|
ENDOCRINE DISORDERS WITHOUT CC/MCC
|
Facility
|
IP
|
$21,372.00
|
|
|
Service Code
|
MSDRG 645
|
| Min. Negotiated Rate |
$6,390.58 |
| Max. Negotiated Rate |
$21,372.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,390.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,763.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,849.23
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,207.61
|
| Rate for Payer: Anthem Medicare Advantage |
$6,390.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,390.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,390.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,390.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,551.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,390.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,431.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,390.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,390.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,390.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,390.58
|
| Rate for Payer: NAPHCARE Commercial |
$9,585.87
|
| Rate for Payer: Quartz Medicare Advantage |
$6,390.58
|
| Rate for Payer: The Alliance Commercial |
$21,372.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,390.58
|
| Rate for Payer: United Healthcare PPO |
$12,013.27
|
| Rate for Payer: Wellcare Medicare |
$6,390.58
|
|
|
ENDODONTICS
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDODONTICS
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960005
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOLYMPHADIC SHUNT
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
ENDOLYMPHADIC SHUNT
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960009
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
ENDOMETR ABLATE, THERMAL 58353
|
Professional
|
Both
|
$1,687.00
|
|
|
Service Code
|
CPT 58353
|
| Hospital Charge Code |
3015110
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$194.34 |
| Max. Negotiated Rate |
$1,666.76 |
| Rate for Payer: Aetna Commercial |
$1,666.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,508.85
|
| Rate for Payer: Aetna Managed Medicare |
$194.34
|
| Rate for Payer: Anthem Medicare Advantage |
$194.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$194.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$194.34
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cash Price |
$506.10
|
| Rate for Payer: Cigna Commercial |
$1,666.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$819.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$194.34
|
| Rate for Payer: Health EOS Commercial |
$1,596.58
|
| Rate for Payer: HFN Commercial |
$1,666.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$798.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$798.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$194.34
|
| Rate for Payer: Multiplan Commercial |
$1,403.58
|
| Rate for Payer: NAPHCARE Commercial |
$291.52
|
| Rate for Payer: Preferred Network Access Commercial |
$1,666.76
|
| Rate for Payer: Quartz Beloit One Network |
$771.97
|
| Rate for Payer: Quartz Commercial |
$1,000.05
|
| Rate for Payer: Quartz Medicare Advantage |
$194.34
|
| Rate for Payer: The Alliance Commercial |
$825.97
|
| Rate for Payer: United Healthcare Medicaid |
$819.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$194.34
|
| Rate for Payer: WEA Trust Commercial |
$964.96
|
| Rate for Payer: WPS Commercial |
$874.55
|
|
|
ENDOMETRIAL ABLATION, NOVASURE
|
Facility
|
IP
|
$1,373.00
|
|
| Hospital Charge Code |
2960253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$699.68 |
| Max. Negotiated Rate |
$1,313.69 |
| Rate for Payer: Aetna Commercial |
$1,285.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.80
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,313.69
|
| Rate for Payer: Health EOS Commercial |
$1,270.85
|
| Rate for Payer: HFN Commercial |
$1,313.69
|
| Rate for Payer: Multiplan Commercial |
$1,142.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.69
|
| Rate for Payer: Quartz Beloit One Network |
$699.68
|
| Rate for Payer: Quartz Commercial |
$856.75
|
| Rate for Payer: WEA Trust Commercial |
$785.36
|
| Rate for Payer: WPS Commercial |
$1,057.62
|
|
|
ENDOMETRIAL ABLATION, NOVASURE
|
Facility
|
OP
|
$1,373.00
|
|
| Hospital Charge Code |
2960253
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$399.82 |
| Max. Negotiated Rate |
$1,313.69 |
| Rate for Payer: Aetna Commercial |
