|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2950498
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIOPANCREATOGRAPHY (ERCP)
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2950498
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH BALLOON DILATATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH BALLOON DILATATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH DILATATION AND PAPILLOTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960543
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH DILATATION AND PAPILLOTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960543
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH PAPILLOTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960544
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH PAPILLOTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960544
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STENT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STENT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STENT AND PAPILLOTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960546
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STENT AND PAPILLOTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960546
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STONE REMOVAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960547
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STONE REMOVAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960547
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STONE REMOVAL AND PAPILLOTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960548
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STONE REMOVAL AND PAPILLOTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960548
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ENDOSCOPY
|
Facility
|
IP
|
$3,784.00
|
|
| Hospital Charge Code |
2960007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.33 |
| Max. Negotiated Rate |
$3,620.53 |
| Rate for Payer: Aetna Commercial |
$3,541.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.74
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,620.53
|
| Rate for Payer: Health EOS Commercial |
$3,502.47
|
| Rate for Payer: HFN Commercial |
$3,620.53
|
| Rate for Payer: Multiplan Commercial |
$3,148.29
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.33
|
| Rate for Payer: Quartz Commercial |
$2,361.22
|
| Rate for Payer: WEA Trust Commercial |
$2,164.45
|
| Rate for Payer: WPS Commercial |
$2,914.82
|
|
|
ENDOSCOPY
|
Facility
|
OP
|
$3,784.00
|
|
| Hospital Charge Code |
2960007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.90 |
| Max. Negotiated Rate |
$3,620.53 |
| Rate for Payer: Aetna Commercial |
$3,541.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.74
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,620.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.29
|
| Rate for Payer: Health EOS Commercial |
$3,502.47
|
| Rate for Payer: HFN Commercial |
$3,620.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.52
|
| Rate for Payer: Multiplan Commercial |
$3,148.29
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.33
|
| Rate for Payer: Quartz Commercial |
$2,557.98
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.22
|
| Rate for Payer: The Alliance Commercial |
$1,967.68
|
| Rate for Payer: WEA Trust Commercial |
$2,164.45
|
| Rate for Payer: WPS Commercial |
$2,914.82
|
|
|
ENDOSCOPY OF URETER 50951
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
CPT 50951
|
| Hospital Charge Code |
3014963
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$140.99 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,363.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,234.27
|
| Rate for Payer: Aetna Managed Medicare |
$260.25
|
| Rate for Payer: Anthem Medicare Advantage |
$260.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$260.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$260.25
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$140.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$260.25
|
| Rate for Payer: Health EOS Commercial |
$1,306.03
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,058.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,058.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$260.25
|
| Rate for Payer: Multiplan Commercial |
$1,148.16
|
| Rate for Payer: NAPHCARE Commercial |
$390.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$631.49
|
| Rate for Payer: Quartz Commercial |
$818.06
|
| Rate for Payer: Quartz Medicare Advantage |
$260.25
|
| Rate for Payer: The Alliance Commercial |
$1,106.06
|
| Rate for Payer: United Healthcare Medicaid |
$140.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$260.25
|
| Rate for Payer: WEA Trust Commercial |
$789.36
|
| Rate for Payer: WPS Commercial |
$1,171.12
|
|
|
ENDOSCOPY OF URETER 50953
|
Professional
|
Both
|
$1,796.00
|
|
|
Service Code
|
CPT 50953
|
| Hospital Charge Code |
3014964
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$156.69 |
| Max. Negotiated Rate |
$1,774.45 |
| Rate for Payer: Aetna Commercial |
$1,774.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,606.34
|
| Rate for Payer: Aetna Managed Medicare |
$277.54
|
| Rate for Payer: Anthem Medicare Advantage |
$277.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$277.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$277.54
