|
COLONOSCOPY THROUGH STOMA WITH DECOMPRESSON
|
Facility
|
IP
|
$1,948.00
|
|
|
Service Code
|
CPT 44408
|
| Hospital Charge Code |
4494713
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$954.52 |
| Max. Negotiated Rate |
$1,792.16 |
| Rate for Payer: Aetna Commercial |
$1,753.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,675.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,032.44
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,792.16
|
| Rate for Payer: Health EOS Commercial |
$1,733.72
|
| Rate for Payer: HFN Commercial |
$1,792.16
|
| Rate for Payer: Multiplan Commercial |
$1,558.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,792.16
|
| Rate for Payer: Quartz Beloit One Network |
$954.52
|
| Rate for Payer: Quartz Commercial |
$1,168.80
|
| Rate for Payer: WEA Trust Commercial |
$1,071.40
|
| Rate for Payer: WPS Commercial |
$1,442.88
|
|
|
COLONOSCOPY THROUGH STOMA; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$4,665.56
|
|
|
Service Code
|
CPT 44394
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,166.39 |
| Max. Negotiated Rate |
$4,665.56 |
| Rate for Payer: Aetna Managed Medicare |
$1,166.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,166.39
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,166.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,166.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,338.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,166.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,166.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,166.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,166.39
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Quartz Medicare Advantage |
$1,166.39
|
| Rate for Payer: The Alliance Commercial |
$4,665.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.39
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
|
|
COLONOSCOPY THROUGH STOMA WITH STENT PLACEMENT
|
Facility
|
OP
|
$4,569.00
|
|
|
Service Code
|
CPT 44402
|
| Hospital Charge Code |
4494711
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,238.81 |
| Max. Negotiated Rate |
$22,532.68 |
| Rate for Payer: Aetna Commercial |
$4,112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,929.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,633.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,633.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,421.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,633.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,633.17
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cigna Commercial |
$4,203.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,633.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,633.17
|
| Rate for Payer: Health EOS Commercial |
$4,066.41
|
| Rate for Payer: HFN Commercial |
$4,203.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,955.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,633.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,633.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,633.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,633.17
|
| Rate for Payer: Multiplan Commercial |
$3,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,449.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,203.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,238.81
|
| Rate for Payer: Quartz Commercial |
$2,969.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5,633.17
|
| Rate for Payer: The Alliance Commercial |
$22,532.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,633.17
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,512.95
|
| Rate for Payer: Wellcare Medicare |
$5,633.17
|
| Rate for Payer: WPS Commercial |
$3,384.26
|
|
|
COLONOSCOPY THROUGH STOMA WITH STENT PLACEMENT
|
Facility
|
IP
|
$4,569.00
|
|
|
Service Code
|
CPT 44402
|
| Hospital Charge Code |
4494711
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,238.81 |
| Max. Negotiated Rate |
$4,203.48 |
| Rate for Payer: Aetna Commercial |
$4,112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,929.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,421.57
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cigna Commercial |
$4,203.48
|
| Rate for Payer: Health EOS Commercial |
$4,066.41
|
| Rate for Payer: HFN Commercial |
$4,203.48
|
| Rate for Payer: Multiplan Commercial |
$3,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,741.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,203.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,238.81
|
| Rate for Payer: Quartz Commercial |
$2,741.40
|
| Rate for Payer: WEA Trust Commercial |
$2,512.95
|
| Rate for Payer: WPS Commercial |
$3,384.26
|
|
|
Colonoscopy thru stoma with submuc inj 44404
|
Facility
|
OP
|
$1,659.00
|
|
|
Service Code
|
CPT 44404
|
| Hospital Charge Code |
5544706
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$796.32 |
| Max. Negotiated Rate |
$4,665.56 |
| Rate for Payer: Aetna Commercial |
$1,493.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,426.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,166.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,078.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$829.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$796.32
