|
XR Barium Enema Therapeutic
|
Facility
|
IP
|
$1,527.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
1536881
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$778.16 |
| Max. Negotiated Rate |
$1,461.03 |
| Rate for Payer: Aetna Commercial |
$1,429.27
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,365.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$841.68
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cigna Commercial |
$1,461.03
|
| Rate for Payer: Health EOS Commercial |
$1,413.39
|
| Rate for Payer: HFN Commercial |
$1,461.03
|
| Rate for Payer: Multiplan Commercial |
$1,270.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,461.03
|
| Rate for Payer: Quartz Beloit One Network |
$778.16
|
| Rate for Payer: Quartz Commercial |
$952.85
|
| Rate for Payer: WEA Trust Commercial |
$873.44
|
| Rate for Payer: WPS Commercial |
$1,176.25
|
|
|
XR Barium Enema Therapeutic
|
Professional
|
Both
|
$1,527.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
1536881
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$279.14 |
| Max. Negotiated Rate |
$1,508.68 |
| Rate for Payer: Aetna Commercial |
$1,508.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,365.75
|
| Rate for Payer: Aetna Managed Medicare |
$279.14
|
| Rate for Payer: Anthem Medicare Advantage |
$279.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$279.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$279.14
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cash Price |
$458.10
|
| Rate for Payer: Cigna Commercial |
$1,508.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$794.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.14
|
| Rate for Payer: Health EOS Commercial |
$1,445.15
|
| Rate for Payer: HFN Commercial |
$1,508.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$939.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$939.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$279.14
|
| Rate for Payer: Multiplan Commercial |
$1,270.46
|
| Rate for Payer: NAPHCARE Commercial |
$418.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,508.68
|
| Rate for Payer: Quartz Beloit One Network |
$698.76
|
| Rate for Payer: Quartz Commercial |
$905.21
|
| Rate for Payer: Quartz Medicare Advantage |
$279.14
|
| Rate for Payer: The Alliance Commercial |
$1,060.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.14
|
| Rate for Payer: WEA Trust Commercial |
$873.44
|
| Rate for Payer: WPS Commercial |
$1,395.68
|
|
|
XR Barium Enema Therapeutic
|
Professional
|
Both
|
$1,468.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
627610
|
| Min. Negotiated Rate |
$279.14 |
| Max. Negotiated Rate |
$1,450.38 |
| Rate for Payer: Aetna Commercial |
$1,450.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.98
|
| Rate for Payer: Aetna Managed Medicare |
$279.14
|
| Rate for Payer: Anthem Medicare Advantage |
$279.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$279.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$279.14
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,450.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$763.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$279.14
|
| Rate for Payer: Health EOS Commercial |
$1,389.32
|
| Rate for Payer: HFN Commercial |
$1,450.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$939.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$939.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$279.14
|
| Rate for Payer: Multiplan Commercial |
$1,221.38
|
| Rate for Payer: NAPHCARE Commercial |
$418.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,450.38
|
| Rate for Payer: Quartz Beloit One Network |
$671.76
|
| Rate for Payer: Quartz Commercial |
$870.23
|
| Rate for Payer: Quartz Medicare Advantage |
$279.14
|
| Rate for Payer: The Alliance Commercial |
$1,060.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$279.14
|
| Rate for Payer: WEA Trust Commercial |
$839.70
|
| Rate for Payer: WPS Commercial |
$1,395.68
|
|
|
XR Barium Enema Therapeutic
|
Facility
|
OP
|
$1,468.00
|
|
|
Service Code
|
CPT 74283
|
| Hospital Charge Code |
627610
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,404.58 |
| Rate for Payer: Aetna Commercial |
$1,374.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,312.98
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$992.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$763.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$732.83
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$809.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cash Price |
$440.40
|
| Rate for Payer: Cigna Commercial |
$1,404.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$854.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,358.78
|
| Rate for Payer: HFN Commercial |
$1,404.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,221.38
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,404.58
|
| Rate for Payer: Quartz Beloit One Network |
$748.09
|
| Rate for Payer: Quartz Commercial |
$992.37
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$839.70
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,130.80
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
OP
|
$1,683.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
627612
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,610.29 |
| Rate for Payer: Aetna Commercial |
$1,575.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.28
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,137.71
