|
XR ERCP Biliary and Pancreatic Duct
|
Professional
|
Both
|
$2,324.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
2448809
|
| Min. Negotiated Rate |
$596.87 |
| Max. Negotiated Rate |
$2,296.11 |
| Rate for Payer: Aetna Commercial |
$2,296.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.59
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,296.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,208.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,450.18
|
| Rate for Payer: Health EOS Commercial |
$2,199.43
|
| Rate for Payer: HFN Commercial |
$2,296.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$596.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$596.87
|
| Rate for Payer: Multiplan Commercial |
$1,933.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,063.46
|
| Rate for Payer: Quartz Commercial |
$1,377.67
|
| Rate for Payer: The Alliance Commercial |
$1,208.48
|
| Rate for Payer: WEA Trust Commercial |
$1,329.33
|
| Rate for Payer: WPS Commercial |
$1,790.18
|
|
|
XR ERCP Biliary and Pancreatic Duct
|
Facility
|
OP
|
$2,510.00
|
|
|
Service Code
|
CPT 74330
|
| Hospital Charge Code |
2587217
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$2,401.57 |
| Rate for Payer: Aetna Commercial |
$2,349.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,244.94
|
| Rate for Payer: Aetna Managed Medicare |
$730.91
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,696.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,305.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,252.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,383.51
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cash Price |
$753.00
|
| Rate for Payer: Cigna Commercial |
$2,401.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,460.82
|
| Rate for Payer: Health EOS Commercial |
$2,323.26
|
| Rate for Payer: HFN Commercial |
$2,401.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,957.80
|
| Rate for Payer: Multiplan Commercial |
$2,088.32
|
| Rate for Payer: NAPHCARE Commercial |
$1,566.24
|
| Rate for Payer: Preferred Network Access Commercial |
$2,401.57
|
| Rate for Payer: Quartz Beloit One Network |
$1,279.10
|
| Rate for Payer: Quartz Commercial |
$1,696.76
|
| Rate for Payer: Quartz Medicare Advantage |
$1,566.24
|
| Rate for Payer: The Alliance Commercial |
$1,305.20
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,435.72
|
| Rate for Payer: WPS Commercial |
$1,933.45
|
|
|
XR ERCP Biliary Duct
|
Facility
|
OP
|
$1,461.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2587214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$1,397.88 |
| Rate for Payer: Aetna Commercial |
$1,367.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.72
|
| Rate for Payer: Aetna Managed Medicare |
$425.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$987.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$759.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$729.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,397.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$850.30
|
| Rate for Payer: Health EOS Commercial |
$1,352.30
|
| Rate for Payer: HFN Commercial |
$1,397.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,139.58
|
| Rate for Payer: Multiplan Commercial |
$1,215.55
|
| Rate for Payer: NAPHCARE Commercial |
$911.66
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.88
|
| Rate for Payer: Quartz Beloit One Network |
$744.53
|
| Rate for Payer: Quartz Commercial |
$987.64
|
| Rate for Payer: Quartz Medicare Advantage |
$911.66
|
| Rate for Payer: The Alliance Commercial |
$759.72
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$835.69
|
| Rate for Payer: WPS Commercial |
$1,125.41
|
|
|
XR ERCP Biliary Duct
|
Facility
|
IP
|
$1,461.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2587214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$744.53 |
| Max. Negotiated Rate |
$1,397.88 |
| Rate for Payer: Aetna Commercial |
$1,367.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$805.30
|
| Rate for Payer: Cash Price |
$438.30
|
| Rate for Payer: Cigna Commercial |
$1,397.88
|
| Rate for Payer: Health EOS Commercial |
$1,352.30
|
| Rate for Payer: HFN Commercial |
$1,397.88
|
| Rate for Payer: Multiplan Commercial |
$1,215.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,397.88
|
| Rate for Payer: Quartz Beloit One Network |
$744.53
|
| Rate for Payer: Quartz Commercial |
$911.66
|
| Rate for Payer: WEA Trust Commercial |
$835.69
