|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$8,077.76
|
|
|
Service Code
|
CPT 43249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,019.44 |
| Max. Negotiated Rate |
$8,077.76 |
| Rate for Payer: Aetna Managed Medicare |
$2,019.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,019.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,019.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,019.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,512.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,019.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,019.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,019.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,019.44
|
| Rate for Payer: NAPHCARE Commercial |
$3,029.16
|
| Rate for Payer: Quartz Medicare Advantage |
$2,019.44
|
| Rate for Payer: The Alliance Commercial |
$8,077.76
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,019.44
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,019.44
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$6,686.00
|
|
| Hospital Charge Code |
2960556
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,407.19 |
| Max. Negotiated Rate |
$6,397.16 |
| Rate for Payer: Aetna Commercial |
$6,258.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,979.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,685.32
|
| Rate for Payer: Cash Price |
$2,005.80
|
| Rate for Payer: Cigna Commercial |
$6,397.16
|
| Rate for Payer: Health EOS Commercial |
$6,188.56
|
| Rate for Payer: HFN Commercial |
$6,397.16
|
| Rate for Payer: Multiplan Commercial |
$5,562.75
|
| Rate for Payer: Preferred Network Access Commercial |
$6,397.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,407.19
|
| Rate for Payer: Quartz Commercial |
$4,172.06
|
| Rate for Payer: WEA Trust Commercial |
$3,824.39
|
| Rate for Payer: WPS Commercial |
$5,150.23
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$6,686.00
|
|
| Hospital Charge Code |
2960556
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,946.96 |
| Max. Negotiated Rate |
$6,397.16 |
| Rate for Payer: Aetna Commercial |
$6,258.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,979.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,946.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,519.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,476.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,337.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,685.32
|
| Rate for Payer: Cash Price |
$2,005.80
|
| Rate for Payer: Cigna Commercial |
$6,397.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,891.25
|
| Rate for Payer: Health EOS Commercial |
$6,188.56
|
| Rate for Payer: HFN Commercial |
$6,397.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,215.08
|
| Rate for Payer: Multiplan Commercial |
$5,562.75
|
| Rate for Payer: NAPHCARE Commercial |
$4,172.06
|
| Rate for Payer: Preferred Network Access Commercial |
$6,397.16
|
| Rate for Payer: Quartz Beloit One Network |
$3,407.19
|
| Rate for Payer: Quartz Commercial |
$4,519.74
|
| Rate for Payer: Quartz Medicare Advantage |
$4,172.06
|
| Rate for Payer: The Alliance Commercial |
$3,476.72
|
| Rate for Payer: WEA Trust Commercial |
$3,824.39
|
| Rate for Payer: WPS Commercial |
$5,150.23
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY AND DILATATION
|
Facility
|
IP
|
$5,970.00
|
|
| Hospital Charge Code |
2975903
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,042.31 |
| Max. Negotiated Rate |
$5,712.10 |
| Rate for Payer: Aetna Commercial |
$5,587.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,339.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,290.66
|
| Rate for Payer: Cash Price |
$1,791.00
|
| Rate for Payer: Cigna Commercial |
$5,712.10
|
| Rate for Payer: Health EOS Commercial |
$5,525.83
|
| Rate for Payer: HFN Commercial |
$5,712.10
|
| Rate for Payer: Multiplan Commercial |
$4,967.04
|
| Rate for Payer: Preferred Network Access Commercial |
$5,712.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,042.31
|
| Rate for Payer: Quartz Commercial |
$3,725.28
|
| Rate for Payer: WEA Trust Commercial |
$3,414.84
|
| Rate for Payer: WPS Commercial |
$4,598.69
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY AND DILATATION
|
Facility
|
OP
|
$5,970.00
|
|
| Hospital Charge Code |
2975903
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,738.46 |
| Max. Negotiated Rate |
$5,712.10 |
| Rate for Payer: Aetna Commercial |
$5,587.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,339.57
|
| Rate for Payer: Aetna Managed Medicare |
$1,738.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,035.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,104.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,980.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,290.66
|
| Rate for Payer: Cash Price |
$1,791.00
|
| Rate for Payer: Cigna Commercial |
$5,712.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,474.54
|
| Rate for Payer: Health EOS Commercial |
$5,525.83
|
| Rate for Payer: HFN Commercial |
