175444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$478.00 |
| Max. Negotiated Rate |
$897.48 |
| Rate for Payer: Aetna Commercial |
$877.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.03
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$897.48
|
| Rate for Payer: Health EOS Commercial |
$868.21
|
| Rate for Payer: HFN Commercial |
$897.48
|
| Rate for Payer: Multiplan Commercial |
$780.42
|
| Rate for Payer: Preferred Network Access Commercial |
$897.48
|
| Rate for Payer: Quartz Beloit One Network |
$478.00
|
| Rate for Payer: Quartz Commercial |
$585.31
|
| Rate for Payer: WEA Trust Commercial |
$536.54
|
| Rate for Payer: WPS Commercial |
$722.54
|
|
|
Dihydrorhodamine Flow Cytometric Test
|
Professional
|
Both
|
$938.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
6175444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$926.74 |
| Rate for Payer: Aetna Commercial |
$926.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.95
|
| Rate for Payer: Aetna Managed Medicare |
$141.29
|
| Rate for Payer: Anthem Medicare Advantage |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.29
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$926.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$487.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$141.29
|
| Rate for Payer: Health EOS Commercial |
$887.72
|
| Rate for Payer: HFN Commercial |
$926.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$498.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$498.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.29
|
| Rate for Payer: Multiplan Commercial |
$780.42
|
| Rate for Payer: NAPHCARE Commercial |
$211.94
|
| Rate for Payer: Preferred Network Access Commercial |
$926.74
|
| Rate for Payer: Quartz Beloit One Network |
$429.23
|
| Rate for Payer: Quartz Commercial |
$556.05
|
| Rate for Payer: Quartz Medicare Advantage |
$141.29
|
| Rate for Payer: The Alliance Commercial |
$558.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.29
|
| Rate for Payer: WEA Trust Commercial |
$536.54
|
| Rate for Payer: WPS Commercial |
$621.70
|
|
|
Dihydrorhodamine Flow Cytometric Test
|
Facility
|
OP
|
$938.00
|
|
|
Service Code
|
CPT 86352
|
| Hospital Charge Code |
6175444
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$141.29 |
| Max. Negotiated Rate |
$897.48 |
| Rate for Payer: Aetna Commercial |
$877.97
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$838.95
|
| Rate for Payer: Aetna Managed Medicare |
$141.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$529.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$247.27
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$234.55
|
| Rate for Payer: Anthem Medicare Advantage |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$141.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$141.29
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cash Price |
$281.40
|
| Rate for Payer: Cigna Commercial |
$897.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$141.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$545.92
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$141.29
|
| Rate for Payer: Health EOS Commercial |
$868.21
|
| Rate for Payer: HFN Commercial |
$897.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$525.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$141.29
|
| Rate for Payer: Independent Care Health Plan Medicare |
$141.29
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$141.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$141.29
|
| Rate for Payer: Multiplan Commercial |
$780.42
|
| Rate for Payer: NAPHCARE Commercial |
$211.94
|
| Rate for Payer: Preferred Network Access Commercial |
$897.48
|
| Rate for Payer: Quartz Beloit One Network |
$478.00
|
| Rate for Payer: Quartz Commercial |
$634.09
|
| Rate for Payer: Quartz Medicare Advantage |
$141.29
|
| Rate for Payer: The Alliance Commercial |
$565.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$141.29
|
| Rate for Payer: United Healthcare PPO |
$731.64
|
| Rate for Payer: WEA Trust Commercial |
$536.54
|
| Rate for Payer: Wellcare Medicare |
$141.29
|
| Rate for Payer: WPS Commercial |
$722.54
|
|
|
Dihydrotestosterone, LC/MS/MS
|
Facility
|
OP
|
$213.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
3400168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$62.03 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Aetna Managed Medicare |
$62.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$106.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.97
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.14
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: NAPHCARE Commercial |
$132.91
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$143.99
|
| Rate for Payer: Quartz Medicare Advantage |
$132.91
|
| Rate for Payer: The Alliance Commercial |
$110.76
|
| Rate for Payer: United Healthcare PPO |
$166.14
