▸ Hospital · IL · CCN 141340
Northwestern Medicine Valley West Hospital
1302 N. MAIN STREET, SANDWICH, IL, 60548-
21 bedsCritical Access Hospitals2
Compliance grade
A
100/100
Procedures tracked
132
of 209 target codes
Payers
16
with negotiated rates
Rates published
6,084
last crawl 2026-05-22
Procedures & rates
| Procedure | Type | Code | Payers | Gross | Cash | Neg min | Neg median | Neg max |
|---|---|---|---|---|---|---|---|---|
| behavioral | ||||||||
| Psychiatric diagnostic evaluation | CPT | 90791 | 12 | $490 | $343 | $28.31 | $128.52 | $490 |
| Psychiatric eval with medical services | CPT | 90792 | 12 | $361 | $252.7 | $68.59 | $227.43 | $361 |
| emergency | ||||||||
| ED visit level 1 | CPT | 99281 | 11 | $571 | $399.7 | $19 | $104.25 | $571 |
| ED visit level 2 | CPT | 99282 | 11 | $1,082 | $757.4 | $19 | $152.79 | $1,082 |
| ED visit level 3 | CPT | 99283 | 16 | $2,544.5 | $1,781.15 | $19 | $85 | $1,924 |
| ED visit level 4 | CPT | 99284 | 15 | $5,906.24 | $4,134.37 | $19 | $86.25 | $3,607 |
| ED visit level 5 | CPT | 99285 | 16 | $14,402 | $10,081 | $19 | $93.75 | $5,049 |
| Critical care, first hour | CPT | 99291 | 11 | $5,045 | $3,531.5 | $958.55 | $3,053.49 | $5,045 |
| imaging | ||||||||
| CT head without contrast | CPT | 70450 | 11 | $3,535 | $2,474.5 | $671.65 | $2,265.05 | $3,535 |
| CT head with contrast | CPT | 70460 | 11 | $4,174 | $2,921.8 | $793.06 | $2,674.49 | $4,174 |
| CT head with and without contrast | CPT | 70470 | 11 | $5,367 | $3,756.9 | $1,019.73 | $3,438.91 | $5,367 |
| CT neck with contrast | CPT | 70491 | 11 | $4,644 | $3,250.8 | $882.36 | $2,975.65 | $4,644 |
| MRI brain without contrast | CPT | 70551 | 11 | $5,553 | $3,887.1 | $1,055.07 | $3,558.09 | $5,553 |
| MRI brain with contrast | CPT | 70552 | 11 | $6,130 | $4,291 | $1,164.7 | $3,927.8 | $6,130 |
| MRI brain with and without contrast | CPT | 70553 | 11 | $7,693 | $5,385.1 | $1,461.67 | $4,929.29 | $7,693 |
| Chest X-ray single view | CPT | 71045 | 11 | $768 | $537.6 | $145.92 | $500.35 | $768 |
| Chest X-ray 2 views | CPT | 71046 | 11 | $963 | $674.1 | $182.97 | $627.39 | $963 |
| Chest X-ray 3 views | CPT | 71047 | 11 | $1,286 | $900.2 | $244.34 | $837.83 | $1,286 |
| CT chest without contrast | CPT | 71250 | 11 | $3,730 | $2,611 | $708.7 | $2,390 | $3,730 |
| CT chest with contrast | CPT | 71260 | 11 | $4,534 | $3,173.8 | $861.46 | $2,905.16 | $4,534 |
| CT chest with and without contrast | CPT | 71270 | 11 | $4,880 | $3,416 | $927.2 | $3,126.86 | $4,880 |
| MRI chest without contrast | CPT | 71550 | 11 | $4,192 | $2,934.4 | $796.48 | $2,686.03 | $4,192 |
| MRI chest with contrast | CPT | 71551 | 11 | $5,311 | $3,717.7 | $1,009.09 | $3,403.03 | $5,311 |
| MRI chest with and without contrast | CPT | 71552 | 11 | $6,246 | $4,372.2 | $1,186.74 | $4,002.13 | $6,246 |
| Lumbosacral spine X-ray | CPT | 72100 | 11 | $931 | $651.7 | $176.89 | $606.55 | $931 |