$5,712.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,656.60
|
| Rate for Payer: Multiplan Commercial |
$4,967.04
|
| Rate for Payer: NAPHCARE Commercial |
$3,725.28
|
| Rate for Payer: Preferred Network Access Commercial |
$5,712.10
|
| Rate for Payer: Quartz Beloit One Network |
$3,042.31
|
| Rate for Payer: Quartz Commercial |
$4,035.72
|
| Rate for Payer: Quartz Medicare Advantage |
$3,725.28
|
| Rate for Payer: The Alliance Commercial |
$3,104.40
|
| Rate for Payer: WEA Trust Commercial |
$3,414.84
|
| Rate for Payer: WPS Commercial |
$4,598.69
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY AND POLYECTOMY
|
Facility
|
OP
|
$8,649.00
|
|
| Hospital Charge Code |
4495006
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,518.59 |
| Max. Negotiated Rate |
$8,275.36 |
| Rate for Payer: Aetna Commercial |
$8,095.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,735.67
|
| Rate for Payer: Aetna Managed Medicare |
$2,518.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,846.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,497.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,317.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,767.33
|
| Rate for Payer: Cash Price |
$2,594.70
|
| Rate for Payer: Cigna Commercial |
$8,275.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,033.72
|
| Rate for Payer: Health EOS Commercial |
$8,005.51
|
| Rate for Payer: HFN Commercial |
$8,275.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,746.22
|
| Rate for Payer: Multiplan Commercial |
$7,195.97
|
| Rate for Payer: NAPHCARE Commercial |
$5,396.98
|
| Rate for Payer: Preferred Network Access Commercial |
$8,275.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,407.53
|
| Rate for Payer: Quartz Commercial |
$5,846.72
|
| Rate for Payer: Quartz Medicare Advantage |
$5,396.98
|
| Rate for Payer: The Alliance Commercial |
$4,497.48
|
| Rate for Payer: WEA Trust Commercial |
$4,947.23
|
| Rate for Payer: WPS Commercial |
$6,662.32
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY AND POLYECTOMY
|
Facility
|
IP
|
$8,649.00
|
|
| Hospital Charge Code |
4495006
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$4,407.53 |
| Max. Negotiated Rate |
$8,275.36 |
| Rate for Payer: Aetna Commercial |
$8,095.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,735.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,767.33
|
| Rate for Payer: Cash Price |
$2,594.70
|
| Rate for Payer: Cigna Commercial |
$8,275.36
|
| Rate for Payer: Health EOS Commercial |
$8,005.51
|
| Rate for Payer: HFN Commercial |
$8,275.36
|
| Rate for Payer: Multiplan Commercial |
$7,195.97
|
| Rate for Payer: Preferred Network Access Commercial |
$8,275.36
|
| Rate for Payer: Quartz Beloit One Network |
$4,407.53
|
| Rate for Payer: Quartz Commercial |
$5,396.98
|
| Rate for Payer: WEA Trust Commercial |
$4,947.23
|
| Rate for Payer: WPS Commercial |
$6,662.32
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH DILATATION
|
Facility
|
IP
|
$5,897.00
|
|
| Hospital Charge Code |
2960557
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,005.11 |
| Max. Negotiated Rate |
$5,642.25 |
| Rate for Payer: Aetna Commercial |
$5,519.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,274.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,250.43
|
| Rate for Payer: Cash Price |
$1,769.10
|
| Rate for Payer: Cigna Commercial |
$5,642.25
|
| Rate for Payer: Health EOS Commercial |
$5,458.26
|
| Rate for Payer: HFN Commercial |
$5,642.25
|
| Rate for Payer: Multiplan Commercial |
$4,906.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,642.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,005.11
|
| Rate for Payer: Quartz Commercial |
$3,679.73
|
| Rate for Payer: WEA Trust Commercial |
$3,373.08
|
| Rate for Payer: WPS Commercial |
$4,542.46
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH DILATATION
|
Facility
|
OP
|
$5,897.00
|
|
| Hospital Charge Code |
2960557
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,717.21 |
| Max. Negotiated Rate |
$5,642.25 |
| Rate for Payer: Aetna Commercial |
$5,519.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,274.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,717.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,986.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,066.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,943.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,250.43
|
| Rate for Payer: Cash Price |
$1,769.10
|
| Rate for Payer: Cigna Commercial |
$5,642.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,432.05
|
| Rate for Payer: Health EOS Commercial |
$5,458.26
|
| Rate for Payer: HFN Commercial |
$5,642.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,599.66
|
| Rate for Payer: Multiplan Commercial |
$4,906.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,679.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,642.25
|
| Rate for Payer: Quartz Beloit One Network |
$3,005.11
|
| Rate for Payer: Quartz Commercial |
$3,986.37
|
| Rate for Payer: Quartz Medicare Advantage |