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
Dihydrotestosterone, LC/MS/MS
|
Facility
|
IP
|
$213.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
3400168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.54 |
| Max. Negotiated Rate |
$203.80 |
| Rate for Payer: Aetna Commercial |
$199.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$117.41
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$203.80
|
| Rate for Payer: Health EOS Commercial |
$197.15
|
| Rate for Payer: HFN Commercial |
$203.80
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$203.80
|
| Rate for Payer: Quartz Beloit One Network |
$108.54
|
| Rate for Payer: Quartz Commercial |
$132.91
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
Dihydrotestosterone, LC/MS/MS
|
Professional
|
Both
|
$213.00
|
|
|
Service Code
|
CPT 80327
|
| Hospital Charge Code |
3400168
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$83.26 |
| Max. Negotiated Rate |
$210.44 |
| Rate for Payer: Aetna Commercial |
$210.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$190.51
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cash Price |
$63.90
|
| Rate for Payer: Cigna Commercial |
$210.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132.91
|
| Rate for Payer: Health EOS Commercial |
$201.58
|
| Rate for Payer: HFN Commercial |
$210.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$83.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$83.26
|
| Rate for Payer: Multiplan Commercial |
$177.22
|
| Rate for Payer: Preferred Network Access Commercial |
$210.44
|
| Rate for Payer: Quartz Beloit One Network |
$97.47
|
| Rate for Payer: Quartz Commercial |
$126.27
|
| Rate for Payer: The Alliance Commercial |
$110.76
|
| Rate for Payer: WEA Trust Commercial |
$121.84
|
| Rate for Payer: WPS Commercial |
$164.07
|
|
|
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 |
$45.50 |
| Max. Negotiated Rate |
$518.70 |
| Rate for Payer: Aetna Commercial |
$518.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$469.56
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cash Price |
$157.50
|
| Rate for Payer: Cigna Commercial |
$518.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$327.60
|
| Rate for Payer: Health EOS Commercial |
$496.86
|
| Rate for Payer: HFN Commercial |
$518.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$274.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$274.67
|
| Rate for Payer: Multiplan Commercial |
$436.80
|
| Rate for Payer: Preferred Network Access Commercial |
$518.70
|
| Rate for Payer: Quartz Beloit One Network |
$240.24
|
| Rate for Payer: Quartz Commercial |
$311.22
|
| Rate for Payer: The Alliance Commercial |
$273.00
|
| Rate for Payer: United Healthcare Medicaid |
$45.50
|
| Rate for Payer: WEA Trust Commercial |
$300.30
|
| Rate for Payer: WPS Commercial |
$404.41
|
|
|
DILATION AND CURETTAGE 58120
|
Professional
|
Both
|
$1,648.00
|
|
|
Service Code
|
CPT 58120
|
| Hospital Charge Code |
3015096
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$199.42 |
| Max. Negotiated Rate |
$1,628.22 |
| Rate for Payer: Aetna Commercial |
$1,628.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,473.97
|
| Rate for Payer: Aetna Managed Medicare |
$199.42
|
| Rate for Payer: Anthem Medicare Advantage |
$199.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$199.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$199.42
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cash Price |
$494.40
|
| Rate for Payer: Cigna Commercial |
$1,628.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$239.03
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$199.42
|
| Rate for Payer: Health EOS Commercial |
$1,559.67
|
| Rate for Payer: HFN Commercial |
$1,628.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$801.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$801.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$199.42
|
| Rate for Payer: Multiplan Commercial |
$1,371.14
|
| Rate for Payer: NAPHCARE Commercial |
$299.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,628.22
|
| Rate for Payer: Quartz Beloit One Network |
$754.12
|
| Rate for Payer: Quartz Commercial |
$976.93
|
| Rate for Payer: Quartz Medicare Advantage |
$199.42
|
| Rate for Payer: The Alliance Commercial |
$847.53
|
| Rate for Payer: United Healthcare Medicaid |
$239.03
|
| Rate for Payer: United Healthcare Medicare Advantage |
$199.42
|
| Rate for Payer: WEA Trust Commercial |
$942.66
|
| Rate for Payer: WPS Commercial |
$897.39
|
|
|
DILATION AND CURETTAGE, DIAGNOSTIC AND/OR THERAPEUTIC (NONOBSTETRICAL)
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 58120
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| 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 |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$22,709.92
|
|
|
Service Code
|
APR-DRG 5174
|
| Min. Negotiated Rate |
$20,172.37 |
| Max. Negotiated Rate |
