|
XR Upper GI w/ Air w/ Small Bowel
|
Facility
|
OP
|
$1,824.00
|
|
| Hospital Charge Code |
613602
|
| Min. Negotiated Rate |
$531.15 |
| Max. Negotiated Rate |
$1,745.20 |
| Rate for Payer: Aetna Commercial |
$1,707.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Aetna Managed Medicare |
$531.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,233.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$948.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$910.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.39
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,745.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,061.57
|
| Rate for Payer: Health EOS Commercial |
$1,688.29
|
| Rate for Payer: HFN Commercial |
$1,745.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,422.72
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,138.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.20
|
| Rate for Payer: Quartz Beloit One Network |
$929.51
|
| Rate for Payer: Quartz Commercial |
$1,233.02
|
| Rate for Payer: Quartz Medicare Advantage |
$1,138.18
|
| Rate for Payer: The Alliance Commercial |
$948.48
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
XR Upper GI w/ Air w/ Small Bowel
|
Professional
|
Both
|
$1,824.00
|
|
| Hospital Charge Code |
613602
|
| Min. Negotiated Rate |
$834.66 |
| Max. Negotiated Rate |
$1,802.11 |
| Rate for Payer: Aetna Commercial |
$1,802.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,802.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$948.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,138.18
|
| Rate for Payer: Health EOS Commercial |
$1,726.23
|
| Rate for Payer: HFN Commercial |
$1,802.11
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,802.11
|
| Rate for Payer: Quartz Beloit One Network |
$834.66
|
| Rate for Payer: Quartz Commercial |
$1,081.27
|
| Rate for Payer: The Alliance Commercial |
$948.48
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
XR Upper GI w/ Gastrografin
|
Facility
|
OP
|
$1,092.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
675803
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,044.83 |
| Rate for Payer: Aetna Commercial |
$1,022.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.68
|
| Rate for Payer: Aetna Managed Medicare |
$184.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$738.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$567.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$545.13
|
| Rate for Payer: Anthem Medicare Advantage |
$184.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.91
|
| 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 |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$1,044.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$635.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,010.76
|
| Rate for Payer: HFN Commercial |
$1,044.83
|
| 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 |
$908.54
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.83
|
| Rate for Payer: Quartz Beloit One Network |
$556.48
|
| Rate for Payer: Quartz Commercial |
$738.19
|
| 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 |
$624.62
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$841.17
|
|
|
XR Upper GI w/ Gastrografin
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
675803
|
| Min. Negotiated Rate |
$121.47 |
| Max. Negotiated Rate |
$1,078.90 |
| Rate for Payer: Quartz Beloit One Network |
$499.70
|
| Rate for Payer: Aetna Commercial |
$1,078.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.68
|
| Rate for Payer: Aetna Managed Medicare |
$121.47
|
| Rate for Payer: Anthem Medicare Advantage |
$121.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.47
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$1,078.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$567.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.47
|
| Rate for Payer: Health EOS Commercial |
$1,033.47
|
| Rate for Payer: HFN Commercial |
$1,078.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$444.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$444.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.47
|
| Rate for Payer: Multiplan Commercial |
$908.54
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.90
|
| Rate for Payer: Quartz Commercial |
$647.34
|
| Rate for Payer: Quartz Medicare Advantage |
$121.47
|
| Rate for Payer: The Alliance Commercial |
$461.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.47
|
| Rate for Payer: WEA Trust Commercial |
$624.62
|
| Rate for Payer: WPS Commercial |
$607.36
|
|
|
XR Upper GI w/ Gastrografin
|
Facility
|
IP
|
$1,156.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1537449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$589.10 |
| Max. Negotiated Rate |
$1,106.06 |
| Rate for Payer: Aetna Commercial |
$1,082.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,033.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$637.19
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$1,106.06
|
| Rate for Payer: Health EOS Commercial |
$1,069.99
|
| Rate for Payer: HFN Commercial |
$1,106.06
|
| Rate for Payer: Multiplan Commercial |
$961.79
|