|
| Rate for Payer: WPS Commercial |
$1,125.41
|
|
|
XR ERCP Biliary Duct
|
Professional
|
Both
|
$1,461.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2587214
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$568.41 |
| Max. Negotiated Rate |
$1,443.47 |
| Rate for Payer: Aetna Commercial |
$1,443.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,306.72
|
| 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 |
$1,443.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$759.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$911.66
|
| Rate for Payer: Health EOS Commercial |
$1,382.69
|
| Rate for Payer: HFN Commercial |
$1,443.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$568.41
|
| Rate for Payer: Multiplan Commercial |
$1,215.55
|
| Rate for Payer: Preferred Network Access Commercial |
$1,443.47
|
| Rate for Payer: Quartz Beloit One Network |
$668.55
|
| Rate for Payer: Quartz Commercial |
$866.08
|
| Rate for Payer: The Alliance Commercial |
$759.72
|
| Rate for Payer: WEA Trust Commercial |
$835.69
|
| Rate for Payer: WPS Commercial |
$1,125.41
|
|
|
XR ERCP Biliary Duct
|
Facility
|
OP
|
$1,353.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2448810
|
| Min. Negotiated Rate |
$393.99 |
| Max. Negotiated Rate |
$1,294.55 |
| Rate for Payer: Aetna Commercial |
$1,266.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.12
|
| Rate for Payer: Aetna Managed Medicare |
$393.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$914.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$703.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$675.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.77
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$787.45
|
| Rate for Payer: Health EOS Commercial |
$1,252.34
|
| Rate for Payer: HFN Commercial |
$1,294.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,055.34
|
| Rate for Payer: Multiplan Commercial |
$1,125.70
|
| Rate for Payer: NAPHCARE Commercial |
$844.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.55
|
| Rate for Payer: Quartz Beloit One Network |
$689.49
|
| Rate for Payer: Quartz Commercial |
$914.63
|
| Rate for Payer: Quartz Medicare Advantage |
$844.27
|
| Rate for Payer: The Alliance Commercial |
$703.56
|
| Rate for Payer: WEA Trust Commercial |
$773.92
|
| Rate for Payer: WPS Commercial |
$1,042.22
|
|
|
XR ERCP Biliary Duct
|
Professional
|
Both
|
$1,353.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2448810
|
| Min. Negotiated Rate |
$568.41 |
| Max. Negotiated Rate |
$1,336.76 |
| Rate for Payer: Aetna Commercial |
$1,336.76
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.12
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,336.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$703.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$844.27
|
| Rate for Payer: Health EOS Commercial |
$1,280.48
|
| Rate for Payer: HFN Commercial |
$1,336.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$568.41
|
| Rate for Payer: Multiplan Commercial |
$1,125.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,336.76
|
| Rate for Payer: Quartz Beloit One Network |
$619.13
|
| Rate for Payer: Quartz Commercial |
$802.06
|
| Rate for Payer: The Alliance Commercial |
$703.56
|
| Rate for Payer: WEA Trust Commercial |
$773.92
|
| Rate for Payer: WPS Commercial |
$1,042.22
|
|
|
XR ERCP Biliary Duct
|
Facility
|
IP
|
$1,353.00
|
|
|
Service Code
|
CPT 74328
|
| Hospital Charge Code |
2448810
|
| Min. Negotiated Rate |
$689.49 |
| Max. Negotiated Rate |
$1,294.55 |
| Rate for Payer: Aetna Commercial |
$1,266.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,210.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$745.77
|
| Rate for Payer: Cash Price |
$405.90
|
| Rate for Payer: Cigna Commercial |
$1,294.55
|
| Rate for Payer: Health EOS Commercial |
$1,252.34
|
| Rate for Payer: HFN Commercial |
$1,294.55
|
| Rate for Payer: Multiplan Commercial |
$1,125.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,294.55
|
| Rate for Payer: Quartz Beloit One Network |
$689.49
|
| Rate for Payer: Quartz Commercial |
$844.27
|
| Rate for Payer: WEA Trust Commercial |
$773.92
|
| Rate for Payer: WPS Commercial |
$1,042.22
|
|
|
XR ERCP Pancreatic Duct
|
Professional
|
Both
|
$2,417.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2587220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$568.41 |
| Max. Negotiated Rate |
$2,388.00 |
| Rate for Payer: Aetna Commercial |