$22,709.92 |
| Rate for Payer: Anthem Medicaid |
$21,746.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$21,746.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21,746.00
|
| Rate for Payer: Dean Health Medicaid |
$21,746.00
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,172.37
|
| Rate for Payer: Managed Health Services Medicaid |
$22,709.92
|
| Rate for Payer: Molina Healthcare Medicaid |
$21,746.00
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$21,746.00
|
| Rate for Payer: United Healthcare Medicaid |
$21,746.00
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$9,908.19
|
|
|
Service Code
|
APR-DRG 5172
|
| Min. Negotiated Rate |
$8,801.07 |
| Max. Negotiated Rate |
$9,908.19 |
| Rate for Payer: Anthem Medicaid |
$9,487.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,487.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,487.64
|
| Rate for Payer: Dean Health Medicaid |
$9,487.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,801.07
|
| Rate for Payer: Managed Health Services Medicaid |
$9,908.19
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,487.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,487.64
|
| Rate for Payer: United Healthcare Medicaid |
$9,487.64
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$7,277.70
|
|
|
Service Code
|
APR-DRG 5171
|
| Min. Negotiated Rate |
$6,464.50 |
| Max. Negotiated Rate |
$7,277.70 |
| Rate for Payer: Anthem Medicaid |
$6,968.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,968.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,968.80
|
| Rate for Payer: Dean Health Medicaid |
$6,968.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,464.50
|
| Rate for Payer: Managed Health Services Medicaid |
$7,277.70
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,968.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,968.80
|
| Rate for Payer: United Healthcare Medicaid |
$6,968.80
|
|
|
DILATION AND CURETTAGE FOR NON-OBSTETRIC DIAGNOSES
|
Facility
|
IP
|
$14,818.44
|
|
|
Service Code
|
APR-DRG 5173
|
| Min. Negotiated Rate |
$13,162.67 |
| Max. Negotiated Rate |
$14,818.44 |
| Rate for Payer: Anthem Medicaid |
$14,189.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,189.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,189.48
|
| Rate for Payer: Dean Health Medicaid |
$14,189.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,162.67
|
| Rate for Payer: Managed Health Services Medicaid |
$14,818.44
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,189.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,189.48
|
| Rate for Payer: United Healthcare Medicaid |
$14,189.48
|
|
|
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 |
$1,412.10 |
| Max. Negotiated Rate |
$2,651.29 |
| Rate for Payer: Aetna Commercial |
$2,593.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,478.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,527.38
|
| Rate for Payer: Cash Price |
$831.30
|
| Rate for Payer: Cigna Commercial |
$2,651.29
|
| Rate for Payer: Health EOS Commercial |
$2,564.84
|
| Rate for Payer: HFN Commercial |
$2,651.29
|
| Rate for Payer: Multiplan Commercial |
$2,305.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,651.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,412.10
|
| Rate for Payer: Quartz Commercial |
$1,729.10
|
| Rate for Payer: WEA Trust Commercial |
$1,585.01
|
| Rate for Payer: WPS Commercial |
$2,134.50
|
|
|
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 |
$806.92 |
| Max. Negotiated Rate |
$2,651.29 |
| Rate for Payer: Aetna Commercial |
$2,593.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,478.38
|
| Rate for Payer: Aetna Managed Medicare |
$806.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,873.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,440.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,383.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,527.38
|
| Rate for Payer: Cash Price |
$831.30
|
| Rate for Payer: Cigna Commercial |
$2,651.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,612.72
|
| Rate for Payer: Health EOS Commercial |
$2,564.84
|
| Rate for Payer: HFN Commercial |
$2,651.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,161.38
|
| Rate for Payer: Multiplan Commercial |
$2,305.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,729.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,651.29
|
| Rate for Payer: Quartz Beloit One Network |
$1,412.10
|
| Rate for Payer: Quartz Commercial |
$1,873.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,729.10
|
| Rate for Payer: The Alliance Commercial |
$1,440.92
|
| Rate for Payer: WEA Trust Commercial |
$1,585.01
|
| Rate for Payer: WPS Commercial |
$2,134.50
|
|
|
DILATION & CURETTAGE
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2959988
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
DILATION & CURETTAGE
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2959988