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$875.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$840.15
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna Commercial |
$1,610.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$979.51
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,557.78
|
| Rate for Payer: HFN Commercial |
$1,610.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,400.26
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.29
|
| Rate for Payer: Quartz Beloit One Network |
$857.66
|
| Rate for Payer: Quartz Commercial |
$1,137.71
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: WEA Trust Commercial |
$962.68
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,296.41
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
IP
|
$1,683.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
627612
|
| Min. Negotiated Rate |
$857.66 |
| Max. Negotiated Rate |
$1,610.29 |
| Rate for Payer: Aetna Commercial |
$1,575.29
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$927.67
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna Commercial |
$1,610.29
|
| Rate for Payer: Health EOS Commercial |
$1,557.78
|
| Rate for Payer: HFN Commercial |
$1,610.29
|
| Rate for Payer: Multiplan Commercial |
$1,400.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,610.29
|
| Rate for Payer: Quartz Beloit One Network |
$857.66
|
| Rate for Payer: Quartz Commercial |
$1,050.19
|
| Rate for Payer: WEA Trust Commercial |
$962.68
|
| Rate for Payer: WPS Commercial |
$1,296.41
|
|
|
XR Barium Enema w/ Air Complete
|
Professional
|
Both
|
$1,683.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
627612
|
| Min. Negotiated Rate |
$210.41 |
| Max. Negotiated Rate |
$1,662.80 |
| Rate for Payer: Aetna Commercial |
$1,662.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,505.28
|
| Rate for Payer: Aetna Managed Medicare |
$210.41
|
| Rate for Payer: Anthem Medicare Advantage |
$210.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.41
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cash Price |
$504.90
|
| Rate for Payer: Cigna Commercial |
$1,662.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$875.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.41
|
| Rate for Payer: Health EOS Commercial |
$1,592.79
|
| Rate for Payer: HFN Commercial |
$1,662.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$816.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$816.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.41
|
| Rate for Payer: Multiplan Commercial |
$1,400.26
|
| Rate for Payer: NAPHCARE Commercial |
$315.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,662.80
|
| Rate for Payer: Quartz Beloit One Network |
$770.14
|
| Rate for Payer: Quartz Commercial |
$997.68
|
| Rate for Payer: Quartz Medicare Advantage |
$210.41
|
| Rate for Payer: The Alliance Commercial |
$799.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.41
|
| Rate for Payer: WEA Trust Commercial |
$962.68
|
| Rate for Payer: WPS Commercial |
$1,052.06
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
IP
|
$1,818.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
1536883
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$926.45 |
| Max. Negotiated Rate |
$1,739.46 |
| Rate for Payer: Aetna Commercial |
$1,701.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.08
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$1,739.46
|
| Rate for Payer: Health EOS Commercial |
$1,682.74
|
| Rate for Payer: HFN Commercial |
$1,739.46
|
| Rate for Payer: Multiplan Commercial |
$1,512.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,739.46
|
| Rate for Payer: Quartz Beloit One Network |
$926.45
|
| Rate for Payer: Quartz Commercial |
$1,134.43
|
| Rate for Payer: WEA Trust Commercial |
$1,039.90
|
| Rate for Payer: WPS Commercial |
$1,400.41
|
|
|
XR Barium Enema w/ Air Complete
|
Professional
|
Both
|
$1,818.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
1536883
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$210.41 |
| Max. Negotiated Rate |
$1,796.18 |
| Rate for Payer: Aetna Commercial |
$1,796.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.02
|
| Rate for Payer: Aetna Managed Medicare |
$210.41
|
| Rate for Payer: Anthem Medicare Advantage |
$210.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$210.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$210.41
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$1,796.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$945.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$210.41
|
| Rate for Payer: Health EOS Commercial |
$1,720.56
|
| Rate for Payer: HFN Commercial |
$1,796.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$816.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$816.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$210.41
|
| Rate for Payer: Multiplan Commercial |
$1,512.58
|
| Rate for Payer: NAPHCARE Commercial |
$315.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,796.18
|
| Rate for Payer: Quartz Beloit One Network |
$831.92
|
| Rate for Payer: Quartz Commercial |
$1,077.71
|
| Rate for Payer: Quartz Medicare Advantage |
$210.41
|
| Rate for Payer: The Alliance Commercial |
$799.57
|
| Rate for Payer: United Healthcare Medicare Advantage |
$210.41
|
| Rate for Payer: WEA Trust Commercial |
$1,039.90
|
| Rate for Payer: WPS Commercial |
$1,052.06
|
|
|
XR Barium Enema w/ Air Complete
|
Facility
|
OP
|
$1,818.00
|
|
|
Service Code
|
CPT 74280
|
| Hospital Charge Code |