| CT cervical spine without contrast | CPT | 72125 | 11 | $4,526 | $3,168.2 | $859.94 | $2,900.04 | $4,526 |
| CT thoracic spine without contrast | CPT | 72128 | 11 | $4,017 | $2,811.9 | $763.23 | $2,573.9 | $4,017 |
| CT lumbar spine without contrast | CPT | 72131 | 11 | $4,405 | $3,083.5 | $836.95 | $2,822.51 | $4,405 |
| MRI cervical spine without contrast | CPT | 72141 | 11 | $5,959 | $4,171.3 | $1,132.21 | $3,818.23 | $5,959 |
| MRI thoracic spine without contrast | CPT | 72146 | 11 | $5,442 | $3,809.4 | $1,033.98 | $3,486.96 | $5,442 |
| MRI lumbar spine without contrast | CPT | 72148 | 11 | $5,482 | $3,837.4 | $1,041.58 | $3,512.59 | $5,482 |
| MRI lumbar spine with and without contrast | CPT | 72149 | 11 | $5,961 | $4,172.7 | $1,132.59 | $3,819.51 | $5,961 |
| MRI cervical spine with and without contrast | CPT | 72156 | 11 | $7,347 | $5,142.9 | $1,395.93 | $4,707.59 | $7,347 |
| MRI lumbar spine with contrast | CPT | 72158 | 11 | $6,724 | $4,706.8 | $1,277.56 | $4,308.41 | $6,724 |
| CT pelvis without contrast | CPT | 72192 | 11 | $3,081 | $2,156.7 | $585.39 | $1,974.15 | $3,081 |
| CT pelvis with contrast | CPT | 72193 | 11 | $4,154 | $2,907.8 | $789.26 | $2,661.68 | $4,154 |
| Shoulder X-ray | CPT | 73030 | 11 | $890 | $623 | $169.1 | $579.84 | $890 |
| Humerus X-ray | CPT | 73060 | 11 | $885 | $619.5 | $168.15 | $576.58 | $885 |
| Hand X-ray 3 views | CPT | 73130 | 11 | $782 | $547.4 | $148.58 | $509.47 | $782 |
| MRI upper extremity joint without contrast | CPT | 73221 | 11 | $5,131 | $3,591.7 | $974.89 | $3,287.69 | $5,131 |
| MRI upper extremity joint with and without contrast | CPT | 73223 | 11 | $6,177 | $4,323.9 | $1,173.63 | $3,957.92 | $6,177 |
| Knee X-ray 1-2 views | CPT | 73560 | 11 | $795 | $556.5 | $151.05 | $517.94 | $795 |
| Ankle X-ray 3 views | CPT | 73610 | 11 | $774 | $541.8 | $147.06 | $504.26 | $774 |
| MRI lower extremity joint without contrast | CPT | 73721 | 11 | $5,479 | $3,835.3 | $1,041.01 | $3,510.67 | $5,479 |
| MRI lower extremity joint with and without contrast | CPT | 73723 | 11 | $6,327 | $4,428.9 | $1,202.13 | $4,054.03 | $6,327 |
| CT abdomen without contrast | CPT | 74150 | 11 | $3,680 | $2,576 | $699.2 | $2,357.96 | $3,680 |
| CT abdomen with contrast | CPT | 74160 | 11 | $4,573 | $3,201.1 | $868.87 | $2,930.15 | $4,573 |
| CT abdomen with and without contrast | CPT | 74170 | 11 | $5,227 | $3,658.9 | $993.13 | $3,349.2 | $5,227 |
| CT abdomen and pelvis without contrast | CPT | 74176 | 11 | $6,860 | $4,802 | $1,303.4 | $4,395.55 | $6,860 |
| CT abdomen and pelvis with contrast | CPT | 74177 | 11 | $8,642 | $6,049.4 | $1,641.98 | $5,537.36 | $8,642 |
| CT abdomen and pelvis with and without contrast | CPT | 74178 | 11 | $10,151 | $7,105.7 | $1,928.69 | $6,504.26 | $10,151 |
| MRI abdomen without contrast | CPT | 74181 | 11 | $5,286 | $3,700.2 | $1,004.34 | $3,387.01 | $5,286 |
