|
HYPOSPADIAS DEFORMITY REPAIR
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960127
|
|
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
|
|
|
Hypothermia protocol - CCC - Cooling Measures
|
Facility
|
IP
|
$11,636.00
|
|
| Hospital Charge Code |
3034560
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$5,929.71 |
| Max. Negotiated Rate |
$11,133.32 |
| Rate for Payer: Aetna Commercial |
$10,891.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,407.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,413.76
|
| Rate for Payer: Cash Price |
$3,490.80
|
| Rate for Payer: Cigna Commercial |
$11,133.32
|
| Rate for Payer: Health EOS Commercial |
$10,770.28
|
| Rate for Payer: HFN Commercial |
$11,133.32
|
| Rate for Payer: Multiplan Commercial |
$9,681.15
|
| Rate for Payer: Preferred Network Access Commercial |
$11,133.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,929.71
|
| Rate for Payer: Quartz Commercial |
$7,260.86
|
| Rate for Payer: WEA Trust Commercial |
$6,655.79
|
| Rate for Payer: WPS Commercial |
$8,963.21
|
|
|
Hypothermia protocol - CCC - Cooling Measures
|
Facility
|
OP
|
$11,636.00
|
|
| Hospital Charge Code |
3034560
|
|
Hospital Revenue Code
|
230
|
| Min. Negotiated Rate |
$3,388.40 |
| Max. Negotiated Rate |
$11,133.32 |
| Rate for Payer: Aetna Commercial |
$10,891.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,407.24
|
| Rate for Payer: Aetna Managed Medicare |
$3,388.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,865.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,050.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,808.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,413.76
|
| Rate for Payer: Cash Price |
$3,490.80
|
| Rate for Payer: Cigna Commercial |
$11,133.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,772.15
|
| Rate for Payer: Health EOS Commercial |
$10,770.28
|
| Rate for Payer: HFN Commercial |
$11,133.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,076.08
|
| Rate for Payer: Multiplan Commercial |
$9,681.15
|
| Rate for Payer: NAPHCARE Commercial |
$7,260.86
|
| Rate for Payer: Preferred Network Access Commercial |
$11,133.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,929.71
|
| Rate for Payer: Quartz Commercial |
$7,865.94
|
| Rate for Payer: Quartz Medicare Advantage |
$7,260.86
|
| Rate for Payer: The Alliance Commercial |
$6,050.72
|
| Rate for Payer: WEA Trust Commercial |
$6,655.79
|
| Rate for Payer: WPS Commercial |
$8,963.21
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$3,858.06
|
|
|
Service Code
|
APR-DRG 4221
|
| Min. Negotiated Rate |
$3,426.97 |
| Max. Negotiated Rate |
$3,858.06 |
| Rate for Payer: Anthem Medicaid |
$3,694.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,694.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,694.30
|
| Rate for Payer: Dean Health Medicaid |
$3,694.30
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,426.97
|
| Rate for Payer: Managed Health Services Medicaid |
$3,858.06
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,694.30
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,694.30
|
| Rate for Payer: United Healthcare Medicaid |
$3,694.30
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$5,173.30
|
|
|
Service Code
|
APR-DRG 4222
|
| Min. Negotiated Rate |
$4,595.25 |
| Max. Negotiated Rate |
$5,173.30 |
| Rate for Payer: Anthem Medicaid |
$4,953.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,953.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,953.72
|
| Rate for Payer: Dean Health Medicaid |
$4,953.72
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,595.25
|
| Rate for Payer: Managed Health Services Medicaid |
$5,173.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,953.72
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,953.72
|
| Rate for Payer: United Healthcare Medicaid |
$4,953.72
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$7,540.75
|
|
|
Service Code
|
APR-DRG 4223
|
| Min. Negotiated Rate |
$6,698.16 |
| Max. Negotiated Rate |
$7,540.75 |
| Rate for Payer: Anthem Medicaid |
$7,220.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,220.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,220.68
|
| Rate for Payer: Dean Health Medicaid |
$7,220.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,698.16
|
| Rate for Payer: Managed Health Services Medicaid |
$7,540.75