|
| Rate for Payer: Anthem Medicare Advantage |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$879.27
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,166.39
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cigna Commercial |
$1,526.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,166.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,166.39
|
| Rate for Payer: Health EOS Commercial |
$1,476.51
|
| Rate for Payer: HFN Commercial |
$1,526.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,338.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,166.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,166.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,166.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,166.39
|
| Rate for Payer: Multiplan Commercial |
$1,327.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,526.28
|
| Rate for Payer: Quartz Beloit One Network |
$812.91
|
| Rate for Payer: Quartz Commercial |
$1,078.35
|
| Rate for Payer: Quartz Medicare Advantage |
$1,166.39
|
| Rate for Payer: The Alliance Commercial |
$4,665.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.39
|
| Rate for Payer: WEA Trust Commercial |
$912.45
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
| Rate for Payer: WPS Commercial |
$1,228.82
|
|
|
Colonoscopy thru stoma with submuc inj 44404
|
Facility
|
IP
|
$1,659.00
|
|
|
Service Code
|
CPT 44404
|
| Hospital Charge Code |
5544706
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$812.91 |
| Max. Negotiated Rate |
$1,526.28 |
| Rate for Payer: Aetna Commercial |
$1,493.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,426.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$879.27
|
| Rate for Payer: Cash Price |
$497.70
|
| Rate for Payer: Cigna Commercial |
$1,526.28
|
| Rate for Payer: Health EOS Commercial |
$1,476.51
|
| Rate for Payer: HFN Commercial |
$1,526.28
|
| Rate for Payer: Multiplan Commercial |
$1,327.20
|
| Rate for Payer: NAPHCARE Commercial |
$995.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,526.28
|
| Rate for Payer: Quartz Beloit One Network |
$812.91
|
| Rate for Payer: Quartz Commercial |
$995.40
|
| Rate for Payer: WEA Trust Commercial |
$912.45
|
| Rate for Payer: WPS Commercial |
$1,228.82
|
|
|
COLONOSCOPY WITH ABLATION OF TUMOR, POLYP OR LESION
|
Facility
|
OP
|
$4,892.00
|
|
|
Service Code
|
CPT 45388
|
| Hospital Charge Code |
4494705
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,166.39 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$4,402.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,207.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,166.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,592.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,166.39
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cigna Commercial |
$4,500.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,166.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,166.39
|
| Rate for Payer: Health EOS Commercial |
$4,353.88
|
| Rate for Payer: HFN Commercial |
$4,500.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,338.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,166.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,166.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,166.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,166.39
|
| Rate for Payer: Multiplan Commercial |
$3,913.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Preferred Network Access Commercial |
$4,500.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,397.08
|
| Rate for Payer: Quartz Commercial |
$3,179.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,166.39
|
| Rate for Payer: The Alliance Commercial |
$4,665.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.39
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$2,690.60
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
| Rate for Payer: WPS Commercial |
$3,623.50
|
|
|
COLONOSCOPY WITH ABLATION OF TUMOR, POLYP OR LESION
|
Facility
|
IP
|
$4,892.00
|
|
|
Service Code
|
CPT 45388
|
| Hospital Charge Code |
4494705
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,397.08 |
| Max. Negotiated Rate |
$4,500.64 |
| Rate for Payer: Aetna Commercial |
$4,402.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,207.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,592.76
|
| Rate for Payer: Cash Price |
$1,467.60
|
| Rate for Payer: Cigna Commercial |
$4,500.64
|
| Rate for Payer: Health EOS Commercial |
$4,353.88
|
| Rate for Payer: HFN Commercial |
$4,500.64
|
| Rate for Payer: Multiplan Commercial |
$3,913.60
|
| Rate for Payer: NAPHCARE Commercial |
$2,935.20
|
| Rate for Payer: Preferred Network Access Commercial |
$4,500.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,397.08
|
| Rate for Payer: Quartz Commercial |
$2,935.20
|
| Rate for Payer: WEA Trust Commercial |
$2,690.60
|
| Rate for Payer: WPS Commercial |
$3,623.50
|
|
|
COLONOSCOPY WITH BANDING
|
Facility
|
IP
|
$6,092.00
|
|
|
Service Code
|
CPT 45398
|
| Hospital Charge Code |
4494704
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,985.08 |