$2,388.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,161.76
|
| 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 |
$2,388.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,256.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,508.21
|
| Rate for Payer: Health EOS Commercial |
$2,287.45
|
| Rate for Payer: HFN Commercial |
$2,388.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$568.41
|
| Rate for Payer: Multiplan Commercial |
$2,010.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,388.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,106.02
|
| Rate for Payer: Quartz Commercial |
$1,432.80
|
| Rate for Payer: The Alliance Commercial |
$1,256.84
|
| Rate for Payer: WEA Trust Commercial |
$1,382.52
|
| Rate for Payer: WPS Commercial |
$1,861.82
|
|
|
XR ERCP Pancreatic Duct
|
Facility
|
OP
|
$2,324.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2448811
|
| Min. Negotiated Rate |
$676.75 |
| Max. Negotiated Rate |
$2,223.60 |
| Rate for Payer: Aetna Commercial |
$2,175.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.59
|
| Rate for Payer: Aetna Managed Medicare |
$676.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,571.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,208.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,160.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,280.99
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,223.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,352.57
|
| Rate for Payer: Health EOS Commercial |
$2,151.09
|
| Rate for Payer: HFN Commercial |
$2,223.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,812.72
|
| Rate for Payer: Multiplan Commercial |
$1,933.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,450.18
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.31
|
| Rate for Payer: Quartz Commercial |
$1,571.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,450.18
|
| Rate for Payer: The Alliance Commercial |
$1,208.48
|
| Rate for Payer: WEA Trust Commercial |
$1,329.33
|
| Rate for Payer: WPS Commercial |
$1,790.18
|
|
|
XR ERCP Pancreatic Duct
|
Facility
|
IP
|
$2,324.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2448811
|
| Min. Negotiated Rate |
$1,184.31 |
| Max. Negotiated Rate |
$2,223.60 |
| Rate for Payer: Aetna Commercial |
$2,175.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,280.99
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,223.60
|
| Rate for Payer: Health EOS Commercial |
$2,151.09
|
| Rate for Payer: HFN Commercial |
$2,223.60
|
| Rate for Payer: Multiplan Commercial |
$1,933.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,223.60
|
| Rate for Payer: Quartz Beloit One Network |
$1,184.31
|
| Rate for Payer: Quartz Commercial |
$1,450.18
|
| Rate for Payer: WEA Trust Commercial |
$1,329.33
|
| Rate for Payer: WPS Commercial |
$1,790.18
|
|
|
XR ERCP Pancreatic Duct
|
Facility
|
OP
|
$2,417.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2587220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$2,312.59 |
| Rate for Payer: Aetna Commercial |
$2,262.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,161.76
|
| Rate for Payer: Aetna Managed Medicare |
$703.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,633.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,256.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,206.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,332.25
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,312.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,406.69
|
| Rate for Payer: Health EOS Commercial |
$2,237.18
|
| Rate for Payer: HFN Commercial |
$2,312.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,885.26
|
| Rate for Payer: Multiplan Commercial |
$2,010.94
|
| Rate for Payer: NAPHCARE Commercial |
$1,508.21
|
| Rate for Payer: Preferred Network Access Commercial |
$2,312.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,231.70
|
| Rate for Payer: Quartz Commercial |
$1,633.89
|
| Rate for Payer: Quartz Medicare Advantage |
$1,508.21
|
| Rate for Payer: The Alliance Commercial |
$1,256.84
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,382.52
|
| Rate for Payer: WPS Commercial |
$1,861.82
|
|
|
XR ERCP Pancreatic Duct
|
Facility
|
IP
|
$2,417.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2587220
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$1,231.70 |
| Max. Negotiated Rate |
$2,312.59 |
| Rate for Payer: Aetna Commercial |