| MRI abdomen with and without contrast | CPT | 74183 | 11 | $6,265 | $4,385.5 | $1,190.35 | $4,014.3 | $6,265 |
| Abdominal ultrasound complete | CPT | 76700 | 11 | $2,532 | $1,772.4 | $481.08 | $1,649.6 | $2,532 |
| Abdominal ultrasound limited | CPT | 76705 | 11 | $2,292 | $1,604.4 | $435.48 | $1,493.24 | $2,292 |
| Retroperitoneal ultrasound complete | CPT | 76770 | 11 | $2,106 | $1,474.2 | $400.14 | $1,372.06 | $2,106 |
| Obstetric ultrasound first trimester | CPT | 76801 | 11 | $1,344 | $940.8 | $255.36 | $875.62 | $1,344 |
| Obstetric ultrasound after first trimester | CPT | 76805 | 11 | $1,723 | $1,206.1 | $327.37 | $1,122.53 | $1,723 |
| Obstetric ultrasound with fetal anatomy | CPT | 76811 | 11 | $1,944 | $1,360.8 | $369.36 | $1,266.52 | $1,944 |
| Transvaginal ultrasound | CPT | 76830 | 11 | $1,542 | $1,079.4 | $292.98 | $1,004.61 | $1,542 |
| Pelvic ultrasound complete | CPT | 76856 | 11 | $2,157 | $1,509.9 | $409.83 | $1,405.29 | $2,157 |
| Scrotal ultrasound | CPT | 76870 | 11 | $1,967 | $1,376.9 | $373.73 | $1,281.5 | $1,967 |
| Diagnostic mammography unilateral | CPT | 77065 | 11 | $664 | $464.8 | $126.16 | $432.6 | $664 |
| Diagnostic mammography bilateral | CPT | 77066 | 11 | $734 | $513.8 | $139.46 | $478.2 | $734 |
| Screening mammography bilateral | CPT | 77067 | 11 | $748 | $523.6 | $142.12 | $487.32 | $748 |
| EKG tracing only | CPT | 93005 | 12 | $309 | $216.3 | $58.71 | $194.67 | $309 |
| Transthoracic echocardiogram complete | CPT | 93306 | 12 | $4,215 | $2,950.5 | $800.85 | $2,655.45 | $4,215 |
| Transthoracic echocardiogram | CPT | 93307 | 12 | $2,853 | $1,997.1 | $542.07 | $1,797.39 | $2,853 |
| Stress echocardiogram | CPT | 93350 | 12 | $4,021 | $2,814.7 | $763.99 | $2,533.23 | $4,021 |
| inpatient | ||||||||
| Intracranial hemorrhage/CVA w CC | MS-DRG | 065 | 9 | $40,829 | $28,580 | $25.4 | $76.7 | $21,621 |
| Respiratory infections & inflammations w MCC | MS-DRG | 177 | 9 | $33,501 | $23,451 | $25.4 | $87.5 | $43,062 |
| COPD w MCC | MS-DRG | 190 | 9 | $25,615 | $17,930 | $25.4 | $87.5 | $30,524 |
| COPD w CC | MS-DRG | 191 | 9 | $55,667 | $38,967 | $25.4 | $87.5 | $23,230 |
| COPD w/o CC/MCC | MS-DRG | 192 | 9 | $16,212 | $11,349 | $25.4 | $87.5 | $17,691 |
| Simple pneumonia & pleurisy w CC | MS-DRG | 194 | 9 | $24,888 | $17,421 | $25.4 | $87.5 | $22,207 |
| Simple pneumonia & pleurisy w/o CC/MCC | MS-DRG | 195 | 9 | $12,831 | $8,981.52 | $25.4 | $87.5 | $17,319 |
| AMI discharged alive w CC | MS-DRG | 281 | 9 | $34,320 | $24,024 | $25.4 | $76.7 | $19,670 |
| Heart failure & shock w MCC | MS-DRG | 291 | 9 | $25,044 | $17,531 | $25.4 | $87.5 | $35,376 |
| Heart failure & shock w CC | MS-DRG | 292 | 9 | $26,935 | $18,855 | $25.4 | $76.7 | $18,169 |
| Heart failure & shock w/o CC/MCC | MS-DRG | 293 | 9 | $12,190 | $8,533 | $25.4 | $87.5 | $15,597 |
| Cardiac arrhythmia w MCC | MS-DRG | 308 | 9 | $22,555 | $15,789 | $25.4 | $87.5 | $33,177 |