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,220.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,220.68
|
| Rate for Payer: United Healthcare Medicaid |
$7,220.68
|
|
|
HYPOVOLEMIA AND RELATED ELECTROLYTE DISORDERS
|
Facility
|
IP
|
$12,275.63
|
|
|
Service Code
|
APR-DRG 4224
|
| Min. Negotiated Rate |
$10,903.98 |
| Max. Negotiated Rate |
$12,275.63 |
| Rate for Payer: Anthem Medicaid |
$11,754.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$11,754.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11,754.60
|
| Rate for Payer: Dean Health Medicaid |
$11,754.60
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$10,903.98
|
| Rate for Payer: Managed Health Services Medicaid |
$12,275.63
|
| Rate for Payer: Molina Healthcare Medicaid |
$11,754.60
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11,754.60
|
| Rate for Payer: United Healthcare Medicaid |
$11,754.60
|
|
|
HYSTEROSCOPY
|
Facility
|
OP
|
$4,075.00
|
|
| Hospital Charge Code |
2960128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.65
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$2,119.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,138.97
|
|
|
HYSTEROSCOPY
|
Facility
|
IP
|
$4,075.00
|
|
| Hospital Charge Code |
2960128
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,222.50
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,138.97
|
|
|
HYSTEROSCOPY, ABLATION 58563
|
Professional
|
Both
|
$10,523.00
|
|
|
Service Code
|
CPT 58563
|
| Hospital Charge Code |
3015122
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$205.06 |
| Max. Negotiated Rate |
$10,396.72 |
| Rate for Payer: Aetna Commercial |
$10,396.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,411.77
|
| Rate for Payer: Aetna Managed Medicare |
$205.06
|
| Rate for Payer: Anthem Medicare Advantage |
$205.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$205.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$205.06
|
| Rate for Payer: Cash Price |
$3,156.90
|
| Rate for Payer: Cash Price |
$3,156.90
|
| Rate for Payer: Cash Price |
$3,156.90
|
| Rate for Payer: Cigna Commercial |
$10,396.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,332.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$205.06
|
| Rate for Payer: Health EOS Commercial |
$9,958.97
|
| Rate for Payer: HFN Commercial |
$10,396.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$848.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$848.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$205.06
|
| Rate for Payer: Multiplan Commercial |
$8,755.14
|
| Rate for Payer: NAPHCARE Commercial |
$307.59
|
| Rate for Payer: Preferred Network Access Commercial |
$10,396.72
|
| Rate for Payer: Quartz Beloit One Network |
$4,815.32
|
| Rate for Payer: Quartz Commercial |
$6,238.03
|
| Rate for Payer: Quartz Medicare Advantage |
$205.06
|
| Rate for Payer: The Alliance Commercial |
$871.49
|
| Rate for Payer: United Healthcare Medicaid |
$1,332.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$205.06
|
| Rate for Payer: WEA Trust Commercial |
$6,019.16
|
| Rate for Payer: WPS Commercial |
$922.76
|
|
|
HYSTEROSCOPY, BIOPSY 58558
|
Professional
|
Both
|
$3,678.00
|
|
|
Service Code
|
CPT 58558
|
| Hospital Charge Code |
3015119
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.86 |
| Max. Negotiated Rate |
$3,633.86 |
| Rate for Payer: Aetna Commercial |
$3,633.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,289.60
|
| Rate for Payer: Aetna Managed Medicare |
$193.35
|
| Rate for Payer: Anthem Medicare Advantage |
$193.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$193.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$193.35
|
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Cash Price |
$1,103.40
|
| Rate for Payer: Cigna Commercial |
$3,633.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$193.35
|
| Rate for Payer: Health EOS Commercial |
$3,480.86
|
| Rate for Payer: HFN Commercial |
$3,633.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$795.33
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$795.33
|
| Rate for Payer: Independent Care Health Plan Medicare |
$193.35
|
| Rate for Payer: Multiplan Commercial |
$3,060.10
|
| Rate for Payer: NAPHCARE Commercial |
$290.02
|
| Rate for Payer: Preferred Network Access Commercial |
$3,633.86
|
| Rate for Payer: Quartz Beloit One Network |
$1,683.05
|