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
DILATION & EVACUATION
|
Facility
|
IP
|
$1,153.00
|
|
| Hospital Charge Code |
2959990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$587.57 |
| Max. Negotiated Rate |
$1,103.19 |
| Rate for Payer: Aetna Commercial |
$1,079.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.53
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,103.19
|
| Rate for Payer: Health EOS Commercial |
$1,067.22
|
| Rate for Payer: HFN Commercial |
$1,103.19
|
| Rate for Payer: Multiplan Commercial |
$959.30
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.19
|
| Rate for Payer: Quartz Beloit One Network |
$587.57
|
| Rate for Payer: Quartz Commercial |
$719.47
|
| Rate for Payer: WEA Trust Commercial |
$659.52
|
| Rate for Payer: WPS Commercial |
$888.16
|
|
|
DILATION & EVACUATION
|
Facility
|
OP
|
$1,153.00
|
|
| Hospital Charge Code |
2959990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$335.75 |
| Max. Negotiated Rate |
$1,103.19 |
| Rate for Payer: Aetna Commercial |
$1,079.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,031.24
|
| Rate for Payer: Aetna Managed Medicare |
$335.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$779.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$599.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$575.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$635.53
|
| Rate for Payer: Cash Price |
$345.90
|
| Rate for Payer: Cigna Commercial |
$1,103.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$671.05
|
| Rate for Payer: Health EOS Commercial |
$1,067.22
|
| Rate for Payer: HFN Commercial |
$1,103.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$899.34
|
| Rate for Payer: Multiplan Commercial |
$959.30
|
| Rate for Payer: NAPHCARE Commercial |
$719.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,103.19
|
| Rate for Payer: Quartz Beloit One Network |
$587.57
|
| Rate for Payer: Quartz Commercial |
$779.43
|
| Rate for Payer: Quartz Medicare Advantage |
$719.47
|
| Rate for Payer: The Alliance Commercial |
$599.56
|
| Rate for Payer: WEA Trust Commercial |
$659.52
|
| Rate for Payer: WPS Commercial |
$888.16
|
|
|
Dilation Of Cervical Canal 57800
|
Professional
|
Both
|
$192.00
|
|
|
Service Code
|
CPT 57800
|
| Hospital Charge Code |
1190836
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$41.19 |
| Max. Negotiated Rate |
$189.70 |
| Rate for Payer: Aetna Commercial |
$189.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$171.72
|
| Rate for Payer: Aetna Managed Medicare |
$41.19
|
| Rate for Payer: Anthem Medicare Advantage |
$41.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.19
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cash Price |
$57.60
|
| Rate for Payer: Cigna Commercial |
$189.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$43.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.19
|
| Rate for Payer: Health EOS Commercial |
$181.71
|
| Rate for Payer: HFN Commercial |
$189.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$165.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$165.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.19
|
| Rate for Payer: Multiplan Commercial |
$159.74
|
| Rate for Payer: NAPHCARE Commercial |
$61.79
|
| Rate for Payer: Preferred Network Access Commercial |
$189.70
|
| Rate for Payer: Quartz Beloit One Network |
$87.86
|
| Rate for Payer: Quartz Commercial |
$113.82
|
| Rate for Payer: Quartz Medicare Advantage |
$41.19
|
| Rate for Payer: The Alliance Commercial |
$175.08
|
| Rate for Payer: United Healthcare Medicaid |
$43.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.19
|
| Rate for Payer: WEA Trust Commercial |
$109.82
|
| Rate for Payer: WPS Commercial |
$185.37
|
|
|
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 |
$21.02 |
| Max. Negotiated Rate |
$273.68 |
| Rate for Payer: Aetna Commercial |
$273.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$247.75
|
| Rate for Payer: Aetna Managed Medicare |
$36.47
|
| Rate for Payer: Anthem Medicare Advantage |
$36.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$36.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$36.47
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cash Price |
$83.10
|
| Rate for Payer: Cigna Commercial |
$273.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$21.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.47
|
| Rate for Payer: Health EOS Commercial |
$262.15
|
| Rate for Payer: HFN Commercial |
$273.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$143.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$143.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$36.47
|
| Rate for Payer: Multiplan Commercial |
$230.46
|
| Rate for Payer: NAPHCARE Commercial |
$54.71
|
| Rate for Payer: Preferred Network Access Commercial |
$273.68
|
| Rate for Payer: Quartz Beloit One Network |