$1,285.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.01
|
| Rate for Payer: Aetna Managed Medicare |
$399.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$713.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.80
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,313.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.09
|
| Rate for Payer: Health EOS Commercial |
$1,270.85
|
| Rate for Payer: HFN Commercial |
$1,313.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,070.94
|
| Rate for Payer: Multiplan Commercial |
$1,142.34
|
| Rate for Payer: NAPHCARE Commercial |
$856.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.69
|
| Rate for Payer: Quartz Beloit One Network |
$699.68
|
| Rate for Payer: Quartz Commercial |
$928.15
|
| Rate for Payer: Quartz Medicare Advantage |
$856.75
|
| Rate for Payer: The Alliance Commercial |
$713.96
|
| Rate for Payer: WEA Trust Commercial |
$785.36
|
| Rate for Payer: WPS Commercial |
$1,057.62
|
|
|
Endometrial Aspiration 58100
|
Professional
|
Both
|
$470.00
|
|
|
Service Code
|
CPT 58100
|
| Hospital Charge Code |
1188851
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$51.89 |
| Max. Negotiated Rate |
$464.36 |
| Rate for Payer: Aetna Commercial |
$464.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$420.37
|
| Rate for Payer: Aetna Managed Medicare |
$51.89
|
| Rate for Payer: Anthem Medicare Advantage |
$51.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$51.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$51.89
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cash Price |
$141.00
|
| Rate for Payer: Cigna Commercial |
$464.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$57.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.89
|
| Rate for Payer: Health EOS Commercial |
$444.81
|
| Rate for Payer: HFN Commercial |
$464.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$219.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$219.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$51.89
|
| Rate for Payer: Multiplan Commercial |
$391.04
|
| Rate for Payer: NAPHCARE Commercial |
$77.83
|
| Rate for Payer: Preferred Network Access Commercial |
$464.36
|
| Rate for Payer: Quartz Beloit One Network |
$215.07
|
| Rate for Payer: Quartz Commercial |
$278.62
|
| Rate for Payer: Quartz Medicare Advantage |
$51.89
|
| Rate for Payer: The Alliance Commercial |
$220.51
|
| Rate for Payer: United Healthcare Medicaid |
$57.45
|
| Rate for Payer: United Healthcare Medicare Advantage |
$51.89
|
| Rate for Payer: WEA Trust Commercial |
$268.84
|
| Rate for Payer: WPS Commercial |
$233.49
|
|
|
ENDOMETRIAL HYDROABLATION
|
Facility
|
IP
|
$1,373.00
|
|
| Hospital Charge Code |
2960124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$699.68 |
| Max. Negotiated Rate |
$1,313.69 |
| Rate for Payer: Aetna Commercial |
$1,285.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.80
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,313.69
|
| Rate for Payer: Health EOS Commercial |
$1,270.85
|
| Rate for Payer: HFN Commercial |
$1,313.69
|
| Rate for Payer: Multiplan Commercial |
$1,142.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.69
|
| Rate for Payer: Quartz Beloit One Network |
$699.68
|
| Rate for Payer: Quartz Commercial |
$856.75
|
| Rate for Payer: WEA Trust Commercial |
$785.36
|
| Rate for Payer: WPS Commercial |
$1,057.62
|
|
|
ENDOMETRIAL HYDROABLATION
|
Facility
|
OP
|
$1,373.00
|
|
| Hospital Charge Code |
2960124
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$399.82 |
| Max. Negotiated Rate |
$1,313.69 |
| Rate for Payer: Aetna Commercial |
$1,285.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,228.01
|
| Rate for Payer: Aetna Managed Medicare |
$399.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$928.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$713.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$685.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$756.80
|
| Rate for Payer: Cash Price |
$411.90
|
| Rate for Payer: Cigna Commercial |
$1,313.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$799.09
|
| Rate for Payer: Health EOS Commercial |
$1,270.85
|
| Rate for Payer: HFN Commercial |
$1,313.69
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,070.94
|
| Rate for Payer: Multiplan Commercial |
$1,142.34
|
| Rate for Payer: NAPHCARE Commercial |
$856.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,313.69
|