$3,679.73
|
| Rate for Payer: The Alliance Commercial |
$3,066.44
|
| Rate for Payer: WEA Trust Commercial |
$3,373.08
|
| Rate for Payer: WPS Commercial |
$4,542.46
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH LESION REMOVAL
|
Facility
|
OP
|
$5,488.00
|
|
| Hospital Charge Code |
2960559
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,598.11 |
| Max. Negotiated Rate |
$5,250.92 |
| Rate for Payer: Aetna Commercial |
$5,136.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,908.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,598.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,709.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,853.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,739.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,024.99
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cigna Commercial |
$5,250.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,194.02
|
| Rate for Payer: Health EOS Commercial |
$5,079.69
|
| Rate for Payer: HFN Commercial |
$5,250.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,280.64
|
| Rate for Payer: Multiplan Commercial |
$4,566.02
|
| Rate for Payer: NAPHCARE Commercial |
$3,424.51
|
| Rate for Payer: Preferred Network Access Commercial |
$5,250.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,796.68
|
| Rate for Payer: Quartz Commercial |
$3,709.89
|
| Rate for Payer: Quartz Medicare Advantage |
$3,424.51
|
| Rate for Payer: The Alliance Commercial |
$2,853.76
|
| Rate for Payer: WEA Trust Commercial |
$3,139.14
|
| Rate for Payer: WPS Commercial |
$4,227.41
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH LESION REMOVAL
|
Facility
|
IP
|
$5,488.00
|
|
| Hospital Charge Code |
2960559
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,796.68 |
| Max. Negotiated Rate |
$5,250.92 |
| Rate for Payer: Aetna Commercial |
$5,136.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,908.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,024.99
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cigna Commercial |
$5,250.92
|
| Rate for Payer: Health EOS Commercial |
$5,079.69
|
| Rate for Payer: HFN Commercial |
$5,250.92
|
| Rate for Payer: Multiplan Commercial |
$4,566.02
|
| Rate for Payer: Preferred Network Access Commercial |
$5,250.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,796.68
|
| Rate for Payer: Quartz Commercial |
$3,424.51
|
| Rate for Payer: WEA Trust Commercial |
$3,139.14
|
| Rate for Payer: WPS Commercial |
$4,227.41
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH POLYECTOMY
|
Facility
|
OP
|
$8,195.00
|
|
| Hospital Charge Code |
4075905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,386.38 |
| Max. Negotiated Rate |
$7,840.98 |
| Rate for Payer: Aetna Commercial |
$7,670.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,329.61
|
| Rate for Payer: Aetna Managed Medicare |
$2,386.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,539.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,261.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,090.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,517.08
|
| Rate for Payer: Cash Price |
$2,458.50
|
| Rate for Payer: Cigna Commercial |
$7,840.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,769.49
|
| Rate for Payer: Health EOS Commercial |
$7,585.29
|
| Rate for Payer: HFN Commercial |
$7,840.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,392.10
|
| Rate for Payer: Multiplan Commercial |
$6,818.24
|
| Rate for Payer: NAPHCARE Commercial |
$5,113.68
|
| Rate for Payer: Preferred Network Access Commercial |
$7,840.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,176.17
|
| Rate for Payer: Quartz Commercial |
$5,539.82
|
| Rate for Payer: Quartz Medicare Advantage |
$5,113.68
|
| Rate for Payer: The Alliance Commercial |
$4,261.40
|
| Rate for Payer: WEA Trust Commercial |
$4,687.54
|
| Rate for Payer: WPS Commercial |
$6,312.61
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH POLYECTOMY
|
Facility
|
IP
|
$8,195.00
|
|
| Hospital Charge Code |
4075905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$4,176.17 |
| Max. Negotiated Rate |
$7,840.98 |
| Rate for Payer: Aetna Commercial |
$7,670.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,329.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,517.08
|
| Rate for Payer: Cash Price |
$2,458.50
|
| Rate for Payer: Cigna Commercial |
$7,840.98
|
| Rate for Payer: Health EOS Commercial |
$7,585.29
|
| Rate for Payer: HFN Commercial |
$7,840.98
|
| Rate for Payer: Multiplan Commercial |
$6,818.24
|
| Rate for Payer: Preferred Network Access Commercial |
$7,840.98
|
| Rate for Payer: Quartz Beloit One Network |
$4,176.17
|
| Rate for Payer: Quartz Commercial |
$5,113.68
|
| Rate for Payer: WEA Trust Commercial |
$4,687.54
|
| Rate for Payer: WPS Commercial |
$6,312.61
|
|
|
ESOPHAGOGASTROSCOPY RIGID/FLEXIBLE
|
Facility
|
IP
|
$2,051.00
|
|
| Hospital Charge Code |
2960019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,045.19 |
| Max. Negotiated Rate |
$1,962.40 |