| Rate for Payer: Preferred Network Access Commercial |
$1,106.06
|
| Rate for Payer: Quartz Beloit One Network |
$589.10
|
| Rate for Payer: Quartz Commercial |
$721.34
|
| Rate for Payer: WEA Trust Commercial |
$661.23
|
| Rate for Payer: WPS Commercial |
$890.47
|
|
|
XR Upper GI w/ Gastrografin
|
Professional
|
Both
|
$1,156.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1537449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.47 |
| Max. Negotiated Rate |
$1,142.13 |
| Rate for Payer: Aetna Commercial |
$1,142.13
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,033.93
|
| Rate for Payer: Aetna Managed Medicare |
$121.47
|
| Rate for Payer: Anthem Medicare Advantage |
$121.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.47
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$1,142.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$601.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.47
|
| Rate for Payer: Health EOS Commercial |
$1,094.04
|
| Rate for Payer: HFN Commercial |
$1,142.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$444.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$444.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.47
|
| Rate for Payer: Multiplan Commercial |
$961.79
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,142.13
|
| Rate for Payer: Quartz Beloit One Network |
$528.99
|
| Rate for Payer: Quartz Commercial |
$685.28
|
| Rate for Payer: Quartz Medicare Advantage |
$121.47
|
| Rate for Payer: The Alliance Commercial |
$461.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.47
|
| Rate for Payer: WEA Trust Commercial |
$661.23
|
| Rate for Payer: WPS Commercial |
$607.36
|
|
|
XR Upper GI w/ Gastrografin
|
Facility
|
OP
|
$1,156.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1537449
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,106.06 |
| Rate for Payer: Aetna Commercial |
$1,082.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,033.93
|
| 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 |
$637.19
|
| 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 |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cash Price |
$346.80
|
| Rate for Payer: Cigna Commercial |
$1,106.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$672.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,069.99
|
| Rate for Payer: HFN Commercial |
$1,106.06
|
| 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 |
$961.79
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,106.06
|
| Rate for Payer: Quartz Beloit One Network |
$589.10
|
| Rate for Payer: Quartz Commercial |
$781.46
|
| 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 |
$661.23
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$890.47
|
|
|
XR Upper GI w/ Gastrografin
|
Facility
|
IP
|
$1,092.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
675803
|
| Min. Negotiated Rate |
$556.48 |
| Max. Negotiated Rate |
$1,044.83 |
| Rate for Payer: Aetna Commercial |
$1,022.11
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$601.91
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$1,044.83
|
| Rate for Payer: Health EOS Commercial |
$1,010.76
|
| Rate for Payer: HFN Commercial |
$1,044.83
|
| Rate for Payer: Multiplan Commercial |
$908.54
|
| Rate for Payer: Preferred Network Access Commercial |
$1,044.83
|
| Rate for Payer: Quartz Beloit One Network |
$556.48
|
| Rate for Payer: Quartz Commercial |
$681.41
|
| Rate for Payer: WEA Trust Commercial |
$624.62
|
| Rate for Payer: WPS Commercial |
$841.17
|
|
|
XR Upper GI w/ Small Bowel
|
Facility
|
IP
|
$1,867.00
|
|
| Hospital Charge Code |
613604
|
| Min. Negotiated Rate |
$951.42 |
| Max. Negotiated Rate |
$1,786.35 |
| Rate for Payer: Aetna Commercial |
$1,747.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.09
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,786.35
|
| Rate for Payer: Health EOS Commercial |
$1,728.10
|
| Rate for Payer: HFN Commercial |
$1,786.35
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,786.35
|
| Rate for Payer: Quartz Beloit One Network |
$951.42
|
| Rate for Payer: Quartz Commercial |
$1,165.01
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
XR Upper GI w/ Small Bowel
|
Facility
|
OP
|
$1,867.00
|
|
| Hospital Charge Code |
613604
|
| Min. Negotiated Rate |
$543.67 |
| Max. Negotiated Rate |
$1,786.35 |
| Rate for Payer: Aetna Commercial |
$1,747.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Aetna Managed Medicare |
$543.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,262.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$970.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$932.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.09
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,786.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,086.59
|
| Rate for Payer: Health EOS Commercial |
$1,728.10
|
| Rate for Payer: HFN Commercial |
$1,786.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,456.26
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,165.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,786.35
|
| Rate for Payer: Quartz Beloit One Network |
$951.42
|
| Rate for Payer: Quartz Commercial |