| Max. Negotiated Rate |
$5,604.64 |
| Rate for Payer: Aetna Commercial |
$5,482.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,239.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,228.76
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$5,604.64
|
| Rate for Payer: Health EOS Commercial |
$5,421.88
|
| Rate for Payer: HFN Commercial |
$5,604.64
|
| Rate for Payer: Multiplan Commercial |
$4,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,655.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,604.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,985.08
|
| Rate for Payer: Quartz Commercial |
$3,655.20
|
| Rate for Payer: WEA Trust Commercial |
$3,350.60
|
| Rate for Payer: WPS Commercial |
$4,512.34
|
|
|
COLONOSCOPY WITH BANDING
|
Facility
|
OP
|
$6,092.00
|
|
|
Service Code
|
CPT 45398
|
| Hospital Charge Code |
4494704
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,166.39 |
| Max. Negotiated Rate |
$5,604.64 |
| Rate for Payer: Aetna Commercial |
$5,482.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,239.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,166.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,228.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,166.39
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cash Price |
$1,827.60
|
| Rate for Payer: Cigna Commercial |
$5,604.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,166.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,166.39
|
| Rate for Payer: Health EOS Commercial |
$5,421.88
|
| Rate for Payer: HFN Commercial |
$5,604.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,338.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,166.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,166.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,166.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,166.39
|
| Rate for Payer: Multiplan Commercial |
$4,873.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Preferred Network Access Commercial |
$5,604.64
|
| Rate for Payer: Quartz Beloit One Network |
$2,985.08
|
| Rate for Payer: Quartz Commercial |
$3,959.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,166.39
|
| Rate for Payer: The Alliance Commercial |
$4,665.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.39
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$3,350.60
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
| Rate for Payer: WPS Commercial |
$4,512.34
|
|
|
COLONOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$6,866.00
|
|
| Hospital Charge Code |
2960553
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,364.34 |
| Max. Negotiated Rate |
$6,316.72 |
| Rate for Payer: Aetna Commercial |
$6,179.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,904.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,638.98
|
| Rate for Payer: Cash Price |
$2,059.80
|
| Rate for Payer: Cigna Commercial |
$6,316.72
|
| Rate for Payer: Health EOS Commercial |
$6,110.74
|
| Rate for Payer: HFN Commercial |
$6,316.72
|
| Rate for Payer: Multiplan Commercial |
$5,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,119.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,316.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,364.34
|
| Rate for Payer: Quartz Commercial |
$4,119.60
|
| Rate for Payer: WEA Trust Commercial |
$3,776.30
|
| Rate for Payer: WPS Commercial |
$5,085.65
|
|
|
COLONOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$6,866.00
|
|
| Hospital Charge Code |
2960553
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,922.48 |
| Max. Negotiated Rate |
$27,464.00 |
| Rate for Payer: Aetna Commercial |
$6,179.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,904.76
|
| Rate for Payer: Aetna Managed Medicare |
$1,922.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,462.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,433.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,295.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,638.98
|
| Rate for Payer: Cash Price |
$2,059.80
|
| Rate for Payer: Cigna Commercial |
$6,316.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,842.21
|
| Rate for Payer: Health EOS Commercial |
$6,110.74
|
| Rate for Payer: HFN Commercial |
$6,316.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,149.50
|
| Rate for Payer: Multiplan Commercial |
$5,492.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,119.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,316.72
|
| Rate for Payer: Quartz Beloit One Network |
$3,364.34
|
| Rate for Payer: Quartz Commercial |
$4,462.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,119.60
|
| Rate for Payer: The Alliance Commercial |
$27,464.00
|
| Rate for Payer: WEA Trust Commercial |
$3,776.30
|
| Rate for Payer: WPS Commercial |
$5,085.65
|
|
|
COLONOSCOPY WITH DECOMPRESSION
|
Facility
|
OP
|
$1,948.00
|
|
|
Service Code
|
CPT 45393
|
| Hospital Charge Code |
4494706
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$954.52 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$1,753.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,675.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,166.39