1536883
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,739.46 |
| Rate for Payer: Aetna Commercial |
$1,701.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,626.02
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$708.24
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$566.59
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$538.26
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,002.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$184.59
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cash Price |
$545.40
|
| Rate for Payer: Cigna Commercial |
$1,739.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,058.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,682.74
|
| Rate for Payer: HFN Commercial |
$1,739.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.67
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$184.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$184.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$184.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$184.59
|
| Rate for Payer: Multiplan Commercial |
$1,512.58
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,739.46
|
| Rate for Payer: Quartz Beloit One Network |
$926.45
|
| Rate for Payer: Quartz Commercial |
$1,228.97
|
| Rate for Payer: Quartz Medicare Advantage |
$184.59
|
| Rate for Payer: The Alliance Commercial |
$738.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$184.59
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,039.90
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,400.41
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
IP
|
$4,426.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
2587211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,255.49 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,761.82
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
OP
|
$4,256.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
2448800
|
| Min. Negotiated Rate |
$1,239.35 |
| Max. Negotiated Rate |
$4,072.14 |
| Rate for Payer: Aetna Commercial |
$3,983.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,239.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,877.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,213.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,124.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.91
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,072.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,476.99
|
| Rate for Payer: Health EOS Commercial |
$3,939.35
|
| Rate for Payer: HFN Commercial |
$4,072.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,319.68
|
| Rate for Payer: Multiplan Commercial |
$3,540.99
|
| Rate for Payer: NAPHCARE Commercial |
$2,655.74
|
| Rate for Payer: Preferred Network Access Commercial |
$4,072.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.86
|
| Rate for Payer: Quartz Commercial |
$2,877.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,655.74
|
| Rate for Payer: The Alliance Commercial |
$2,213.12
|
| Rate for Payer: WEA Trust Commercial |
$2,434.43
|
| Rate for Payer: WPS Commercial |
$3,278.40
|
|
|
XR Biliary Drainage Percutaneous
|
Professional
|
Both
|
$4,426.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
2587211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$81.62 |
| Max. Negotiated Rate |
$4,372.89 |
| Rate for Payer: Aetna Commercial |
$4,372.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Aetna Managed Medicare |
$81.62
|
| Rate for Payer: Anthem Medicare Advantage |
$81.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$81.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$81.62
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,372.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$325.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81.62
|
| Rate for Payer: Health EOS Commercial |
$4,188.77
|
| Rate for Payer: HFN Commercial |
$4,372.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$334.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$334.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$81.62
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: NAPHCARE Commercial |
$122.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,372.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,025.34
|
| Rate for Payer: Quartz Commercial |
$2,623.73
|
| Rate for Payer: Quartz Medicare Advantage |
$81.62
|
| Rate for Payer: The Alliance Commercial |
$346.88
|
| Rate for Payer: United Healthcare Medicaid |
$325.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$81.62
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$367.29
|
|
|
XR Biliary Drainage Percutaneous
|
Professional
|
Both
|
$4,256.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
2448800
|
| Min. Negotiated Rate |
$1,947.55 |
| Max. Negotiated Rate |
$4,204.93 |
| Rate for Payer: Aetna Commercial |
$4,204.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.57
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,204.93
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,213.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,655.74
|
| Rate for Payer: Health EOS Commercial |
$4,027.88
|
| Rate for Payer: HFN Commercial |
$4,204.93
|
| Rate for Payer: Multiplan Commercial |
$3,540.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,204.93
|
| Rate for Payer: Quartz Beloit One Network |
$1,947.55
|
| Rate for Payer: Quartz Commercial |
$2,522.96
|
| Rate for Payer: The Alliance Commercial |
$2,213.12
|