| Rate for Payer: Quartz Commercial |
$2,180.32
|
| Rate for Payer: Quartz Medicare Advantage |
$193.35
|
| Rate for Payer: The Alliance Commercial |
$821.72
|
| Rate for Payer: United Healthcare Medicaid |
$184.86
|
| Rate for Payer: United Healthcare Medicare Advantage |
$193.35
|
| Rate for Payer: WEA Trust Commercial |
$2,103.82
|
| Rate for Payer: WPS Commercial |
$870.06
|
|
|
Hysteroscopy, diagnostic (separate procedure)
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 58555
|
|
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 |
$4,386.95
|
| 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
|
|
|
HYSTEROSCOPY, DX, SEP PROC 58555
|
Professional
|
Both
|
$1,593.00
|
|
|
Service Code
|
CPT 58555
|
| Hospital Charge Code |
3015118
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$127.71 |
| Max. Negotiated Rate |
$1,573.88 |
| Rate for Payer: Aetna Commercial |
$1,573.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,424.78
|
| Rate for Payer: Aetna Managed Medicare |
$127.71
|
| Rate for Payer: Anthem Medicare Advantage |
$127.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$127.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$127.71
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cash Price |
$477.90
|
| Rate for Payer: Cigna Commercial |
$1,573.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$168.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$127.71
|
| Rate for Payer: Health EOS Commercial |
$1,507.62
|
| Rate for Payer: HFN Commercial |
$1,573.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$522.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$522.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$127.71
|
| Rate for Payer: Multiplan Commercial |
$1,325.38
|
| Rate for Payer: NAPHCARE Commercial |
$191.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,573.88
|
| Rate for Payer: Quartz Beloit One Network |
$728.96
|
| Rate for Payer: Quartz Commercial |
$944.33
|
| Rate for Payer: Quartz Medicare Advantage |
$127.71
|
| Rate for Payer: The Alliance Commercial |
$542.78
|
| Rate for Payer: United Healthcare Medicaid |
$168.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$127.71
|
| Rate for Payer: WEA Trust Commercial |
$911.20
|
| Rate for Payer: WPS Commercial |
$574.70
|
|
|
HYSTEROSCOPY, REMOVE FB 58562
|
Professional
|
Both
|
$1,808.00
|
|
|
Service Code
|
CPT 58562
|
| Hospital Charge Code |
3015121
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$181.78 |
| Max. Negotiated Rate |
$1,786.30 |
| Rate for Payer: Aetna Commercial |
$1,786.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,617.08
|
| Rate for Payer: Aetna Managed Medicare |
$184.68
|
| Rate for Payer: Anthem Medicare Advantage |
$184.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.68
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cash Price |
$542.40
|
| Rate for Payer: Cigna Commercial |
$1,786.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$181.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.68
|
| Rate for Payer: Health EOS Commercial |
$1,711.09
|
| Rate for Payer: HFN Commercial |
$1,786.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$763.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$763.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.68
|
| Rate for Payer: Multiplan Commercial |
$1,504.26
|
| Rate for Payer: NAPHCARE Commercial |
$277.02
|
| Rate for Payer: Preferred Network Access Commercial |
$1,786.30
|
| Rate for Payer: Quartz Beloit One Network |
$827.34
|
| Rate for Payer: Quartz Commercial |
$1,071.78
|
| Rate for Payer: Quartz Medicare Advantage |
$184.68
|
| Rate for Payer: The Alliance Commercial |
$784.90
|
| Rate for Payer: United Healthcare Medicaid |
$181.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.68
|
| Rate for Payer: WEA Trust Commercial |
$1,034.18
|
| Rate for Payer: WPS Commercial |
$831.07
|
|
|
HYSTEROSCOPY, STERILIZATION 58565
|
Professional
|
Both
|
$8,527.00
|
|
|
Service Code
|
CPT 58565
|
| Hospital Charge Code |
3015123
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$385.25 |
| Max. Negotiated Rate |
$8,424.68 |
| Rate for Payer: Aetna Commercial |
$8,424.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,626.55
|
| Rate for Payer: Aetna Managed Medicare |
$385.25
|
| Rate for Payer: Anthem Medicare Advantage |