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,032.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,166.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,166.39
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,792.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,166.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,166.39
|
| Rate for Payer: Health EOS Commercial |
$1,733.72
|
| Rate for Payer: HFN Commercial |
$1,792.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,338.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,166.39
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,166.39
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,166.39
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,166.39
|
| Rate for Payer: Multiplan Commercial |
$1,558.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,749.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,792.16
|
| Rate for Payer: Quartz Beloit One Network |
$954.52
|
| Rate for Payer: Quartz Commercial |
$1,266.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,166.39
|
| Rate for Payer: The Alliance Commercial |
$4,665.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,166.39
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: WEA Trust Commercial |
$1,071.40
|
| Rate for Payer: Wellcare Medicare |
$1,166.39
|
| Rate for Payer: WPS Commercial |
$1,442.88
|
|
|
COLONOSCOPY WITH DECOMPRESSION
|
Facility
|
IP
|
$1,948.00
|
|
|
Service Code
|
CPT 45393
|
| Hospital Charge Code |
4494706
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$954.52 |
| Max. Negotiated Rate |
$1,792.16 |
| Rate for Payer: Aetna Commercial |
$1,753.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,675.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,032.44
|
| Rate for Payer: Cash Price |
$584.40
|
| Rate for Payer: Cigna Commercial |
$1,792.16
|
| Rate for Payer: Health EOS Commercial |
$1,733.72
|
| Rate for Payer: HFN Commercial |
$1,792.16
|
| Rate for Payer: Multiplan Commercial |
$1,558.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,168.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,792.16
|
| Rate for Payer: Quartz Beloit One Network |
$954.52
|
| Rate for Payer: Quartz Commercial |
$1,168.80
|
| Rate for Payer: WEA Trust Commercial |
$1,071.40
|
| Rate for Payer: WPS Commercial |
$1,442.88
|
|
|
COLONOSCOPY WITH POLYPECTOMY
|
Facility
|
IP
|
$7,205.00
|
|
| Hospital Charge Code |
2960554
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,530.45 |
| Max. Negotiated Rate |
$6,628.60 |
| Rate for Payer: Aetna Commercial |
$6,484.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,196.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,818.65
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cigna Commercial |
$6,628.60
|
| Rate for Payer: Health EOS Commercial |
$6,412.45
|
| Rate for Payer: HFN Commercial |
$6,628.60
|
| Rate for Payer: Multiplan Commercial |
$5,764.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,323.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,628.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,530.45
|
| Rate for Payer: Quartz Commercial |
$4,323.00
|
| Rate for Payer: WEA Trust Commercial |
$3,962.75
|
| Rate for Payer: WPS Commercial |
$5,336.74
|
|
|
COLONOSCOPY WITH POLYPECTOMY
|
Facility
|
OP
|
$7,205.00
|
|
| Hospital Charge Code |
2960554
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,017.40 |
| Max. Negotiated Rate |
$28,820.00 |
| Rate for Payer: Aetna Commercial |
$6,484.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,196.30
|
| Rate for Payer: Aetna Managed Medicare |
$2,017.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,683.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,602.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,458.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,818.65
|
| Rate for Payer: Cash Price |
$2,161.50
|
| Rate for Payer: Cigna Commercial |
$6,628.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,031.92
|
| Rate for Payer: Health EOS Commercial |
$6,412.45
|
| Rate for Payer: HFN Commercial |
$6,628.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,403.75
|
| Rate for Payer: Multiplan Commercial |
$5,764.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,323.00
|
| Rate for Payer: Preferred Network Access Commercial |
$6,628.60
|
| Rate for Payer: Quartz Beloit One Network |
$3,530.45
|
| Rate for Payer: Quartz Commercial |
$4,683.25
|
| Rate for Payer: Quartz Medicare Advantage |
$4,323.00
|
| Rate for Payer: The Alliance Commercial |
$28,820.00
|
| Rate for Payer: WEA Trust Commercial |
$3,962.75
|
| Rate for Payer: WPS Commercial |
$5,336.74
|
|
|
COLONOSCOPY WITH POLYPECTOMY AND BIOPSY
|
Facility
|
OP
|
$7,221.00
|
|
| Hospital Charge Code |
2960555
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,021.88 |
| Max. Negotiated Rate |
$28,884.00 |
| Rate for Payer: Aetna Commercial |
$6,498.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,210.06
|
| Rate for Payer: Aetna Managed Medicare |