| Rate for Payer: WEA Trust Commercial |
$2,434.43
|
| Rate for Payer: WPS Commercial |
$3,278.40
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 47537
|
| Hospital Charge Code |
2587211
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Aetna Managed Medicare |
$954.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,991.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,301.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,209.46
|
| Rate for Payer: Anthem Medicare Advantage |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$954.50
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$954.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$954.50
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,550.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$954.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$954.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$954.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$954.50
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,991.98
|
| Rate for Payer: Quartz Medicare Advantage |
$954.50
|
| Rate for Payer: The Alliance Commercial |
$3,818.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$954.50
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: Wellcare Medicare |
$954.50
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
XR Biliary Drainage Percutaneous
|
Facility
|
IP
|
$4,256.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
2448800
|
| Min. Negotiated Rate |
$2,168.86 |
| Max. Negotiated Rate |
$4,072.14 |
| Rate for Payer: Aetna Commercial |
$3,983.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,806.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,345.91
|
| Rate for Payer: Cash Price |
$1,276.80
|
| Rate for Payer: Cigna Commercial |
$4,072.14
|
| Rate for Payer: Health EOS Commercial |
$3,939.35
|
| Rate for Payer: HFN Commercial |
$4,072.14
|
| Rate for Payer: Multiplan Commercial |
$3,540.99
|
| Rate for Payer: Preferred Network Access Commercial |
$4,072.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,168.86
|
| Rate for Payer: Quartz Commercial |
$2,655.74
|
| Rate for Payer: WEA Trust Commercial |
$2,434.43
|
| Rate for Payer: WPS Commercial |
$3,278.40
|
|
|
XR Biliary Drain Transhep Perc in + out
|
Facility
|
OP
|
$4,580.00
|
|
|
Service Code
|
CPT 75982
|
| Hospital Charge Code |
2448803
|
| Min. Negotiated Rate |
$1,333.70 |
| Max. Negotiated Rate |
$4,382.14 |
| Rate for Payer: Aetna Commercial |
$4,286.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,096.35
|
| Rate for Payer: Aetna Managed Medicare |
$1,333.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,096.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,381.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,286.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,524.50
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$4,382.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,665.56
|
| Rate for Payer: Health EOS Commercial |
$4,239.25
|
| Rate for Payer: HFN Commercial |
$4,382.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,572.40
|
| Rate for Payer: Multiplan Commercial |
$3,810.56
|
| Rate for Payer: NAPHCARE Commercial |
$2,857.92
|
| Rate for Payer: Preferred Network Access Commercial |
$4,382.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.97
|
| Rate for Payer: Quartz Commercial |
$3,096.08
|
| Rate for Payer: Quartz Medicare Advantage |
$2,857.92
|
| Rate for Payer: The Alliance Commercial |
$2,381.60
|
| Rate for Payer: WEA Trust Commercial |
$2,619.76
|
| Rate for Payer: WPS Commercial |
$3,527.97
|
|
|
XR Biliary Drain Transhep Perc in + out
|
Professional
|
Both
|
$4,580.00
|
|
|
Service Code
|
CPT 75982
|
| Hospital Charge Code |
2448803
|
| Min. Negotiated Rate |
$2,095.81 |
| Max. Negotiated Rate |
$4,525.04 |
| Rate for Payer: Aetna Commercial |
$4,525.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,096.35
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$4,525.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,381.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,857.92
|
| Rate for Payer: Health EOS Commercial |
$4,334.51
|
| Rate for Payer: HFN Commercial |
$4,525.04
|
| Rate for Payer: Multiplan Commercial |
$3,810.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,525.04
|
| Rate for Payer: Quartz Beloit One Network |
$2,095.81
|
| Rate for Payer: Quartz Commercial |
$2,715.02
|
| Rate for Payer: The Alliance Commercial |
$2,381.60
|
| Rate for Payer: WEA Trust Commercial |
$2,619.76
|
| Rate for Payer: WPS Commercial |
$3,527.97
|
|
|
XR Biliary Drain Transhep Perc in + out
|
Facility
|
IP
|
$4,580.00
|
|
|
Service Code
|
CPT 75982
|
| Hospital Charge Code |
2448803
|
| Min. Negotiated Rate |
$2,333.97 |
| Max. Negotiated Rate |
$4,382.14 |
| Rate for Payer: Aetna Commercial |
$4,286.88
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,096.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,524.50
|
| Rate for Payer: Cash Price |
$1,374.00
|
| Rate for Payer: Cigna Commercial |
$4,382.14
|
| Rate for Payer: Health EOS Commercial |
$4,239.25
|
| Rate for Payer: HFN Commercial |
$4,382.14
|
| Rate for Payer: Multiplan Commercial |
$3,810.56
|
| Rate for Payer: Preferred Network Access Commercial |
$4,382.14
|
| Rate for Payer: Quartz Beloit One Network |
$2,333.97
|
| Rate for Payer: Quartz Commercial |
$2,857.92
|
| Rate for Payer: WEA Trust Commercial |
$2,619.76
|
| Rate for Payer: WPS Commercial |
$3,527.97
|
|
|