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$1,774.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$156.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$277.54
|
| Rate for Payer: Health EOS Commercial |
$1,699.73
|
| Rate for Payer: HFN Commercial |
$1,774.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,127.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,127.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$277.54
|
| Rate for Payer: Multiplan Commercial |
$1,494.27
|
| Rate for Payer: NAPHCARE Commercial |
$416.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,774.45
|
| Rate for Payer: Quartz Beloit One Network |
$821.85
|
| Rate for Payer: Quartz Commercial |
$1,064.67
|
| Rate for Payer: Quartz Medicare Advantage |
$277.54
|
| Rate for Payer: The Alliance Commercial |
$1,179.57
|
| Rate for Payer: United Healthcare Medicaid |
$156.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$277.54
|
| Rate for Payer: WEA Trust Commercial |
$1,027.31
|
| Rate for Payer: WPS Commercial |
$1,248.95
|
|
|
ENDO STITCH SUTURE DEVICE 10MM 173016
|
Facility
|
IP
|
$1,259.00
|
|
| Hospital Charge Code |
2965507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$641.59 |
| Max. Negotiated Rate |
$1,204.61 |
| Rate for Payer: Aetna Commercial |
$1,178.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,126.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.96
|
| Rate for Payer: Cash Price |
$377.70
|
| Rate for Payer: Cigna Commercial |
$1,204.61
|
| Rate for Payer: Health EOS Commercial |
$1,165.33
|
| Rate for Payer: HFN Commercial |
$1,204.61
|
| Rate for Payer: Multiplan Commercial |
$1,047.49
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.61
|
| Rate for Payer: Quartz Beloit One Network |
$641.59
|
| Rate for Payer: Quartz Commercial |
$785.62
|
| Rate for Payer: WEA Trust Commercial |
$720.15
|
| Rate for Payer: WPS Commercial |
$969.81
|
|
|
ENDO STITCH SUTURE DEVICE 10MM 173016
|
Facility
|
OP
|
$1,259.00
|
|
| Hospital Charge Code |
2965507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$366.62 |
| Max. Negotiated Rate |
$1,204.61 |
| Rate for Payer: Aetna Commercial |
$1,178.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,126.05
|
| Rate for Payer: Aetna Managed Medicare |
$366.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$851.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$654.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$628.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$693.96
|
| Rate for Payer: Cash Price |
$377.70
|
| Rate for Payer: Cigna Commercial |
$1,204.61
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.74
|
| Rate for Payer: Health EOS Commercial |
$1,165.33
|
| Rate for Payer: HFN Commercial |
$1,204.61
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$982.02
|
| Rate for Payer: Multiplan Commercial |
$1,047.49
|
| Rate for Payer: NAPHCARE Commercial |
$785.62
|
| Rate for Payer: Preferred Network Access Commercial |
$1,204.61
|
| Rate for Payer: Quartz Beloit One Network |
$641.59
|
| Rate for Payer: Quartz Commercial |
$851.08
|
| Rate for Payer: Quartz Medicare Advantage |
$785.62
|
| Rate for Payer: The Alliance Commercial |
$654.68
|
| Rate for Payer: WEA Trust Commercial |
$720.15
|
| Rate for Payer: WPS Commercial |
$969.81
|
|
|
Endotrach Guide-Satin Slip
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3040314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2.04 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.50
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Endotrach Guide-Satin Slip
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3040314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.16 |
| Max. Negotiated Rate |
$3.83 |
| Rate for Payer: Aetna Commercial |
$3.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.58
|
| Rate for Payer: Aetna Managed Medicare |
$1.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.20
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.33
|
| Rate for Payer: Health EOS Commercial |
$3.70
|
| Rate for Payer: HFN Commercial |
$3.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.12
|
| Rate for Payer: Multiplan Commercial |
$3.33
|
| Rate for Payer: NAPHCARE Commercial |
$2.50
|
| Rate for Payer: Preferred Network Access Commercial |
$3.83
|
| Rate for Payer: Quartz Beloit One Network |
$2.04
|
| Rate for Payer: Quartz Commercial |
$2.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2.50
|
| Rate for Payer: The Alliance Commercial |
$2.08
|
| Rate for Payer: WEA Trust Commercial |
$2.29
|
| Rate for Payer: WPS Commercial |
$3.08
|
|
|
Endotrach Guide Stylet
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
3040315
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.55 |
| Max. Negotiated Rate |
$4.78 |
| Rate for Payer: Aetna Commercial |
$4.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.76
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.78
|
| Rate for Payer: Health EOS Commercial |
$4.63
|
| Rate for Payer: HFN Commercial |
$4.78
|
| Rate for Payer: Multiplan Commercial |
$4.16
|
| Rate for Payer: Preferred Network Access Commercial |
$4.78
|
| Rate for Payer: Quartz Beloit One Network |
$2.55
|
| Rate for Payer: Quartz Commercial |
$3.12
|
| Rate for Payer: WEA Trust Commercial |
$2.86
|
| Rate for Payer: WPS Commercial |
$3.85
|
|
