|
XR ERCP Biliary Duct
|
Facility
OP
|
$1,461.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2587214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$1,344.12 |
| Rate for Payer: Aetna Commercial |
$1,314.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,256.46
|
| Rate for Payer: Aetna Managed Medicare |
$409.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$949.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$730.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$701.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.33
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,344.12
|
| Rate for Payer: Health EOS Commercial |
$1,300.29
|
| Rate for Payer: HFN Commercial |
$1,344.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,095.75
|
| Rate for Payer: Multiplan Commercial |
$1,168.80
|
| Rate for Payer: NAPHCARE Commercial |
$876.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,344.12
|
| Rate for Payer: Quartz Beloit One Network |
$715.89
|
| Rate for Payer: Quartz Commercial |
$949.65
|
| Rate for Payer: Quartz Medicare Advantage |
$876.60
|
| Rate for Payer: The Alliance Commercial |
$842.24
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$803.55
|
| Rate for Payer: WPS Commercial |
$1,082.16
|
|
|
XR ERCP Biliary Duct
|
Facility
IP
|
$1,461.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2587214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$715.89 |
| Max. Negotiated Rate |
$1,344.12 |
| Rate for Payer: Aetna Commercial |
$1,314.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$774.33
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,344.12
|
| Rate for Payer: Health EOS Commercial |
$1,300.29
|
| Rate for Payer: HFN Commercial |
$1,344.12
|
| Rate for Payer: Multiplan Commercial |
$1,168.80
|
| Rate for Payer: NAPHCARE Commercial |
$876.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,344.12
|
| Rate for Payer: Quartz Beloit One Network |
$715.89
|
| Rate for Payer: Quartz Commercial |
$876.60
|
| Rate for Payer: WEA Trust Commercial |
$803.55
|
| Rate for Payer: WPS Commercial |
$1,082.16
|
|
|
XR ERCP Biliary Duct
|
Facility
OP
|
$1,353.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2448810
|
| Min. Negotiated Rate |
$378.84 |
| Max. Negotiated Rate |
$1,244.76 |
| Rate for Payer: Aetna Commercial |
$1,217.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,163.58
|
| Rate for Payer: Aetna Managed Medicare |
$378.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$879.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$676.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$649.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.09
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,244.76
|
| Rate for Payer: Health EOS Commercial |
$1,204.17
|
| Rate for Payer: HFN Commercial |
$1,244.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,014.75
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$811.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,244.76
|
| Rate for Payer: Quartz Beloit One Network |
$662.97
|
| Rate for Payer: Quartz Commercial |
$879.45
|
| Rate for Payer: Quartz Medicare Advantage |
$811.80
|
| Rate for Payer: The Alliance Commercial |
$842.24
|
| Rate for Payer: WEA Trust Commercial |
$744.15
|
| Rate for Payer: WPS Commercial |
$1,002.17
|
|
|
XR ERCP Biliary Duct
|
Professional
|
$1,353.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2448810
|
| Min. Negotiated Rate |
$546.55 |
| Max. Negotiated Rate |
$1,285.35 |
| Rate for Payer: Aetna Commercial |
$1,285.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,163.58
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,285.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$676.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$811.80
|
| Rate for Payer: Health EOS Commercial |
$1,231.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$546.55
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,285.35
|
| Rate for Payer: Quartz Beloit One Network |
$595.32
|
| Rate for Payer: Quartz Commercial |
$771.21
|
| Rate for Payer: The Alliance Commercial |
$676.50
|
| Rate for Payer: WEA Trust Commercial |
$744.15
|
| Rate for Payer: WPS Commercial |
$1,002.17
|
|
|
XR ERCP Biliary Duct
|
Facility
IP
|
$1,353.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2448810
|
| Min. Negotiated Rate |
$662.97 |
| Max. Negotiated Rate |
$1,244.76 |
| Rate for Payer: Aetna Commercial |
$1,217.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$717.09
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,244.76
|
| Rate for Payer: Health EOS Commercial |
$1,204.17
|
| Rate for Payer: HFN Commercial |
$1,244.76
|
| Rate for Payer: Multiplan Commercial |
$1,082.40
|
| Rate for Payer: NAPHCARE Commercial |
$811.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,244.76
|
| Rate for Payer: Quartz Beloit One Network |
$662.97
|
| Rate for Payer: Quartz Commercial |
$811.80
|
| Rate for Payer: WEA Trust Commercial |
$744.15
|
| Rate for Payer: WPS Commercial |
$1,002.17
|
|
|
XR ERCP Biliary Duct
|
Professional
|
$1,461.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2587214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$546.55 |