$126.76
|
| Rate for Payer: Quartz Commercial |
$164.21
|
| Rate for Payer: Quartz Medicare Advantage |
$36.47
|
| Rate for Payer: The Alliance Commercial |
$155.01
|
| Rate for Payer: United Healthcare Medicaid |
$21.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$36.47
|
| Rate for Payer: WEA Trust Commercial |
$158.44
|
| Rate for Payer: WPS Commercial |
$164.13
|
|
|
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 |
$19.62 |
| Max. Negotiated Rate |
$284.54 |
| Rate for Payer: Aetna Commercial |
$284.54
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$257.59
|
| Rate for Payer: Aetna Managed Medicare |
$35.15
|
| Rate for Payer: Anthem Medicare Advantage |
$35.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$35.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$35.15
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cash Price |
$86.40
|
| Rate for Payer: Cigna Commercial |
$284.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35.15
|
| Rate for Payer: Health EOS Commercial |
$272.56
|
| Rate for Payer: HFN Commercial |
$284.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$139.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$139.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$35.15
|
| Rate for Payer: Multiplan Commercial |
$239.62
|
| Rate for Payer: NAPHCARE Commercial |
$52.73
|
| Rate for Payer: Preferred Network Access Commercial |
$284.54
|
| Rate for Payer: Quartz Beloit One Network |
$131.79
|
| Rate for Payer: Quartz Commercial |
$170.73
|
| Rate for Payer: Quartz Medicare Advantage |
$35.15
|
| Rate for Payer: The Alliance Commercial |
$149.40
|
| Rate for Payer: United Healthcare Medicaid |
$19.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$35.15
|
| Rate for Payer: WEA Trust Commercial |
$164.74
|
| Rate for Payer: WPS Commercial |
$158.18
|
|
|
Dilation Of Lacrimal Punctum 68801
|
Professional
|
Both
|
$354.00
|
|
|
Service Code
|
CPT 68801
|
| Hospital Charge Code |
1190820
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.50 |
| Max. Negotiated Rate |
$349.75 |
| Rate for Payer: Aetna Commercial |
$349.75
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.62
|
| Rate for Payer: Aetna Managed Medicare |
$71.58
|
| Rate for Payer: Anthem Medicare Advantage |
$71.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$71.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$71.58
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cash Price |
$106.20
|
| Rate for Payer: Cigna Commercial |
$349.75
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$45.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$71.58
|
| Rate for Payer: Health EOS Commercial |
$335.03
|
| Rate for Payer: HFN Commercial |
$349.75
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$274.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$274.67
|
| Rate for Payer: Independent Care Health Plan Medicare |
$71.58
|
| Rate for Payer: Multiplan Commercial |
$294.53
|
| Rate for Payer: NAPHCARE Commercial |
$107.37
|
| Rate for Payer: Preferred Network Access Commercial |
$349.75
|
| Rate for Payer: Quartz Beloit One Network |
$161.99
|
| Rate for Payer: Quartz Commercial |
$209.85
|
| Rate for Payer: Quartz Medicare Advantage |
$71.58
|
| Rate for Payer: The Alliance Commercial |
$304.23
|
| Rate for Payer: United Healthcare Medicaid |
$45.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$71.58
|
| Rate for Payer: WEA Trust Commercial |
$202.49
|
| Rate for Payer: WPS Commercial |
$322.12
|
|
|
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 |
$23.11 |
| Max. Negotiated Rate |
$485.11 |
| Rate for Payer: Aetna Commercial |
$485.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$439.15
|
| Rate for Payer: Aetna Managed Medicare |
$46.28
|
| Rate for Payer: Anthem Medicare Advantage |
$46.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$46.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$46.28
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cash Price |
$147.30
|
| Rate for Payer: Cigna Commercial |
$485.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$23.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$46.28
|
| Rate for Payer: Health EOS Commercial |
$464.68
|
| Rate for Payer: HFN Commercial |
$485.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$46.28
|
| Rate for Payer: Multiplan Commercial |
$408.51
|
| Rate for Payer: NAPHCARE Commercial |
$69.42
|
| Rate for Payer: Preferred Network Access Commercial |
$485.11
|
| Rate for Payer: Quartz Beloit One Network |
$224.68
|
| Rate for Payer: Quartz Commercial |
$291.06
|
| Rate for Payer: Quartz Medicare Advantage |
$46.28
|
| Rate for Payer: The Alliance Commercial |
$196.69
|
| Rate for Payer: United Healthcare Medicaid |
$23.11
|
| Rate for Payer: United Healthcare Medicare Advantage |
$46.28
|
| Rate for Payer: WEA Trust Commercial |
$280.85
|
| Rate for Payer: WPS Commercial |
$208.26
|
|