$2,262.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,161.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,332.25
|
| Rate for Payer: Cash Price |
$725.10
|
| Rate for Payer: Cigna Commercial |
$2,312.59
|
| Rate for Payer: Health EOS Commercial |
$2,237.18
|
| Rate for Payer: HFN Commercial |
$2,312.59
|
| Rate for Payer: Multiplan Commercial |
$2,010.94
|
| Rate for Payer: Preferred Network Access Commercial |
$2,312.59
|
| Rate for Payer: Quartz Beloit One Network |
$1,231.70
|
| Rate for Payer: Quartz Commercial |
$1,508.21
|
| Rate for Payer: WEA Trust Commercial |
$1,382.52
|
| Rate for Payer: WPS Commercial |
$1,861.82
|
|
|
XR ERCP Pancreatic Duct
|
Professional
|
Both
|
$2,324.00
|
|
|
Service Code
|
CPT 74329
|
| Hospital Charge Code |
2448811
|
| Min. Negotiated Rate |
$568.41 |
| Max. Negotiated Rate |
$2,296.11 |
| Rate for Payer: Aetna Commercial |
$2,296.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,078.59
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cash Price |
$697.20
|
| Rate for Payer: Cigna Commercial |
$2,296.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,208.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,450.18
|
| Rate for Payer: Health EOS Commercial |
$2,199.43
|
| Rate for Payer: HFN Commercial |
$2,296.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$568.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$568.41
|
| Rate for Payer: Multiplan Commercial |
$1,933.57
|
| Rate for Payer: Preferred Network Access Commercial |
$2,296.11
|
| Rate for Payer: Quartz Beloit One Network |
$1,063.46
|
| Rate for Payer: Quartz Commercial |
$1,377.67
|
| Rate for Payer: The Alliance Commercial |
$1,208.48
|
| Rate for Payer: WEA Trust Commercial |
$1,329.33
|
| Rate for Payer: WPS Commercial |
$1,790.18
|
|
|
XR Esophagus
|
Facility
|
IP
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
630671
|
| Min. Negotiated Rate |
$511.13 |
| Max. Negotiated Rate |
$959.67 |
| Rate for Payer: Aetna Commercial |
$938.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.85
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$959.67
|
| Rate for Payer: Health EOS Commercial |
$928.38
|
| Rate for Payer: HFN Commercial |
$959.67
|
| Rate for Payer: Multiplan Commercial |
$834.50
|
| Rate for Payer: Preferred Network Access Commercial |
$959.67
|
| Rate for Payer: Quartz Beloit One Network |
$511.13
|
| Rate for Payer: Quartz Commercial |
$625.87
|
| Rate for Payer: WEA Trust Commercial |
$573.72
|
| Rate for Payer: WPS Commercial |
$772.61
|
|
|
XR Esophagus
|
Facility
|
OP
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
630671
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$959.67 |
| Rate for Payer: Aetna Commercial |
$938.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.08
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$678.03
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$521.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$500.70
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$552.85
|
| 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 |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$959.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$583.75
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$928.38
|
| Rate for Payer: HFN Commercial |
$959.67
|
| 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 |
$834.50
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$959.67
|
| Rate for Payer: Quartz Beloit One Network |
$511.13
|
| Rate for Payer: Quartz Commercial |
$678.03
|
| 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 |
$573.72
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$772.61
|
|
|
XR Esophagus
|
Professional
|
Both
|
$1,003.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
630671
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$990.96 |
| Rate for Payer: Aetna Commercial |
$990.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$897.08
|
| Rate for Payer: Aetna Managed Medicare |
$93.80
|
| Rate for Payer: Anthem Medicare Advantage |
$93.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.80
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cash Price |
$300.90
|
| Rate for Payer: Cigna Commercial |
$990.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$521.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.80
|
| Rate for Payer: Health EOS Commercial |
$949.24
|
| Rate for Payer: HFN Commercial |
$990.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$357.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$357.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$834.50