| Max. Negotiated Rate |
$1,387.95 |
| Rate for Payer: Aetna Commercial |
$1,387.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,256.46
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,387.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$730.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$876.60
|
| Rate for Payer: Health EOS Commercial |
$1,329.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$546.55
|
| Rate for Payer: Multiplan Commercial |
$1,168.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,387.95
|
| Rate for Payer: Quartz Beloit One Network |
$642.84
|
| Rate for Payer: Quartz Commercial |
$832.77
|
| Rate for Payer: The Alliance Commercial |
$730.50
|
| Rate for Payer: WEA Trust Commercial |
$803.55
|
| Rate for Payer: WPS Commercial |
$1,082.16
|
|
|
XR ERCP Pancreatic Duct
|
Facility
OP
|
$2,324.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2448811
|
| Min. Negotiated Rate |
$147.24 |
| Max. Negotiated Rate |
$2,138.08 |
| Rate for Payer: Aetna Commercial |
$2,091.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.64
|
| Rate for Payer: Aetna Managed Medicare |
$650.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,510.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,162.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,115.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.72
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,138.08
|
| Rate for Payer: Health EOS Commercial |
$2,068.36
|
| Rate for Payer: HFN Commercial |
$2,138.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,743.00
|
| Rate for Payer: Multiplan Commercial |
$1,859.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,138.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.76
|
| Rate for Payer: Quartz Commercial |
$1,510.60
|
| Rate for Payer: Quartz Medicare Advantage |
$1,394.40
|
| Rate for Payer: The Alliance Commercial |
$147.24
|
| Rate for Payer: WEA Trust Commercial |
$1,278.20
|
| Rate for Payer: WPS Commercial |
$1,721.39
|
|
|
XR ERCP Pancreatic Duct
|
Facility
IP
|
$2,324.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2448811
|
| Min. Negotiated Rate |
$1,138.76 |
| Max. Negotiated Rate |
$2,138.08 |
| Rate for Payer: Aetna Commercial |
$2,091.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,231.72
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,138.08
|
| Rate for Payer: Health EOS Commercial |
$2,068.36
|
| Rate for Payer: HFN Commercial |
$2,138.08
|
| Rate for Payer: Multiplan Commercial |
$1,859.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,138.08
|
| Rate for Payer: Quartz Beloit One Network |
$1,138.76
|
| Rate for Payer: Quartz Commercial |
$1,394.40
|
| Rate for Payer: WEA Trust Commercial |
$1,278.20
|
| Rate for Payer: WPS Commercial |
$1,721.39
|
|
|
XR ERCP Pancreatic Duct
|
Facility
OP
|
$2,417.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2587220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$147.24 |
| Max. Negotiated Rate |
$2,223.64 |
| Rate for Payer: Aetna Commercial |
$2,175.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.62
|
| Rate for Payer: Aetna Managed Medicare |
$676.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,571.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,208.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,160.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,281.01
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,223.64
|
| Rate for Payer: Health EOS Commercial |
$2,151.13
|
| Rate for Payer: HFN Commercial |
$2,223.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,812.75
|
| Rate for Payer: Multiplan Commercial |
$1,933.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,450.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.33
|
| Rate for Payer: Quartz Commercial |
$1,571.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,450.20
|
| Rate for Payer: The Alliance Commercial |
$147.24
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,329.35
|
| Rate for Payer: WPS Commercial |
$1,790.27
|
|
|
XR ERCP Pancreatic Duct
|
Professional
|
$2,324.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2448811
|
| Min. Negotiated Rate |
$546.55 |
| Max. Negotiated Rate |
$2,207.80 |
| Rate for Payer: Aetna Commercial |
$2,207.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,998.64
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,207.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,162.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,394.40
|
| Rate for Payer: Health EOS Commercial |
$2,114.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$546.55
|
| Rate for Payer: Multiplan Commercial |
$1,859.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,207.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,022.56
|
| Rate for Payer: Quartz Commercial |
$1,324.68
|
| Rate for Payer: The Alliance Commercial |
$1,162.00
|
| Rate for Payer: WEA Trust Commercial |
$1,278.20
|
| Rate for Payer: WPS Commercial |
$1,721.39
|
|
|
XR ERCP Pancreatic Duct
|
Professional
|
$2,417.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2587220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$546.55 |