| Rate for Payer: Quartz Beloit One Network |
$699.68
|
| Rate for Payer: Quartz Commercial |
$928.15
|
| Rate for Payer: Quartz Medicare Advantage |
$856.75
|
| Rate for Payer: The Alliance Commercial |
$713.96
|
| Rate for Payer: WEA Trust Commercial |
$785.36
|
| Rate for Payer: WPS Commercial |
$1,057.62
|
|
|
ENDOMETRIAL SAMPLING (BIOPSY) WITH OR WITHOUT ENDOCERVICAL SAMPLING (BIOPSY), WITHOUT CERVICAL DILATION, ANY METHOD (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 58100
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$212.76 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Managed Medicare |
$212.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,030.56
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,388.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,270.32
|
| Rate for Payer: Anthem Medicare Advantage |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$212.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$212.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$212.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$212.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$791.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$212.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$212.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$212.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$212.76
|
| Rate for Payer: NAPHCARE Commercial |
$319.14
|
| Rate for Payer: Quartz Medicare Advantage |
$212.76
|
| Rate for Payer: The Alliance Commercial |
$851.05
|
| Rate for Payer: United Healthcare Medicare Advantage |
$212.76
|
| Rate for Payer: United Healthcare PPO |
$2,347.28
|
| Rate for Payer: Wellcare Medicare |
$212.76
|
|
|
ENDOMETRIOSIS, FULGURATION OF
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOMETRIOSIS, FULGURATION OF
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960080
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
Endomysial Antibody
|
Facility
|
OP
|
$212.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
977934
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.93
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.80
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$123.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$143.31
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$50.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: United Healthcare PPO |
$165.36
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: Wellcare Medicare |
$12.53
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
Endomysial Antibody
|
Professional
|
Both
|
$212.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
977934
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.53 |
| Max. Negotiated Rate |
$209.46 |
| Rate for Payer: Aetna Commercial |
$209.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Aetna Managed Medicare |
$12.53
|
| Rate for Payer: Anthem Commercial |
$17.27
|
| Rate for Payer: Anthem Medicare Advantage |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.53
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$209.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$110.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.53
|
| Rate for Payer: Health EOS Commercial |
$200.64
|
| Rate for Payer: HFN Commercial |
$209.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.24
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$44.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.53
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: NAPHCARE Commercial |
$18.80
|
| Rate for Payer: Preferred Network Access Commercial |
$209.46
|
| Rate for Payer: Quartz Beloit One Network |
$97.01
|
| Rate for Payer: Quartz Commercial |
$125.67
|
| Rate for Payer: Quartz Medicare Advantage |
$12.53
|
| Rate for Payer: The Alliance Commercial |
$49.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.53
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$55.14
|
|
|
Endomysial Antibody
|
Facility
|
IP
|
$212.00
|
|
|
Service Code
|
CPT 86255
|
| Hospital Charge Code |
977934
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$108.04 |
| Max. Negotiated Rate |
$202.84 |
| Rate for Payer: Aetna Commercial |
$198.43
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$189.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$116.85
|
| Rate for Payer: Cash Price |
$63.60
|
| Rate for Payer: Cigna Commercial |
$202.84
|
| Rate for Payer: Health EOS Commercial |
$196.23
|