|
| Rate for Payer: NAPHCARE Commercial |
$140.70
|
| Rate for Payer: Preferred Network Access Commercial |
$990.96
|
| Rate for Payer: Quartz Beloit One Network |
$458.97
|
| Rate for Payer: Quartz Commercial |
$594.58
|
| Rate for Payer: Quartz Medicare Advantage |
$93.80
|
| Rate for Payer: The Alliance Commercial |
$356.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.80
|
| Rate for Payer: WEA Trust Commercial |
$573.72
|
| Rate for Payer: WPS Commercial |
$468.99
|
|
|
XR Esophagus
|
Facility
|
IP
|
$1,227.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$625.28 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$676.32
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$765.65
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
XR Esophagus
|
Facility
|
OP
|
$1,227.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,173.99 |
| Rate for Payer: Aetna Commercial |
$1,148.47
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| 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 |
$676.32
|
| 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 |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cash Price |
$368.10
|
| Rate for Payer: Cigna Commercial |
$1,173.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$714.11
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,135.71
|
| Rate for Payer: HFN Commercial |
$1,173.99
|
| 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 |
$1,020.86
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,173.99
|
| Rate for Payer: Quartz Beloit One Network |
$625.28
|
| Rate for Payer: Quartz Commercial |
$829.45
|
| 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 |
$701.84
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$945.16
|
|
|
XR Esophagus
|
Professional
|
Both
|
$1,227.00
|
|
|
Service Code
|
CPT 74220
|
| Hospital Charge Code |
1537014
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$93.80 |
| Max. Negotiated Rate |
$1,212.28 |
| Rate for Payer: Aetna Commercial |
$1,212.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,097.43
|
| Rate for Payer: Aetna Managed Medicare |
$93.80
|
| Rate for Payer: Anthem Medicare Advantage |
$93.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$93.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$93.80
|
| 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 |
$1,212.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$638.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$93.80
|
| Rate for Payer: Health EOS Commercial |
$1,161.23
|
| Rate for Payer: HFN Commercial |
$1,212.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$357.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$357.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$93.80
|
| Rate for Payer: Multiplan Commercial |
$1,020.86
|
| Rate for Payer: NAPHCARE Commercial |
$140.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,212.28
|
| Rate for Payer: Quartz Beloit One Network |
$561.48
|
| Rate for Payer: Quartz Commercial |
$727.37
|
| Rate for Payer: Quartz Medicare Advantage |
$93.80
|
| Rate for Payer: The Alliance Commercial |
$356.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$93.80
|
| Rate for Payer: WEA Trust Commercial |
$701.84
|
| Rate for Payer: WPS Commercial |
$468.99
|
|
|
XR Facial Bones < 3 Views
|
Facility
|
IP
|
$497.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
630666
|
| Min. Negotiated Rate |
$253.27 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$310.13
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
XR Facial Bones < 3 Views
|
Professional
|
Both
|
$497.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
630666
|
| Min. Negotiated Rate |
$31.44 |
| Max. Negotiated Rate |
$491.04 |
| Rate for Payer: Aetna Commercial |
$491.04
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$31.44
|
| Rate for Payer: Anthem Medicare Advantage |
$31.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31.44
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$491.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$258.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31.44
|
| Rate for Payer: Health EOS Commercial |
$470.36
|
| Rate for Payer: HFN Commercial |
$491.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$113.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$113.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31.44