$385.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$385.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$385.25
|
| Rate for Payer: Cash Price |
$2,558.10
|
| Rate for Payer: Cash Price |
$2,558.10
|
| Rate for Payer: Cash Price |
$2,558.10
|
| Rate for Payer: Cigna Commercial |
$8,424.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$402.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$385.25
|
| Rate for Payer: Health EOS Commercial |
$8,069.95
|
| Rate for Payer: HFN Commercial |
$8,424.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,579.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,579.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$385.25
|
| Rate for Payer: Multiplan Commercial |
$7,094.46
|
| Rate for Payer: NAPHCARE Commercial |
$577.87
|
| Rate for Payer: Preferred Network Access Commercial |
$8,424.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,901.96
|
| Rate for Payer: Quartz Commercial |
$5,054.81
|
| Rate for Payer: Quartz Medicare Advantage |
$385.25
|
| Rate for Payer: The Alliance Commercial |
$1,637.30
|
| Rate for Payer: United Healthcare Medicaid |
$402.22
|
| Rate for Payer: United Healthcare Medicare Advantage |
$385.25
|
| Rate for Payer: WEA Trust Commercial |
$4,877.44
|
| Rate for Payer: WPS Commercial |
$1,733.61
|
|
|
Hysteroscopy, surgical; with endometrial ablation (e.g., endometrial resection, electrosurgical ablation, thermoablation)
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 58563
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| 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 |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
Hysteroscopy, surgical; with lysis of intrauterine adhesions (any method)
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 58559
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| 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 |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
HYSTEROSCOPY, SURGICAL; WITH REMOVAL OF IMPACTED FOREIGN BODY
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 58562
|
|
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 |
$6,807.99
|
| 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
|
|
|
Hysteroscopy, surgical; with removal of leiomyomata
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 58561
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| 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 |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
Hysteroscopy, surgical; with sampling (biopsy) of endometrium and/or polypectomy, with or without D & C
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 58558
|
|
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 |
$6,807.99
|
| 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
|
|
|
I-123 Iobenguane(MIBG)
|
Professional
|
Both
|
$15,177.00
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
1486836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$6,945.00 |
| Max. Negotiated Rate |
$14,994.88 |
| Rate for Payer: Aetna Commercial |
$14,994.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,574.31
|
| Rate for Payer: Cash Price |
$4,553.10
|
| Rate for Payer: Cash Price |
$4,553.10
|
| Rate for Payer: Cigna Commercial |
$14,994.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,892.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,470.45
|
| Rate for Payer: Health EOS Commercial |
$14,363.51
|
| Rate for Payer: HFN Commercial |
$14,994.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,757.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,757.87
|
| Rate for Payer: Multiplan Commercial |
$12,627.26
|
| Rate for Payer: Preferred Network Access Commercial |
$14,994.88
|
| Rate for Payer: Quartz Beloit One Network |
$6,945.00
|
| Rate for Payer: Quartz Commercial |
$8,996.93
|
| Rate for Payer: The Alliance Commercial |
$7,892.04
|
| Rate for Payer: WEA Trust Commercial |
$8,681.24
|
| Rate for Payer: WPS Commercial |
$11,690.84
|
|
|
I-123 Iobenguane(MIBG)
|
Facility
|
OP
|
$15,177.00
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
1486836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$2,410.20 |
| Max. Negotiated Rate |
$14,521.35 |
| Rate for Payer: Aetna Commercial |
$14,205.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,574.31
|
| Rate for Payer: Aetna Managed Medicare |