| Cardiac arrhythmia w CC | MS-DRG | 309 | 9 | $16,829 | $11,780 | $25.4 | $76.7 | $15,745 |
| Cardiac arrhythmia w/o CC/MCC | MS-DRG | 310 | 9 | $7,127.5 | $4,989.25 | $25.4 | $87.5 | $15,599 |
| GI hemorrhage w CC | MS-DRG | 378 | 9 | $33,692 | $23,585 | $25.4 | $76.7 | $20,988 |
| Esophagitis/gastroenteritis w/o MCC | MS-DRG | 392 | 9 | $23,087 | $16,161 | $25.4 | $87.5 | $21,483 |
| Kidney/UTI w MCC | MS-DRG | 689 | 9 | $21,653 | $15,157 | $25.4 | $87.5 | $31,973 |
| Kidney/UTI w/o MCC | MS-DRG | 690 | 9 | $19,010 | $13,307 | $25.4 | $87.5 | $22,307 |
| Septicemia or severe sepsis w MV 96+ hrs | MS-DRG | 871 | 9 | $31,497 | $22,048 | $25.4 | $87.5 | $53,528 |
| Septicemia or severe sepsis w/o MV 96+ hrs | MS-DRG | 872 | 9 | $31,606 | $22,124 | $25.4 | $87.5 | $28,198 |
| Initial hospital care, high complexity | CPT | 99223 | 12 | $200 | $140 | $38 | $130.3 | $200 |
| Hospital discharge, <30 min | CPT | 99238 | 12 | $125 | $87.5 | $23.75 | $81.44 | $125 |
| Hospital discharge, >30 min | CPT | 99239 | 12 | $125 | $87.5 | $23.75 | $81.44 | $125 |
| lab | ||||||||
| Basic metabolic panel (BMP) | CPT | 80048 | 11 | $314 | $219.8 | $59.66 | $201.2 | $314 |
| Electrolyte panel | CPT | 80051 | 11 | $107 | $74.9 | $19.95 | $67.91 | $107 |
| Comprehensive metabolic panel | CPT | 80053 | 11 | $438 | $306.6 | $83.22 | $280.65 | $438 |
| Lipid panel | CPT | 80061 | 11 | $263 | $184.1 | $49.97 | $168.52 | $263 |
| Renal function panel | CPT | 80069 | 11 | $212 | $148.4 | $37.24 | $130.08 | $212 |
| Hepatic function panel | CPT | 80076 | 11 | $237 | $165.9 | $32.68 | $129.33 | $237 |
| Urinalysis non-automated | CPT | 81002 | 11 | $31 | $21.7 | $5.89 | $19.87 | $31 |
| Urinalysis automated | CPT | 81003 | 11 | $86 | $60.2 | $1.9 | $29.22 | $86 |
| Glucose quantitative | CPT | 82947 | 11 | $112 | $78.4 | $2.09 | $36.99 | $112 |
| Hemoglobin A1c | CPT | 83036 | 11 | $167 | $116.9 | $31.73 | $107.01 | $167 |
| Thyroid stimulating hormone (TSH) | CPT | 84443 | 11 | $232 | $162.4 | $44.08 | $148.66 | $232 |
| Complete blood count with automated differential | CPT | 85025 | 11 | $181 | $126.7 | $21.28 | $90.55 | $181 |
| Complete blood count without differential | CPT | 85027 | 11 | $131 | $91.7 | $17.67 | $66.3 | $131 |
| Urine culture bacterial | CPT | 87086 | 11 | $186 | $130.2 | $24.89 | $102.53 | $186 |
| Urine culture identification | CPT | 87088 | 11 | $166 | $116.2 | $18.62 | $79.24 | $166 |
| Tissue exam by pathologist level IV | CPT | 88305 | 16 | $12,112 | $8,478.68 | $19 | $215.02 | $589 |
| maternity | ||||||||
| Fetal non-stress test | CPT | 59025 | 12 | $940 | $658 | $178.6 | $592.2 | $940 |
| Vaginal delivery only | CPT | 59409 | 12 | $6,714 | $4,699.8 | $1,275.66 | $4,374.17 | $6,714 |
| office | ||||||||
| Office visit, new patient, 15-29 min | CPT | 99202 | 12 | $308 | $215.6 | $58.52 | $194.04 | $308 |