| Max. Negotiated Rate |
$2,296.15 |
| Rate for Payer: Aetna Commercial |
$2,296.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.62
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,296.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,208.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,450.20
|
| Rate for Payer: Health EOS Commercial |
$2,199.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$546.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$546.55
|
| Rate for Payer: Multiplan Commercial |
$1,933.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.15
|
| Rate for Payer: Quartz Beloit One Network |
$1,063.48
|
| Rate for Payer: Quartz Commercial |
$1,377.69
|
| Rate for Payer: The Alliance Commercial |
$1,208.50
|
| Rate for Payer: WEA Trust Commercial |
$1,329.35
|
| Rate for Payer: WPS Commercial |
$1,790.27
|
|
|
XR ERCP Pancreatic Duct
|
Facility
IP
|
$2,417.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2587220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,184.33 |
| Max. Negotiated Rate |
$2,223.64 |
| Rate for Payer: Aetna Commercial |
$2,175.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,281.01
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,223.64
|
| Rate for Payer: Health EOS Commercial |
$2,151.13
|
| Rate for Payer: HFN Commercial |
$2,223.64
|
| Rate for Payer: Multiplan Commercial |
$1,933.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,450.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.64
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.33
|
| Rate for Payer: Quartz Commercial |
$1,450.20
|
| Rate for Payer: WEA Trust Commercial |
$1,329.35
|
| Rate for Payer: WPS Commercial |
$1,790.27
|
|
|
XR Esophagus
|
Facility
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$65.72 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$681.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$544.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$517.56
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$797.55
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$65.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
XR Esophagus
|
Professional
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
630671
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$952.85 |
| Rate for Payer: Aetna Commercial |
$952.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Aetna Managed Medicare |
$96.20
|
| Rate for Payer: Anthem Medicare Advantage |
$96.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.20
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$952.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$501.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.20
|
| Rate for Payer: Health EOS Commercial |
$912.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$343.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: Preferred Network Access Commercial |
$952.85
|
| Rate for Payer: Quartz Beloit One Network |
$441.32
|
| Rate for Payer: Quartz Commercial |
$571.71
|
| Rate for Payer: Quartz Medicare Advantage |
$96.20
|
| Rate for Payer: The Alliance Commercial |
$365.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.20
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: WPS Commercial |
$481.00
|
|
|
XR Esophagus
|
Professional
|
$1,227.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$96.20 |
| Max. Negotiated Rate |
$1,165.65 |
| Rate for Payer: Aetna Commercial |
$1,165.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,055.22
|
| Rate for Payer: Aetna Managed Medicare |
$96.20
|
| Rate for Payer: Anthem Medicare Advantage |
$96.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$96.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$96.20
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,165.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$613.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96.20
|
| Rate for Payer: Health EOS Commercial |
$1,116.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$343.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$343.75
|
| Rate for Payer: Independent Care Health Plan Medicare |
$96.20
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,165.65
|
| Rate for Payer: Quartz Beloit One Network |
$539.88
|
| Rate for Payer: Quartz Commercial |
$699.39
|
| Rate for Payer: Quartz Medicare Advantage |
$96.20
|
| Rate for Payer: The Alliance Commercial |
$365.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$96.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$481.00
|
|
|
XR Esophagus
|
Facility
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
630671
|
| Min. Negotiated Rate |
$491.47 |
| Max. Negotiated Rate |
$922.76 |
| Rate for Payer: Aetna Commercial |
$902.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.59
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$922.76
|
| Rate for Payer: Health EOS Commercial |
$892.67
|
| Rate for Payer: HFN Commercial |
$922.76
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: NAPHCARE Commercial |
$601.80
|
| Rate for Payer: Preferred Network Access Commercial |
$922.76
|
| Rate for Payer: Quartz Beloit One Network |
$491.47
|