XR Biliary Drain Transhep Perc w/ Cont
|
Facility
|
OP
|
$4,426.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
3072724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Aetna Managed Medicare |
$1,288.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,991.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,301.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,209.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,575.93
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,452.28
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: NAPHCARE Commercial |
$2,761.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,991.98
|
| Rate for Payer: Quartz Medicare Advantage |
$2,761.82
|
| Rate for Payer: The Alliance Commercial |
$2,301.52
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
XR Biliary Drain Transhep Perc w/ Cont
|
Professional
|
Both
|
$4,426.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
3072724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,025.34 |
| Max. Negotiated Rate |
$4,372.89 |
| Rate for Payer: Aetna Commercial |
$4,372.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,372.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,301.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,761.82
|
| Rate for Payer: Health EOS Commercial |
$4,188.77
|
| Rate for Payer: HFN Commercial |
$4,372.89
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,372.89
|
| Rate for Payer: Quartz Beloit One Network |
$2,025.34
|
| Rate for Payer: Quartz Commercial |
$2,623.73
|
| Rate for Payer: The Alliance Commercial |
$2,301.52
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
XR Biliary Drain Transhep Perc w/ Cont
|
Facility
|
IP
|
$4,426.00
|
|
|
Service Code
|
CPT 75980
|
| Hospital Charge Code |
3072724
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$2,255.49 |
| Max. Negotiated Rate |
$4,234.80 |
| Rate for Payer: Aetna Commercial |
$4,142.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,958.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,439.61
|
| Rate for Payer: Cash Price |
$1,327.80
|
| Rate for Payer: Cigna Commercial |
$4,234.80
|
| Rate for Payer: Health EOS Commercial |
$4,096.71
|
| Rate for Payer: HFN Commercial |
$4,234.80
|
| Rate for Payer: Multiplan Commercial |
$3,682.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,234.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,255.49
|
| Rate for Payer: Quartz Commercial |
$2,761.82
|
| Rate for Payer: WEA Trust Commercial |
$2,531.67
|
| Rate for Payer: WPS Commercial |
$3,409.35
|
|
|
XR Biliary Duct Calculus Removal
|
Facility
|
IP
|
$2,578.00
|
|
|
Service Code
|
CPT 74327
|
| Hospital Charge Code |
627616
|
| Min. Negotiated Rate |
$1,313.75 |
| Max. Negotiated Rate |
$2,466.63 |
| Rate for Payer: Aetna Commercial |
$2,413.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.99
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,466.63
|
| Rate for Payer: Health EOS Commercial |
$2,386.20
|
| Rate for Payer: HFN Commercial |
$2,466.63
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,466.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.75
|
| Rate for Payer: Quartz Commercial |
$1,608.67
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
|
XR Biliary Duct Calculus Removal
|
Facility
|
OP
|
$2,578.00
|
|
|
Service Code
|
CPT 74327
|
| Hospital Charge Code |
627616
|
| Min. Negotiated Rate |
$750.71 |
| Max. Negotiated Rate |
$2,466.63 |
| Rate for Payer: Aetna Commercial |
$2,413.01
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Aetna Managed Medicare |
$750.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,742.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,340.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,286.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,420.99
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,466.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,500.40
|
| Rate for Payer: Health EOS Commercial |
$2,386.20
|
| Rate for Payer: HFN Commercial |
$2,466.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,010.84
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: NAPHCARE Commercial |
$1,608.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,466.63
|
| Rate for Payer: Quartz Beloit One Network |
$1,313.75
|
| Rate for Payer: Quartz Commercial |
$1,742.73
|
| Rate for Payer: Quartz Medicare Advantage |
$1,608.67
|
| Rate for Payer: The Alliance Commercial |
$1,340.56
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
|
XR Biliary Duct Calculus Removal
|
Professional
|
Both
|
$2,578.00
|
|
|
Service Code
|
CPT 74327
|
| Hospital Charge Code |
627616
|
| Min. Negotiated Rate |
$1,179.69 |
| Max. Negotiated Rate |
$2,547.06 |
| Rate for Payer: Aetna Commercial |
$2,547.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,305.76
|
| Rate for Payer: Cash Price |
$773.40
|
| Rate for Payer: Cigna Commercial |
$2,547.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,340.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,608.67
|
| Rate for Payer: Health EOS Commercial |
$2,439.82
|
| Rate for Payer: HFN Commercial |
$2,547.06
|
| Rate for Payer: Multiplan Commercial |
$2,144.90
|
| Rate for Payer: Preferred Network Access Commercial |
$2,547.06
|
| Rate for Payer: Quartz Beloit One Network |
$1,179.69
|
| Rate for Payer: Quartz Commercial |
$1,528.24
|
| Rate for Payer: The Alliance Commercial |
$1,340.56
|
| Rate for Payer: WEA Trust Commercial |
$1,474.62
|
| Rate for Payer: WPS Commercial |
$1,985.83
|
|