| Rate for Payer: HFN Commercial |
$202.84
|
| Rate for Payer: Multiplan Commercial |
$176.38
|
| Rate for Payer: Preferred Network Access Commercial |
$202.84
|
| Rate for Payer: Quartz Beloit One Network |
$108.04
|
| Rate for Payer: Quartz Commercial |
$132.29
|
| Rate for Payer: WEA Trust Commercial |
$121.26
|
| Rate for Payer: WPS Commercial |
$163.30
|
|
|
.Endomysial Antibody Titier
|
Professional
|
Both
|
$114.40
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
4558606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$113.03 |
| Rate for Payer: Aetna Commercial |
$113.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.32
|
| Rate for Payer: Aetna Managed Medicare |
$12.57
|
| Rate for Payer: Anthem Commercial |
$18.43
|
| Rate for Payer: Anthem Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.57
|
| Rate for Payer: Cash Price |
$34.32
|
| Rate for Payer: Cash Price |
$34.32
|
| Rate for Payer: Cigna Commercial |
$113.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$59.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.57
|
| Rate for Payer: Health EOS Commercial |
$108.27
|
| Rate for Payer: HFN Commercial |
$113.03
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$95.18
|
| Rate for Payer: NAPHCARE Commercial |
$18.86
|
| Rate for Payer: Preferred Network Access Commercial |
$113.03
|
| Rate for Payer: Quartz Beloit One Network |
$52.35
|
| Rate for Payer: Quartz Commercial |
$67.82
|
| Rate for Payer: Quartz Medicare Advantage |
$12.57
|
| Rate for Payer: The Alliance Commercial |
$49.67
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.57
|
| Rate for Payer: WEA Trust Commercial |
$65.44
|
| Rate for Payer: WPS Commercial |
$55.32
|
|
|
.Endomysial Antibody Titier
|
Facility
|
IP
|
$114.40
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
4558606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$58.30 |
| Max. Negotiated Rate |
$109.46 |
| Rate for Payer: Aetna Commercial |
$107.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.06
|
| Rate for Payer: Cash Price |
$34.32
|
| Rate for Payer: Cigna Commercial |
$109.46
|
| Rate for Payer: Health EOS Commercial |
$105.89
|
| Rate for Payer: HFN Commercial |
$109.46
|
| Rate for Payer: Multiplan Commercial |
$95.18
|
| Rate for Payer: Preferred Network Access Commercial |
$109.46
|
| Rate for Payer: Quartz Beloit One Network |
$58.30
|
| Rate for Payer: Quartz Commercial |
$71.39
|
| Rate for Payer: WEA Trust Commercial |
$65.44
|
| Rate for Payer: WPS Commercial |
$88.12
|
|
|
.Endomysial Antibody Titier
|
Facility
|
OP
|
$114.40
|
|
|
Service Code
|
CPT 86231
|
| Hospital Charge Code |
4558606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.57 |
| Max. Negotiated Rate |
$109.46 |
| Rate for Payer: Aetna Commercial |
$107.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$102.32
|
| Rate for Payer: Aetna Managed Medicare |
$12.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$47.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.87
|
| Rate for Payer: Anthem Medicare Advantage |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$63.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.57
|
| Rate for Payer: Cash Price |
$34.32
|
| Rate for Payer: Cash Price |
$34.32
|
| Rate for Payer: Cigna Commercial |
$109.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.57
|
| Rate for Payer: Health EOS Commercial |
$105.89
|
| Rate for Payer: HFN Commercial |
$109.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.57
|
| Rate for Payer: Multiplan Commercial |
$95.18
|
| Rate for Payer: NAPHCARE Commercial |
$18.86
|
| Rate for Payer: Preferred Network Access Commercial |
$109.46
|
| Rate for Payer: Quartz Beloit One Network |
$58.30
|
| Rate for Payer: Quartz Commercial |
$77.33
|
| Rate for Payer: Quartz Medicare Advantage |
$12.57
|
| Rate for Payer: The Alliance Commercial |
$50.29
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.57
|
| Rate for Payer: United Healthcare PPO |
$89.23
|
| Rate for Payer: WEA Trust Commercial |
$65.44
|
| Rate for Payer: Wellcare Medicare |
$12.57
|
| Rate for Payer: WPS Commercial |
$88.12
|
|
|
ENDOSCOPIC EUSTACHIAN TUBE BALLOONING
|
Facility
|
IP
|
$4,385.00
|
|
| Hospital Charge Code |
5360686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,234.60 |
| Max. Negotiated Rate |
$4,195.57 |
| Rate for Payer: Aetna Commercial |
$4,104.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,417.01
|
| Rate for Payer: Cash Price |
$1,315.50