| Rate for Payer: Quartz Commercial |
$601.80
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
|
XR Esophagus
|
Facility
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
630671
|
| Min. Negotiated Rate |
$65.72 |
| Max. Negotiated Rate |
$922.76 |
| Rate for Payer: Aetna Commercial |
$902.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$862.58
|
| Rate for Payer: Aetna Managed Medicare |
$181.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$651.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$501.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$481.44
|
| Rate for Payer: Anthem Medicare Advantage |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$531.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$181.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$181.60
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$922.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$181.60
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$181.60
|
| Rate for Payer: Health EOS Commercial |
$892.67
|
| Rate for Payer: HFN Commercial |
$922.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$675.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$181.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$181.60
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$181.60
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$181.60
|
| Rate for Payer: Multiplan Commercial |
$802.40
|
| Rate for Payer: NAPHCARE Commercial |
$272.40
|
| Rate for Payer: Preferred Network Access Commercial |
$922.76
|
| Rate for Payer: Quartz Beloit One Network |
$491.47
|
| Rate for Payer: Quartz Commercial |
$651.95
|
| Rate for Payer: Quartz Medicare Advantage |
$181.60
|
| Rate for Payer: The Alliance Commercial |
$65.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$181.60
|
| Rate for Payer: WEA Trust Commercial |
$551.65
|
| Rate for Payer: Wellcare Medicare |
$181.60
|
| Rate for Payer: WPS Commercial |
$742.92
|
|
|
XR Esophagus
|
Facility
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$601.23 |
| Max. Negotiated Rate |
$1,128.84 |
| Rate for Payer: Aetna Commercial |
$1,104.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$650.31
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,128.84
|
| Rate for Payer: Health EOS Commercial |
$1,092.03
|
| Rate for Payer: HFN Commercial |
$1,128.84
|
| Rate for Payer: Multiplan Commercial |
$981.60
|
| Rate for Payer: NAPHCARE Commercial |
$736.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,128.84
|
| Rate for Payer: Quartz Beloit One Network |
$601.23
|
| Rate for Payer: Quartz Commercial |
$736.20
|
| Rate for Payer: WEA Trust Commercial |
$674.85
|
| Rate for Payer: WPS Commercial |
$908.84
|
|
|
XR Facial Bones < 3 Views
|
Facility
OP
|
$537.00
|
|
|
Service Code
|
CPT 70140 TC
|
| Hospital Charge Code |
1537016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$150.36 |
| Max. Negotiated Rate |
$2,148.00 |
| Rate for Payer: Aetna Commercial |
$483.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Aetna Managed Medicare |
$150.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$349.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$268.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$257.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.61
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$494.04
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$494.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$402.75
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: NAPHCARE Commercial |
$322.20
|
| Rate for Payer: Preferred Network Access Commercial |
$494.04
|
| Rate for Payer: Quartz Beloit One Network |
$263.13
|
| Rate for Payer: Quartz Commercial |
$349.05
|
| Rate for Payer: Quartz Medicare Advantage |
$322.20
|
| Rate for Payer: The Alliance Commercial |
$2,148.00
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
XR Facial Bones < 3 Views
|
Facility
IP
|
$537.00
|
|
|
Service Code
|
CPT 70140 TC
|
| Hospital Charge Code |
1537016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$263.13 |
| Max. Negotiated Rate |
$494.04 |
| Rate for Payer: Aetna Commercial |
$483.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$284.61
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$494.04
|
| Rate for Payer: Health EOS Commercial |
$477.93
|
| Rate for Payer: HFN Commercial |
$494.04
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: NAPHCARE Commercial |
$322.20
|
| Rate for Payer: Preferred Network Access Commercial |
$494.04
|
| Rate for Payer: Quartz Beloit One Network |
$263.13
|
| Rate for Payer: Quartz Commercial |
$322.20
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$397.76
|
|
|
XR Facial Bones < 3 Views
|
Facility
IP
|
$497.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
630666
|
| Min. Negotiated Rate |
$243.53 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$298.20
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$298.20
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
XR Facial Bones < 3 Views
|
Professional
|
$537.00
|
|
|
Service Code
|
CPT 70140 TC
|
| Hospital Charge Code |
1537016
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$21.68 |