$2,410.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,259.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,892.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,576.36
|
| Rate for Payer: Anthem Medicare Advantage |
$2,410.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,365.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,410.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,410.20
|
| Rate for Payer: Cash Price |
$4,553.10
|
| Rate for Payer: Cash Price |
$4,553.10
|
| Rate for Payer: Cigna Commercial |
$14,521.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,410.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,833.01
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,410.20
|
| Rate for Payer: Health EOS Commercial |
$14,047.83
|
| Rate for Payer: HFN Commercial |
$14,521.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,965.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,410.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,410.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,410.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,410.20
|
| Rate for Payer: Multiplan Commercial |
$12,627.26
|
| Rate for Payer: NAPHCARE Commercial |
$3,615.30
|
| Rate for Payer: Preferred Network Access Commercial |
$14,521.35
|
| Rate for Payer: Quartz Beloit One Network |
$7,734.20
|
| Rate for Payer: Quartz Commercial |
$10,259.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,410.20
|
| Rate for Payer: The Alliance Commercial |
$9,640.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,410.20
|
| Rate for Payer: WEA Trust Commercial |
$8,681.24
|
| Rate for Payer: Wellcare Medicare |
$2,410.20
|
| Rate for Payer: WPS Commercial |
$11,690.84
|
|
|
I-123 Iobenguane(MIBG)
|
Facility
|
IP
|
$15,177.00
|
|
|
Service Code
|
HCPCS A9582
|
| Hospital Charge Code |
1486836
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$7,734.20 |
| Max. Negotiated Rate |
$14,521.35 |
| Rate for Payer: Aetna Commercial |
$14,205.67
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,574.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,365.56
|
| Rate for Payer: Cash Price |
$4,553.10
|
| Rate for Payer: Cigna Commercial |
$14,521.35
|
| Rate for Payer: Health EOS Commercial |
$14,047.83
|
| Rate for Payer: HFN Commercial |
$14,521.35
|
| Rate for Payer: Multiplan Commercial |
$12,627.26
|
| Rate for Payer: Preferred Network Access Commercial |
$14,521.35
|
| Rate for Payer: Quartz Beloit One Network |
$7,734.20
|
| Rate for Payer: Quartz Commercial |
$9,470.45
|
| Rate for Payer: WEA Trust Commercial |
$8,681.24
|
| Rate for Payer: WPS Commercial |
$11,690.84
|
|
|
I-123 sodium iodide(per 100 uCi)
|
Facility
|
IP
|
$1.00
|
|
|
Service Code
|
HCPCS A9509
|
| Hospital Charge Code |
1486824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.51 |
| Max. Negotiated Rate |
$0.96 |
| Rate for Payer: Aetna Commercial |
$0.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$0.55
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.96
|
| Rate for Payer: Health EOS Commercial |
$0.93
|
| Rate for Payer: HFN Commercial |
$0.96
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.96
|
| Rate for Payer: Quartz Beloit One Network |
$0.51
|
| Rate for Payer: Quartz Commercial |
$0.62
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
|
I-123 sodium iodide(per 100 uCi)
|
Professional
|
Both
|
$1.00
|
|
|
Service Code
|
HCPCS A9509
|
| Hospital Charge Code |
1486824
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$0.46 |
| Max. Negotiated Rate |
$3,295.23 |
| Rate for Payer: Aetna Commercial |
$0.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$0.89
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cash Price |
$0.30
|
| Rate for Payer: Cigna Commercial |
$0.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$0.62
|
| Rate for Payer: Health EOS Commercial |
$0.95
|
| Rate for Payer: HFN Commercial |
$0.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,295.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,295.23
|
| Rate for Payer: Multiplan Commercial |
$0.83
|
| Rate for Payer: Preferred Network Access Commercial |
$0.99
|
| Rate for Payer: Quartz Beloit One Network |
$0.46
|
| Rate for Payer: Quartz Commercial |
$0.59
|
| Rate for Payer: The Alliance Commercial |
$0.52
|
| Rate for Payer: United Healthcare Medicaid |
$73.69
|
| Rate for Payer: WEA Trust Commercial |
$0.57
|
| Rate for Payer: WPS Commercial |
$0.77
|
|
