|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH BALLOON DILATATION
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH BALLOON DILATATION
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH DILATATION AND PAPILLOTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960543
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH DILATATION AND PAPILLOTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960543
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH PAPILLOTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960544
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH PAPILLOTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960544
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STENT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STENT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STENT AND PAPILLOTOMY
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960546
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STENT AND PAPILLOTOMY
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960546
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STONE REMOVAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960547
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPIC RETROGRADE CHOLANGIO PANCREATOGRAPHY WITH STONE REMOVAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960547
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
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 |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
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 |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ENDOSCOPY
|
Facility
|
OP
|
$3,784.00
|
|
| Hospital Charge Code |
2960007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,059.52 |
| Max. Negotiated Rate |
$15,136.00 |
| Rate for Payer: Aetna Commercial |
$3,405.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,254.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,059.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,459.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,892.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,816.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,005.52
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,481.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,117.53
|
| Rate for Payer: Health EOS Commercial |
$3,367.76
|
| Rate for Payer: HFN Commercial |
$3,481.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,838.00
|
| Rate for Payer: Multiplan Commercial |
$3,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,481.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,854.16
|
| Rate for Payer: Quartz Commercial |
$2,459.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,270.40
|
| Rate for Payer: The Alliance Commercial |
$15,136.00
|
| Rate for Payer: WEA Trust Commercial |
$2,081.20
|
| Rate for Payer: WPS Commercial |
$2,802.81
|
|
|
ENDOSCOPY
|
Facility
|
IP
|
$3,784.00
|
|
| Hospital Charge Code |
2960007
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,854.16 |
| Max. Negotiated Rate |
$3,481.28 |
| Rate for Payer: Aetna Commercial |
$3,405.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,254.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,005.52
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,481.28
|
| Rate for Payer: Health EOS Commercial |
$3,367.76
|
| Rate for Payer: HFN Commercial |
$3,481.28
|
| Rate for Payer: Multiplan Commercial |
$3,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,481.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,854.16
|
| Rate for Payer: Quartz Commercial |
$2,270.40
|
| Rate for Payer: WEA Trust Commercial |
$2,081.20
|
| Rate for Payer: WPS Commercial |
$2,802.81
|
|
|
ENDOSCOPY OF URETER 50951
|
Professional
|
Both
|
$1,380.00
|
|
|
Service Code
|
CPT 50951
|
| Hospital Charge Code |
3014963
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.57 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Aetna Commercial |
$1,311.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,186.80
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cash Price |
$414.00
|
| Rate for Payer: Cigna Commercial |
$1,311.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$828.00
|
| Rate for Payer: Health EOS Commercial |
$1,255.80
|
| Rate for Payer: HFN Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,018.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,018.23
|
| Rate for Payer: Multiplan Commercial |
$1,104.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.00
|
| Rate for Payer: Quartz Beloit One Network |
$607.20
|
| Rate for Payer: Quartz Commercial |
$786.60
|
| Rate for Payer: The Alliance Commercial |
$690.00
|
| Rate for Payer: United Healthcare Medicaid |
$135.57
|
| Rate for Payer: WEA Trust Commercial |
$759.00
|
| Rate for Payer: WPS Commercial |
$1,022.17
|
|
|
ENDOSCOPY OF URETER 50953
|
Professional
|
Both
|
$1,796.00
|
|
|
Service Code
|
CPT 50953
|
| Hospital Charge Code |
3014964
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$150.66 |
| Max. Negotiated Rate |
$1,706.20 |
| Rate for Payer: Aetna Commercial |
$1,706.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,544.56
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cash Price |
$538.80
|
| Rate for Payer: Cigna Commercial |
$1,706.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$150.66
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,077.60
|
| Rate for Payer: Health EOS Commercial |
$1,634.36
|
| Rate for Payer: HFN Commercial |
$1,706.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,084.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,084.49
|
| Rate for Payer: Multiplan Commercial |
$1,436.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,706.20
|
| Rate for Payer: Quartz Beloit One Network |
$790.24
|
| Rate for Payer: Quartz Commercial |
$1,023.72
|
| Rate for Payer: The Alliance Commercial |
$898.00
|
| Rate for Payer: United Healthcare Medicaid |
$150.66
|
| Rate for Payer: WEA Trust Commercial |
$987.80
|
| Rate for Payer: WPS Commercial |
$1,330.30
|
|
|
ENDO STITCH SUTURE DEVICE 10MM 173016
|
Facility
|
OP
|
$1,259.00
|
|
| Hospital Charge Code |
2965507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$352.52 |
| Max. Negotiated Rate |
$5,036.00 |
| Rate for Payer: Aetna Commercial |