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$47.16
|
| Rate for Payer: Preferred Network Access Commercial |
$491.04
|
| Rate for Payer: Quartz Beloit One Network |
$227.43
|
| Rate for Payer: Quartz Commercial |
$294.62
|
| Rate for Payer: Quartz Medicare Advantage |
$31.44
|
| Rate for Payer: The Alliance Commercial |
$119.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31.44
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: WPS Commercial |
$157.20
|
|
|
XR Facial Bones < 3 Views
|
Facility
|
OP
|
$497.00
|
|
|
Service Code
|
CPT 70140
|
| Hospital Charge Code |
630666
|
| Min. Negotiated Rate |
$91.58 |
| Max. Negotiated Rate |
$475.53 |
| Rate for Payer: Aetna Commercial |
$465.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$444.52
|
| Rate for Payer: Aetna Managed Medicare |
$91.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$335.97
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$258.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$248.10
|
| Rate for Payer: Anthem Medicare Advantage |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$273.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$91.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$91.58
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cash Price |
$149.10
|
| Rate for Payer: Cigna Commercial |
$475.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$91.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$289.25
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$91.58
|
| Rate for Payer: Health EOS Commercial |
$460.02
|
| Rate for Payer: HFN Commercial |
$475.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$340.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$91.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$91.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$91.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$91.58
|
| Rate for Payer: Multiplan Commercial |
$413.50
|
| Rate for Payer: NAPHCARE Commercial |
$137.37
|
| Rate for Payer: Preferred Network Access Commercial |
$475.53
|
| Rate for Payer: Quartz Beloit One Network |
$253.27
|
| Rate for Payer: Quartz Commercial |
$335.97
|
| Rate for Payer: Quartz Medicare Advantage |
$91.58
|
| Rate for Payer: The Alliance Commercial |
$366.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$91.58
|
| Rate for Payer: WEA Trust Commercial |
$284.28
|
| Rate for Payer: Wellcare Medicare |
$91.58
|
| Rate for Payer: WPS Commercial |
$382.84
|
|
|
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 |
$273.66 |
| Max. Negotiated Rate |
$513.80 |
| Rate for Payer: Aetna Commercial |
$502.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$480.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.99
|
| Rate for Payer: Cash Price |
$161.10
|
| Rate for Payer: Cigna Commercial |
$513.80
|
| Rate for Payer: Health EOS Commercial |
$497.05
|
| Rate for Payer: HFN Commercial |
$513.80
|
| Rate for Payer: Multiplan Commercial |
$446.78
|
| Rate for Payer: Preferred Network Access Commercial |
$513.80
|
| Rate for Payer: Quartz Beloit One Network |
$273.66
|
| Rate for Payer: Quartz Commercial |
$335.09
|
| Rate for Payer: WEA Trust Commercial |
$307.16
|
| Rate for Payer: WPS Commercial |
$413.65
|
|
|
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 |
$86.94 |
| Max. Negotiated Rate |
$513.80 |
| Rate for Payer: Aetna Commercial |
$502.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$480.29
|
| Rate for Payer: Aetna Managed Medicare |
$156.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$350.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$280.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$266.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$295.99
|
| 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 |
$513.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$312.53
|
| Rate for Payer: Health EOS Commercial |
$497.05
|
| Rate for Payer: HFN Commercial |
$513.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$418.86
|
| Rate for Payer: Multiplan Commercial |
$446.78
|
| Rate for Payer: NAPHCARE Commercial |
$335.09
|
| Rate for Payer: Preferred Network Access Commercial |
$513.80
|
| Rate for Payer: Quartz Beloit One Network |
$273.66
|
| Rate for Payer: Quartz Commercial |
$363.01
|
| Rate for Payer: Quartz Medicare Advantage |
$335.09
|
| Rate for Payer: The Alliance Commercial |
$86.94
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$307.16
|
| Rate for Payer: WPS Commercial |
$413.65
|
|