$1,262.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,165.01
|
| Rate for Payer: The Alliance Commercial |
$970.84
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
XR Upper GI w/ Small Bowel
|
Facility
|
IP
|
$1,940.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1537451
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$988.62 |
| Max. Negotiated Rate |
$1,856.19 |
| Rate for Payer: Aetna Commercial |
$1,815.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,735.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,069.33
|
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Cigna Commercial |
$1,856.19
|
| Rate for Payer: Health EOS Commercial |
$1,795.66
|
| Rate for Payer: HFN Commercial |
$1,856.19
|
| Rate for Payer: Multiplan Commercial |
$1,614.08
|
| Rate for Payer: Preferred Network Access Commercial |
$1,856.19
|
| Rate for Payer: Quartz Beloit One Network |
$988.62
|
| Rate for Payer: Quartz Commercial |
$1,210.56
|
| Rate for Payer: WEA Trust Commercial |
$1,109.68
|
| Rate for Payer: WPS Commercial |
$1,494.38
|
|
|
XR Upper GI w/ Small Bowel
|
Professional
|
Both
|
$1,092.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1537451
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$121.47 |
| Max. Negotiated Rate |
$1,078.90 |
| Rate for Payer: Aetna Commercial |
$1,078.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$976.68
|
| Rate for Payer: Aetna Managed Medicare |
$121.47
|
| Rate for Payer: Anthem Medicare Advantage |
$121.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$121.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$121.47
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cash Price |
$327.60
|
| Rate for Payer: Cigna Commercial |
$1,078.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$567.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$121.47
|
| Rate for Payer: Health EOS Commercial |
$1,033.47
|
| Rate for Payer: HFN Commercial |
$1,078.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$444.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$444.65
|
| Rate for Payer: Independent Care Health Plan Medicare |
$121.47
|
| Rate for Payer: Multiplan Commercial |
$908.54
|
| Rate for Payer: NAPHCARE Commercial |
$182.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,078.90
|
| Rate for Payer: Quartz Beloit One Network |
$499.70
|
| Rate for Payer: Quartz Commercial |
$647.34
|
| Rate for Payer: Quartz Medicare Advantage |
$121.47
|
| Rate for Payer: The Alliance Commercial |
$461.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$121.47
|
| Rate for Payer: WEA Trust Commercial |
$624.62
|
| Rate for Payer: WPS Commercial |
$607.36
|
|
|
XR Upper GI w/ Small Bowel
|
Professional
|
Both
|
$1,867.00
|
|
| Hospital Charge Code |
613604
|
| Min. Negotiated Rate |
$854.34 |
| Max. Negotiated Rate |
$1,844.60 |
| Rate for Payer: Aetna Commercial |
$1,844.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,844.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$970.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,165.01
|
| Rate for Payer: Health EOS Commercial |
$1,766.93
|
| Rate for Payer: HFN Commercial |
$1,844.60
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,844.60
|
| Rate for Payer: Quartz Beloit One Network |
$854.34
|
| Rate for Payer: Quartz Commercial |
$1,106.76
|
| Rate for Payer: The Alliance Commercial |
$970.84
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
XR Upper GI w/ Small Bowel
|
Facility
|
OP
|
$1,940.00
|
|
|
Service Code
|
CPT 74240
|
| Hospital Charge Code |
1537451
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$184.59 |
| Max. Negotiated Rate |
$1,856.19 |
| Rate for Payer: Aetna Commercial |
$1,815.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,735.14
|
| 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 |
$1,069.33
|
| 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 |
$582.00
|
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Cash Price |
$582.00
|
| Rate for Payer: Cigna Commercial |
$1,856.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$184.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,129.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$184.59
|
| Rate for Payer: Health EOS Commercial |
$1,795.66
|
| Rate for Payer: HFN Commercial |
$1,856.19
|
| 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 |
$1,614.08
|
| Rate for Payer: NAPHCARE Commercial |
$276.88
|
| Rate for Payer: Preferred Network Access Commercial |
$1,856.19
|
| Rate for Payer: Quartz Beloit One Network |
$988.62
|
| Rate for Payer: Quartz Commercial |
$1,311.44
|
| 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 |
$1,109.68
|
| Rate for Payer: Wellcare Medicare |
$184.59
|
| Rate for Payer: WPS Commercial |
$1,494.38
|
|
|
XR Upper GI w/ Small Bowel Gastrografin
|
Professional
|
Both
|
$1,867.00
|
|
| Hospital Charge Code |
675805
|
| Min. Negotiated Rate |
$854.34 |
| Max. Negotiated Rate |
$1,844.60 |
| Rate for Payer: Aetna Commercial |
$1,844.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,844.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$970.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,165.01
|