|
| Rate for Payer: Cigna Commercial |
$4,195.57
|
| Rate for Payer: Health EOS Commercial |
$4,058.76
|
| Rate for Payer: HFN Commercial |
$4,195.57
|
| Rate for Payer: Multiplan Commercial |
$3,648.32
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.57
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.60
|
| Rate for Payer: Quartz Commercial |
$2,736.24
|
| Rate for Payer: WEA Trust Commercial |
$2,508.22
|
| Rate for Payer: WPS Commercial |
$3,377.77
|
|
|
ENDOSCOPIC EUSTACHIAN TUBE BALLOONING
|
Facility
|
OP
|
$4,385.00
|
|
| Hospital Charge Code |
5360686
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,276.91 |
| Max. Negotiated Rate |
$4,195.57 |
| Rate for Payer: Aetna Commercial |
$4,104.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,921.94
|
| Rate for Payer: Aetna Managed Medicare |
$1,276.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,964.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,280.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,188.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,417.01
|
| Rate for Payer: Cash Price |
$1,315.50
|
| Rate for Payer: Cigna Commercial |
$4,195.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,552.07
|
| Rate for Payer: Health EOS Commercial |
$4,058.76
|
| Rate for Payer: HFN Commercial |
$4,195.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,420.30
|
| Rate for Payer: Multiplan Commercial |
$3,648.32
|
| Rate for Payer: NAPHCARE Commercial |
$2,736.24
|
| Rate for Payer: Preferred Network Access Commercial |
$4,195.57
|
| Rate for Payer: Quartz Beloit One Network |
$2,234.60
|
| Rate for Payer: Quartz Commercial |
$2,964.26
|
| Rate for Payer: Quartz Medicare Advantage |
$2,736.24
|
| Rate for Payer: The Alliance Commercial |
$2,280.20
|
| Rate for Payer: WEA Trust Commercial |
$2,508.22
|
| Rate for Payer: WPS Commercial |
$3,377.77
|
|
|
ENDOSCOPIC GASTROCNEMIUS RESECTION
|
Facility
|
OP
|
$4,167.00
|
|
| Hospital Charge Code |
5747691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,213.43 |
| Max. Negotiated Rate |
$3,986.99 |
| Rate for Payer: Aetna Commercial |
$3,900.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,726.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,213.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,816.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,166.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,080.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,296.85
|
| Rate for Payer: Cash Price |
$1,250.10
|
| Rate for Payer: Cigna Commercial |
$3,986.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,425.19
|
| Rate for Payer: Health EOS Commercial |
$3,856.98
|
| Rate for Payer: HFN Commercial |
$3,986.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,250.26
|
| Rate for Payer: Multiplan Commercial |
$3,466.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,600.21
|
| Rate for Payer: Preferred Network Access Commercial |
$3,986.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,123.50
|
| Rate for Payer: Quartz Commercial |
$2,816.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,600.21
|
| Rate for Payer: The Alliance Commercial |
$2,166.84
|
| Rate for Payer: WEA Trust Commercial |
$2,383.52
|
| Rate for Payer: WPS Commercial |
$3,209.84
|
|
|
ENDOSCOPIC GASTROCNEMIUS RESECTION
|
Facility
|
IP
|
$4,167.00
|
|
| Hospital Charge Code |
5747691
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,123.50 |
| Max. Negotiated Rate |
$3,986.99 |
| Rate for Payer: Aetna Commercial |
$3,900.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,726.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,296.85
|
| Rate for Payer: Cash Price |
$1,250.10
|
| Rate for Payer: Cigna Commercial |
$3,986.99
|
| Rate for Payer: Health EOS Commercial |
$3,856.98
|
| Rate for Payer: HFN Commercial |
$3,986.99
|
| Rate for Payer: Multiplan Commercial |
$3,466.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,986.99
|
| Rate for Payer: Quartz Beloit One Network |
$2,123.50
|
| Rate for Payer: Quartz Commercial |
$2,600.21
|
| Rate for Payer: WEA Trust Commercial |
$2,383.52
|
| Rate for Payer: WPS Commercial |
$3,209.84
|
|
|
ENDOSCOPIC INJECTION OF IMPLANT MATERIAL INTO THE SUBMUCOSAL TISSUES OF THE URETHRA AND/OR BLADDER NECK
|
Facility
|
OP
|
$14,838.60
|
|
|
Service Code
|
CPT 51715
|
|
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 |
$4,386.95
|
| 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
|
|