$2,021.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,693.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,610.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,466.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,827.13
|
| Rate for Payer: Cash Price |
$2,166.30
|
| Rate for Payer: Cigna Commercial |
$6,643.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,040.87
|
| Rate for Payer: Health EOS Commercial |
$6,426.69
|
| Rate for Payer: HFN Commercial |
$6,643.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,415.75
|
| Rate for Payer: Multiplan Commercial |
$5,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,332.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,643.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,538.29
|
| Rate for Payer: Quartz Commercial |
$4,693.65
|
| Rate for Payer: Quartz Medicare Advantage |
$4,332.60
|
| Rate for Payer: The Alliance Commercial |
$28,884.00
|
| Rate for Payer: WEA Trust Commercial |
$3,971.55
|
| Rate for Payer: WPS Commercial |
$5,348.59
|
|
|
COLONOSCOPY WITH POLYPECTOMY AND BIOPSY
|
Facility
|
IP
|
$7,221.00
|
|
| Hospital Charge Code |
2960555
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,538.29 |
| Max. Negotiated Rate |
$6,643.32 |
| Rate for Payer: Aetna Commercial |
$6,498.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,210.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,827.13
|
| Rate for Payer: Cash Price |
$2,166.30
|
| Rate for Payer: Cigna Commercial |
$6,643.32
|
| Rate for Payer: Health EOS Commercial |
$6,426.69
|
| Rate for Payer: HFN Commercial |
$6,643.32
|
| Rate for Payer: Multiplan Commercial |
$5,776.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,332.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,643.32
|
| Rate for Payer: Quartz Beloit One Network |
$3,538.29
|
| Rate for Payer: Quartz Commercial |
$4,332.60
|
| Rate for Payer: WEA Trust Commercial |
$3,971.55
|
| Rate for Payer: WPS Commercial |
$5,348.59
|
|
|
COLONOSCOPY WITH STENT PLACEMENT
|
Facility
|
IP
|
$4,569.00
|
|
|
Service Code
|
CPT 45389
|
| Hospital Charge Code |
4494708
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,238.81 |
| Max. Negotiated Rate |
$4,203.48 |
| Rate for Payer: Aetna Commercial |
$4,112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,929.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,421.57
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cigna Commercial |
$4,203.48
|
| Rate for Payer: Health EOS Commercial |
$4,066.41
|
| Rate for Payer: HFN Commercial |
$4,203.48
|
| Rate for Payer: Multiplan Commercial |
$3,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,741.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,203.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,238.81
|
| Rate for Payer: Quartz Commercial |
$2,741.40
|
| Rate for Payer: WEA Trust Commercial |
$2,512.95
|
| Rate for Payer: WPS Commercial |
$3,384.26
|
|
|
COLONOSCOPY WITH STENT PLACEMENT
|
Facility
|
OP
|
$4,569.00
|
|
|
Service Code
|
CPT 45389
|
| Hospital Charge Code |
4494708
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,238.81 |
| Max. Negotiated Rate |
$22,532.68 |
| Rate for Payer: Aetna Commercial |
$4,112.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,929.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,633.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,238.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,914.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,367.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,633.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,421.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,633.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,633.17
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cash Price |
$1,370.70
|
| Rate for Payer: Cigna Commercial |
$4,203.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,633.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,633.17
|
| Rate for Payer: Health EOS Commercial |
$4,066.41
|
| Rate for Payer: HFN Commercial |
$4,203.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,955.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,633.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,633.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,633.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,633.17
|
| Rate for Payer: Multiplan Commercial |
$3,655.20
|
| Rate for Payer: NAPHCARE Commercial |
$8,449.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,203.48
|
| Rate for Payer: Quartz Beloit One Network |
$2,238.81
|
| Rate for Payer: Quartz Commercial |
$2,969.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5,633.17
|
| Rate for Payer: The Alliance Commercial |
$22,532.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,633.17
|
| Rate for Payer: United Healthcare PPO |
$4,240.00
|
| Rate for Payer: WEA Trust Commercial |
$2,512.95
|
| Rate for Payer: Wellcare Medicare |
$5,633.17
|
| Rate for Payer: WPS Commercial |
$3,384.26
|
|
|
COLON RESECTION
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2959938
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,353.47 |
| Max. Negotiated Rate |
$4,418.76 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$2,881.80
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