| Rate for Payer: Health EOS Commercial |
$1,766.93
|
| Rate for Payer: HFN Commercial |
$1,844.60
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,844.60
|
| Rate for Payer: Quartz Beloit One Network |
$854.34
|
| Rate for Payer: Quartz Commercial |
$1,106.76
|
| Rate for Payer: The Alliance Commercial |
$970.84
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
XR Upper GI w/ Small Bowel Gastrografin
|
Professional
|
Both
|
$1,867.00
|
|
| Hospital Charge Code |
1537453
|
| Min. Negotiated Rate |
$854.34 |
| Max. Negotiated Rate |
$1,844.60 |
| Rate for Payer: Aetna Commercial |
$1,844.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,844.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$970.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,165.01
|
| Rate for Payer: Health EOS Commercial |
$1,766.93
|
| Rate for Payer: HFN Commercial |
$1,844.60
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,844.60
|
| Rate for Payer: Quartz Beloit One Network |
$854.34
|
| Rate for Payer: Quartz Commercial |
$1,106.76
|
| Rate for Payer: The Alliance Commercial |
$970.84
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
XR Upper GI w/ Small Bowel Gastrografin
|
Facility
|
IP
|
$1,867.00
|
|
| Hospital Charge Code |
1537453
|
| Min. Negotiated Rate |
$951.42 |
| Max. Negotiated Rate |
$1,786.35 |
| Rate for Payer: Aetna Commercial |
$1,747.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.09
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,786.35
|
| Rate for Payer: Health EOS Commercial |
$1,728.10
|
| Rate for Payer: HFN Commercial |
$1,786.35
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,786.35
|
| Rate for Payer: Quartz Beloit One Network |
$951.42
|
| Rate for Payer: Quartz Commercial |
$1,165.01
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
XR Upper GI w/ Small Bowel Gastrografin
|
Facility
|
OP
|
$1,867.00
|
|
| Hospital Charge Code |
1537453
|
| Min. Negotiated Rate |
$543.67 |
| Max. Negotiated Rate |
$1,786.35 |
| Rate for Payer: Aetna Commercial |
$1,747.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Aetna Managed Medicare |
$543.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,262.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$970.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$932.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.09
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,786.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,086.59
|
| Rate for Payer: Health EOS Commercial |
$1,728.10
|
| Rate for Payer: HFN Commercial |
$1,786.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,456.26
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,165.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,786.35
|
| Rate for Payer: Quartz Beloit One Network |
$951.42
|
| Rate for Payer: Quartz Commercial |
$1,262.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,165.01
|
| Rate for Payer: The Alliance Commercial |
$970.84
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
XR Upper GI w/ Small Bowel Gastrografin
|
Facility
|
OP
|
$1,867.00
|
|
| Hospital Charge Code |
675805
|
| Min. Negotiated Rate |
$543.67 |
| Max. Negotiated Rate |
$1,786.35 |
| Rate for Payer: Aetna Commercial |
$1,747.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Aetna Managed Medicare |
$543.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,262.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$970.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$932.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.09
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,786.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,086.59
|
| Rate for Payer: Health EOS Commercial |
$1,728.10
|
| Rate for Payer: HFN Commercial |
$1,786.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,456.26
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,165.01
|
| Rate for Payer: Preferred Network Access Commercial |
$1,786.35
|
| Rate for Payer: Quartz Beloit One Network |
$951.42
|
| Rate for Payer: Quartz Commercial |
$1,262.09
|
| Rate for Payer: Quartz Medicare Advantage |
$1,165.01
|
| Rate for Payer: The Alliance Commercial |
$970.84
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
XR Upper GI w/ Small Bowel Gastrografin
|
Facility
|
IP
|
$1,867.00
|
|
| Hospital Charge Code |
675805
|
| Min. Negotiated Rate |
$951.42 |
| Max. Negotiated Rate |
$1,786.35 |
| Rate for Payer: Aetna Commercial |
$1,747.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,669.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,029.09
|
| Rate for Payer: Cash Price |
$560.10
|
| Rate for Payer: Cigna Commercial |
$1,786.35
|
| Rate for Payer: Health EOS Commercial |
$1,728.10
|
| Rate for Payer: HFN Commercial |
$1,786.35
|
| Rate for Payer: Multiplan Commercial |
$1,553.34
|
| Rate for Payer: Preferred Network Access Commercial |
$1,786.35
|
| Rate for Payer: Quartz Beloit One Network |
$951.42
|
| Rate for Payer: Quartz Commercial |
$1,165.01
|
| Rate for Payer: WEA Trust Commercial |
$1,067.92
|
| Rate for Payer: WPS Commercial |
$1,438.15
|
|
|
XR Ureteral Cath/Stent Place Left
|
Facility
|
OP
|
$610.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