$1,133.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,082.74
|
| Rate for Payer: Aetna Managed Medicare |
$352.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$818.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$629.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$604.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$667.27
|
| Rate for Payer: Cash Price |
$377.70
|
| Rate for Payer: Cigna Commercial |
$1,158.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$704.54
|
| Rate for Payer: Health EOS Commercial |
$1,120.51
|
| Rate for Payer: HFN Commercial |
$1,158.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$944.25
|
| Rate for Payer: Multiplan Commercial |
$1,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$755.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,158.28
|
| Rate for Payer: Quartz Beloit One Network |
$616.91
|
| Rate for Payer: Quartz Commercial |
$818.35
|
| Rate for Payer: Quartz Medicare Advantage |
$755.40
|
| Rate for Payer: The Alliance Commercial |
$5,036.00
|
| Rate for Payer: WEA Trust Commercial |
$692.45
|
| Rate for Payer: WPS Commercial |
$932.54
|
|
|
ENDO STITCH SUTURE DEVICE 10MM 173016
|
Facility
|
IP
|
$1,259.00
|
|
| Hospital Charge Code |
2965507
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$616.91 |
| Max. Negotiated Rate |
$1,158.28 |
| Rate for Payer: Aetna Commercial |
$1,133.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,082.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$667.27
|
| Rate for Payer: Cash Price |
$377.70
|
| Rate for Payer: Cigna Commercial |
$1,158.28
|
| Rate for Payer: Health EOS Commercial |
$1,120.51
|
| Rate for Payer: HFN Commercial |
$1,158.28
|
| Rate for Payer: Multiplan Commercial |
$1,007.20
|
| Rate for Payer: NAPHCARE Commercial |
$755.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,158.28
|
| Rate for Payer: Quartz Beloit One Network |
$616.91
|
| Rate for Payer: Quartz Commercial |
$755.40
|
| Rate for Payer: WEA Trust Commercial |
$692.45
|
| Rate for Payer: WPS Commercial |
$932.54
|
|
|
Endotrach Guide-Satin Slip
|
Facility
|
IP
|
$4.00
|
|
| Hospital Charge Code |
3040314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.96 |
| Max. Negotiated Rate |
$3.68 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.40
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Endotrach Guide-Satin Slip
|
Facility
|
OP
|
$4.00
|
|
| Hospital Charge Code |
3040314
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1.12 |
| Max. Negotiated Rate |
$16.00 |
| Rate for Payer: Aetna Commercial |
$3.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3.44
|
| Rate for Payer: Aetna Managed Medicare |
$1.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.12
|
| Rate for Payer: Cash Price |
$1.20
|
| Rate for Payer: Cigna Commercial |
$3.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.24
|
| Rate for Payer: Health EOS Commercial |
$3.56
|
| Rate for Payer: HFN Commercial |
$3.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.00
|
| Rate for Payer: Multiplan Commercial |
$3.20
|
| Rate for Payer: NAPHCARE Commercial |
$2.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3.68
|
| Rate for Payer: Quartz Beloit One Network |
$1.96
|
| Rate for Payer: Quartz Commercial |
$2.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2.40
|
| Rate for Payer: The Alliance Commercial |
$16.00
|
| Rate for Payer: WEA Trust Commercial |
$2.20
|
| Rate for Payer: WPS Commercial |
$2.96
|
|
|
Endotrach Guide Stylet
|
Facility
|
IP
|
$5.00
|
|
| Hospital Charge Code |
3040315
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2.45 |
| Max. Negotiated Rate |
$4.60 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
Endotrach Guide Stylet
|
Facility
|
OP
|
$5.00
|
|
| Hospital Charge Code |
3040315
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1.40 |
| Max. Negotiated Rate |
$20.00 |
| Rate for Payer: Aetna Commercial |
$4.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4.30
|
| Rate for Payer: Aetna Managed Medicare |
$1.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2.65
|
| Rate for Payer: Cash Price |
$1.50
|
| Rate for Payer: Cigna Commercial |
$4.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2.80
|
| Rate for Payer: Health EOS Commercial |
$4.45
|
| Rate for Payer: HFN Commercial |
$4.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3.75
|
| Rate for Payer: Multiplan Commercial |
$4.00
|
| Rate for Payer: NAPHCARE Commercial |
$3.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4.60
|
| Rate for Payer: Quartz Beloit One Network |
$2.45
|
| Rate for Payer: Quartz Commercial |
$3.25
|
| Rate for Payer: Quartz Medicare Advantage |
$3.00
|
| Rate for Payer: The Alliance Commercial |
$20.00
|
| Rate for Payer: WEA Trust Commercial |
$2.75
|
| Rate for Payer: WPS Commercial |
$3.70
|
|
|
ENDOVASCULAR CARDIAC VALVE REPLACEMENT AND SUPPLEMENT PROCEDURES WITH MCC
|
Facility
|
IP
|
$166,379.00
|
|
|
Service Code
|
MSDRG 266
|
| Min. Negotiated Rate |
$59,848.56 |
| Max. Negotiated Rate |
$166,379.00 |
| Rate for Payer: Aetna Managed Medicare |
$59,848.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$131,125.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$100,506.25
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$95,487.50
|
| Rate for Payer: Anthem Medicare Advantage |
$59,848.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59,848.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59,848.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$59,848.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105,999.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$59,848.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121,799.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59,848.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59,848.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$59,848.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$59,848.56
|
| Rate for Payer: NAPHCARE Commercial |
$89,772.84
|
| Rate for Payer: Quartz Medicare Advantage |
$59,848.56
|
| Rate for Payer: The Alliance Commercial |
$166,379.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59,848.56
|
| Rate for Payer: United Healthcare PPO |
$94,822.04
|
| Rate for Payer: Wellcare Medicare |
$59,848.56
|
|