COLON RESECTION
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2959938
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,344.84 |
| Max. Negotiated Rate |
$19,212.00 |
| Rate for Payer: Aetna Commercial |
$4,322.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,130.58
|
| Rate for Payer: Aetna Managed Medicare |
$1,344.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,121.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,401.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,305.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,545.59
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,418.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,687.76
|
| Rate for Payer: Health EOS Commercial |
$4,274.67
|
| Rate for Payer: HFN Commercial |
$4,418.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,602.25
|
| Rate for Payer: Multiplan Commercial |
$3,842.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,881.80
|
| Rate for Payer: Preferred Network Access Commercial |
$4,418.76
|
| Rate for Payer: Quartz Beloit One Network |
$2,353.47
|
| Rate for Payer: Quartz Commercial |
$3,121.95
|
| Rate for Payer: Quartz Medicare Advantage |
$2,881.80
|
| Rate for Payer: The Alliance Commercial |
$19,212.00
|
| Rate for Payer: WEA Trust Commercial |
$2,641.65
|
| Rate for Payer: WPS Commercial |
$3,557.58
|
|
|
Colorectal Cancer Screening: Flexible Sigmoidoscopy
|
Professional
|
Both
|
$461.00
|
|
|
Service Code
|
CPT 45330
|
| Hospital Charge Code |
1188849
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$67.21 |
| Max. Negotiated Rate |
$437.95 |
| Rate for Payer: Aetna Commercial |
$437.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$396.46
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cash Price |
$138.30
|
| Rate for Payer: Cigna Commercial |
$437.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.60
|
| Rate for Payer: Health EOS Commercial |
$419.51
|
| Rate for Payer: HFN Commercial |
$437.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.22
|
| Rate for Payer: Multiplan Commercial |
$368.80
|
| Rate for Payer: Preferred Network Access Commercial |
$437.95
|
| Rate for Payer: Quartz Beloit One Network |
$202.84
|
| Rate for Payer: Quartz Commercial |
$262.77
|
| Rate for Payer: The Alliance Commercial |
$230.50
|
| Rate for Payer: United Healthcare Medicaid |
$67.21
|
| Rate for Payer: WEA Trust Commercial |
$253.55
|
| Rate for Payer: WPS Commercial |
$341.46
|
|
|
Colorectal Cancer Screening: Flexible Sigmoidoscopy Medicare Screening
|
Professional
|
Both
|
$382.00
|
|
|
Service Code
|
HCPCS G0104
|
| Hospital Charge Code |
1188848
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$101.36 |
| Max. Negotiated Rate |
$362.90 |
| Rate for Payer: Aetna Commercial |
$362.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$328.52
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cash Price |
$114.60
|
| Rate for Payer: Cigna Commercial |
$362.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$101.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$229.20
|
| Rate for Payer: Health EOS Commercial |
$347.62
|
| Rate for Payer: HFN Commercial |
$362.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$185.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$185.22
|
| Rate for Payer: Multiplan Commercial |
$305.60
|
| Rate for Payer: Preferred Network Access Commercial |
$362.90
|
| Rate for Payer: Quartz Beloit One Network |
$168.08
|
| Rate for Payer: Quartz Commercial |
$217.74
|
| Rate for Payer: The Alliance Commercial |
$191.00
|
| Rate for Payer: United Healthcare Medicaid |
$101.36
|
| Rate for Payer: WEA Trust Commercial |
$210.10
|
| Rate for Payer: WPS Commercial |
$282.95
|
|
|
Color Flow 93325
|
Facility
|
OP
|
$917.00
|
|
|
Service Code
|
CPT 93325
|
| Hospital Charge Code |
5381791
|
|
Hospital Revenue Code
|
480
|
| Min. Negotiated Rate |
$256.76 |
| Max. Negotiated Rate |
$3,668.00 |
| Rate for Payer: Aetna Commercial |
$825.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$788.62
|
| Rate for Payer: Aetna Managed Medicare |
$256.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$596.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$458.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$440.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$486.01
|
| Rate for Payer: Cash Price |
$275.10
|
| Rate for Payer: Cigna Commercial |
$843.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$513.15
|
| Rate for Payer: Health EOS Commercial |
$816.13
|
| Rate for Payer: HFN Commercial |
$843.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$687.75
|
| Rate for Payer: Multiplan Commercial |
$733.60
|
| Rate for Payer: NAPHCARE Commercial |
$550.20
|
| Rate for Payer: Preferred Network Access Commercial |
$843.64
|
| Rate for Payer: Quartz Beloit One Network |
$449.33
|
| Rate for Payer: Quartz Commercial |
$596.05
|
| Rate for Payer: Quartz Medicare Advantage |
$550.20
|
| Rate for Payer: The Alliance Commercial |
$3,668.00
|
| Rate for Payer: United Healthcare PPO |
$687.75
|
| Rate for Payer: WEA Trust Commercial |
$504.35
|
| Rate for Payer: WPS Commercial |
$679.22
|
|