2587322
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$110.02 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$110.02
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Anthem Medicare Advantage |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$110.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$110.02
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$110.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$355.02
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$110.02
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$409.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$110.02
|
| Rate for Payer: Independent Care Health Plan Medicare |
$110.02
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$110.02
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$110.02
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$165.03
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$412.36
|
| Rate for Payer: Quartz Medicare Advantage |
$110.02
|
| Rate for Payer: The Alliance Commercial |
$440.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$110.02
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: Wellcare Medicare |
$110.02
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
XR Ureteral Cath/Stent Place Left
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
2587322
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
XR Ureteral Cath/Stent Place Left
|
Professional
|
Both
|
$610.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
2587322
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$41.86 |
| Max. Negotiated Rate |
$602.68 |
| Rate for Payer: Aetna Commercial |
$602.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Aetna Managed Medicare |
$41.86
|
| Rate for Payer: Anthem Medicare Advantage |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$41.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$41.86
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$602.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$317.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.86
|
| Rate for Payer: Health EOS Commercial |
$577.30
|
| Rate for Payer: HFN Commercial |
$602.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$151.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$151.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$41.86
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: NAPHCARE Commercial |
$62.79
|
| Rate for Payer: Preferred Network Access Commercial |
$602.68
|
| Rate for Payer: Quartz Beloit One Network |
$279.14
|
| Rate for Payer: Quartz Commercial |
$361.61
|
| Rate for Payer: Quartz Medicare Advantage |
$41.86
|
| Rate for Payer: The Alliance Commercial |
$159.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$41.86
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$209.30
|
|
|
XR Ureteral Cath/Stent Place Right
|
Facility
|
IP
|
$610.00
|
|
|
Service Code
|
CPT 74021
|
| Hospital Charge Code |
2587325
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$310.86 |
| Max. Negotiated Rate |
$583.65 |
| Rate for Payer: Aetna Commercial |
$570.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$545.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$336.23
|
| Rate for Payer: Cash Price |
$183.00
|
| Rate for Payer: Cigna Commercial |
$583.65
|
| Rate for Payer: Health EOS Commercial |
$564.62
|
| Rate for Payer: HFN Commercial |
$583.65
|
| Rate for Payer: Multiplan Commercial |
$507.52
|
| Rate for Payer: Preferred Network Access Commercial |
$583.65
|
| Rate for Payer: Quartz Beloit One Network |
$310.86
|
| Rate for Payer: Quartz Commercial |
$380.64
|
| Rate for Payer: WEA Trust Commercial |
$348.92
|
| Rate for Payer: WPS Commercial |
$469.88
|
|
|
XR Ureteral Cath/Stent Place Right
|
Facility
|
OP
|
$588.00
|
|
|
Service Code
|
CPT 74021 TC,RT
|
| Hospital Charge Code |
5577652
|
|
Hospital Revenue Code
|
320
|
| Min. Negotiated Rate |
$171.23 |
| Max. Negotiated Rate |
$562.60 |
| Rate for Payer: Aetna Commercial |
$550.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$525.91
|
| Rate for Payer: Aetna Managed Medicare |
$171.23
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$423.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$339.05
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$322.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$324.11
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cash Price |
$176.40
|
| Rate for Payer: Cigna Commercial |
$562.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$342.22
|
| Rate for Payer: Health EOS Commercial |
$544.25
|
| Rate for Payer: HFN Commercial |
$562.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$458.64
|
| Rate for Payer: Multiplan Commercial |
$489.22
|
| Rate for Payer: NAPHCARE Commercial |
$366.91
|
| Rate for Payer: Preferred Network Access Commercial |
$562.60
|
| Rate for Payer: Quartz Beloit One Network |
$299.64
|
| Rate for Payer: Quartz Commercial |
$397.49
|
| Rate for Payer: Quartz Medicare Advantage |
$366.91
|
| Rate for Payer: The Alliance Commercial |
$305.76
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$336.34
|
| Rate for Payer: WPS Commercial |
$452.94
|
|