| Office visit, new patient, 30-44 minutes | CPT | 99203 | 12 | $543 | $380.1 | $103.17 | $342.09 | $543 |
| Office visit, new patient, 45-59 min | CPT | 99204 | 12 | $626 | $438.2 | $118.94 | $394.38 | $626 |
| Office visit, new patient, 60-74 min | CPT | 99205 | 12 | $915 | $640.5 | $173.85 | $576.45 | $915 |
| Office visit, established patient, 5 min | CPT | 99211 | 12 | $227 | $158.9 | $43.13 | $143.01 | $227 |
| Office visit, established patient, 10-19 min | CPT | 99212 | 12 | $280 | $196 | $28.69 | $122.09 | $280 |
| Office visit, established patient, 20-29 minutes | CPT | 99213 | 12 | $416 | $291.2 | $41.04 | $174.64 | $416 |
| Office visit, established patient, 30-39 minutes | CPT | 99214 | 12 | $569 | $398.3 | $44.65 | $195.01 | $569 |
| Office visit, established patient, 40-54 min | CPT | 99215 | 12 | $870 | $609 | $165.3 | $548.1 | $870 |
| preventive | ||||||||
| Upper GI endoscopy diagnostic | CPT | 43235 | 16 | $6,931.74 | $4,852.22 | $19 | $295.85 | $3,919 |
| Upper GI endoscopy with biopsy | CPT | 43239 | 16 | $14,764 | $10,335 | $19 | $306.4 | $4,597 |
| Sigmoidoscopy diagnostic | CPT | 45330 | 16 | $12,603 | $8,821.94 | $19 | $141 | $3,329 |
| Sigmoidoscopy with biopsy | CPT | 45331 | 16 | $5,927.51 | $4,149.26 | $19 | $176.7 | $1,676 |
| Colonoscopy diagnostic | CPT | 45378 | 16 | $6,132.24 | $4,292.57 | $19 | $270.7 | $3,607 |
| Colonoscopy with biopsy | CPT | 45380 | 16 | $17,517 | $12,262 | $19 | $270.7 | $5,849 |
| Colonoscopy with polyp removal | CPT | 45385 | 16 | $11,603 | $8,121.99 | $19 | $342.1 | $5,849 |
| surgery | ||||||||
| Shoulder arthroscopy with decompression | CPT | 29826 | 16 | $94,877 | $66,414 | $6.9 | $55.9 | $100 |
| Shoulder arthroscopy with rotator cuff repair | CPT | 29827 | 16 | $94,877 | $66,414 | $6.9 | $55.9 | $100 |
| Laparoscopic cholecystectomy | CPT | 47562 | 12 | $22,604 | $15,823 | $4,294.76 | $14,727 | $22,604 |
| Lap cholecystectomy with cholangiography | CPT | 47563 | 12 | $20,232 | $14,162 | $3,844.08 | $13,181 | $20,232 |
| Intravitreal injection | CPT | 67028 | 12 | $4,384 | $3,068.8 | $832.96 | $2,856.18 | $4,384 |
| PCI with drug-eluting stent | CPT | 92928 | 12 | $31,809 | $22,266 | $6,043.71 | $18,354 | $31,809 |
Payer mix (top 16)
| Payer | Codes covered | Median rate |
|---|---|---|
| Aetna | 132 | $269.35 |
| Blue Cross Blue Shield | 132 | $481.21 |
| choicecare [177] | 132 | $374.75 |
| First Health | 132 | $556 |
| health's finest network [126] | 132 | $318.58 |
| healthlink [125] | 132 | $417 |
| Multiplan | 132 | $570 |
| the alliance [1703] | 132 | $302.19 |
| UnitedHealthcare | 128 | $380.5 |
| Humana | 112 | $149.82 |
| global excel [1712] | 112 | $149.82 |
| Cigna | 40 | $188.45 |
| countycare il cook co [1607] | 13 | $141 |
| meridian health plan hmo [1604] | 13 | $141 |
| family health network hmo [1610] | 13 | $141 |
| Medicaid | 13 | $141 |