| Max. Negotiated Rate |
$510.15 |
| Rate for Payer: Aetna Commercial |
$510.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$461.82
|
| Rate for Payer: Aetna Managed Medicare |
$21.68
|
| Rate for Payer: Anthem Medicare Advantage |
$21.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$21.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$21.68
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$510.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$268.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21.68
|
| Rate for Payer: Health EOS Commercial |
$488.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$74.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$21.68
|
| Rate for Payer: Multiplan Commercial |
$429.60
|
| Rate for Payer: Preferred Network Access Commercial |
$510.15
|
| Rate for Payer: Quartz Beloit One Network |
$236.28
|
| Rate for Payer: Quartz Commercial |
$306.09
|
| Rate for Payer: Quartz Medicare Advantage |
$21.68
|
| Rate for Payer: The Alliance Commercial |
$82.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$21.68
|
| Rate for Payer: WEA Trust Commercial |
$295.35
|
| Rate for Payer: WPS Commercial |
$108.40
|
|
|
XR Facial Bones < 3 Views
|
Facility
OP
|
$497.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
630666
|
| Min. Negotiated Rate |
$3.80 |
| Max. Negotiated Rate |
$457.24 |
| Rate for Payer: Aetna Commercial |
$447.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$89.82
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$323.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$248.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$238.56
|
| Rate for Payer: Anthem Medicare Advantage |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$263.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$89.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$89.82
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$457.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$89.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$89.82
|
| Rate for Payer: Health EOS Commercial |
$442.33
|
| Rate for Payer: HFN Commercial |
$457.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.13
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$89.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$89.82
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$89.82
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$89.82
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: NAPHCARE Commercial |
$134.73
|
| Rate for Payer: Preferred Network Access Commercial |
$457.24
|
| Rate for Payer: Quartz Beloit One Network |
$243.53
|
| Rate for Payer: Quartz Commercial |
$323.05
|
| Rate for Payer: Quartz Medicare Advantage |
$89.82
|
| Rate for Payer: The Alliance Commercial |
$3.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$89.82
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: Wellcare Medicare |
$89.82
|
| Rate for Payer: WPS Commercial |
$368.13
|
|
|
XR Facial Bones < 3 Views
|
Professional
|
$497.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
630666
|
| Min. Negotiated Rate |
$31.12 |
| Max. Negotiated Rate |
$472.15 |
| Rate for Payer: Aetna Commercial |
$472.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$427.42
|
| Rate for Payer: Aetna Managed Medicare |
$31.12
|
| Rate for Payer: Anthem Medicare Advantage |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.12
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$472.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$248.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.12
|
| Rate for Payer: Health EOS Commercial |
$452.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$108.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$108.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.12
|
| Rate for Payer: Multiplan Commercial |
$397.60
|
| Rate for Payer: Preferred Network Access Commercial |
$472.15
|
| Rate for Payer: Quartz Beloit One Network |
$218.68
|
| Rate for Payer: Quartz Commercial |
$283.29
|
| Rate for Payer: Quartz Medicare Advantage |
$31.12
|
| Rate for Payer: The Alliance Commercial |
$118.26
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.12
|
| Rate for Payer: WEA Trust Commercial |
$273.35
|
| Rate for Payer: WPS Commercial |
$155.60
|
|
|
XR Facial Bones Minimum 3 Views
|
Facility
IP
|
$753.00
|
|
|
Service Code
|
CPT 70150 TC
|
| Hospital Charge Code |
1537018
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$368.97 |
| Max. Negotiated Rate |
$692.76 |
| Rate for Payer: Aetna Commercial |
$677.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$399.09
|
| Rate for Payer: Cash Price |
$225.90
|
| Rate for Payer: Cigna Commercial |
$692.76
|
| Rate for Payer: Health EOS Commercial |
$670.17
|
| Rate for Payer: HFN Commercial |
$692.76
|
| Rate for Payer: Multiplan Commercial |
$602.40
|
| Rate for Payer: NAPHCARE Commercial |
$451.80
|
| Rate for Payer: Preferred Network Access Commercial |
$692.76
|
| Rate for Payer: Quartz Beloit One Network |
$368.97
|
| Rate for Payer: Quartz Commercial |
$451.80
|
| Rate for Payer: WEA Trust Commercial |
$414.15
|
| Rate for Payer: WPS Commercial |
$557.75
|
|