| Rate for Payer: Aetna Commercial |
$1,919.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.51
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,962.40
|
| Rate for Payer: Health EOS Commercial |
$1,898.41
|
| Rate for Payer: HFN Commercial |
$1,962.40
|
| Rate for Payer: Multiplan Commercial |
$1,706.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.19
|
| Rate for Payer: Quartz Commercial |
$1,279.82
|
| Rate for Payer: WEA Trust Commercial |
$1,173.17
|
| Rate for Payer: WPS Commercial |
$1,579.89
|
|
|
ESOPHAGOGASTROSCOPY RIGID/FLEXIBLE
|
Facility
|
OP
|
$2,051.00
|
|
| Hospital Charge Code |
2960019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$597.25 |
| Max. Negotiated Rate |
$1,962.40 |
| Rate for Payer: Aetna Commercial |
$1,919.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.41
|
| Rate for Payer: Aetna Managed Medicare |
$597.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,386.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,066.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,023.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.51
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,962.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,193.68
|
| Rate for Payer: Health EOS Commercial |
$1,898.41
|
| Rate for Payer: HFN Commercial |
$1,962.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,599.78
|
| Rate for Payer: Multiplan Commercial |
$1,706.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,279.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.19
|
| Rate for Payer: Quartz Commercial |
$1,386.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,279.82
|
| Rate for Payer: The Alliance Commercial |
$1,066.52
|
| Rate for Payer: WEA Trust Commercial |
$1,173.17
|
| Rate for Payer: WPS Commercial |
$1,579.89
|
|
|
ESOPHAGOSCOPY & BIOPSY
|
Facility
|
IP
|
$2,051.00
|
|
| Hospital Charge Code |
2960021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,045.19 |
| Max. Negotiated Rate |
$1,962.40 |
| Rate for Payer: Aetna Commercial |
$1,919.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.51
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,962.40
|
| Rate for Payer: Health EOS Commercial |
$1,898.41
|
| Rate for Payer: HFN Commercial |
$1,962.40
|
| Rate for Payer: Multiplan Commercial |
$1,706.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.19
|
| Rate for Payer: Quartz Commercial |
$1,279.82
|
| Rate for Payer: WEA Trust Commercial |
$1,173.17
|
| Rate for Payer: WPS Commercial |
$1,579.89
|
|
|
ESOPHAGOSCOPY & BIOPSY
|
Facility
|
OP
|
$2,051.00
|
|
| Hospital Charge Code |
2960021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$597.25 |
| Max. Negotiated Rate |
$1,962.40 |
| Rate for Payer: Aetna Commercial |
$1,919.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,834.41
|
| Rate for Payer: Aetna Managed Medicare |
$597.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,386.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,066.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,023.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,130.51
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,962.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,193.68
|
| Rate for Payer: Health EOS Commercial |
$1,898.41
|
| Rate for Payer: HFN Commercial |
$1,962.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,599.78
|
| Rate for Payer: Multiplan Commercial |
$1,706.43
|
| Rate for Payer: NAPHCARE Commercial |
$1,279.82
|
| Rate for Payer: Preferred Network Access Commercial |
$1,962.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,045.19
|
| Rate for Payer: Quartz Commercial |
$1,386.48
|
| Rate for Payer: Quartz Medicare Advantage |
$1,279.82
|
| Rate for Payer: The Alliance Commercial |
$1,066.52
|
| Rate for Payer: WEA Trust Commercial |
$1,173.17
|
| Rate for Payer: WPS Commercial |
$1,579.89
|
|
|
ESOPHAGOSCOPY WITH ABLATION SURGERY/HALO PROCEDURE
|
Facility
|
OP
|
$3,569.00
|
|
| Hospital Charge Code |
2975904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,039.29 |
| Max. Negotiated Rate |
$3,414.82 |
| Rate for Payer: Aetna Commercial |
$3,340.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,192.11
|
| Rate for Payer: Aetna Managed Medicare |
$1,039.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,412.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,855.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,781.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,967.23
|
| Rate for Payer: Cash Price |
$1,070.70
|
| Rate for Payer: Cigna Commercial |
$3,414.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,077.16
|
| Rate for Payer: Health EOS Commercial |
$3,303.47
|
| Rate for Payer: HFN Commercial |
$3,414.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,783.82
|
| Rate for Payer: Multiplan Commercial |
$2,969.41
|
| Rate for Payer: NAPHCARE Commercial |
$2,227.06
|
| Rate for Payer: Preferred Network Access Commercial |
$3,414.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,818.76
|
| Rate for Payer: Quartz Commercial |
$2,412.64
|
| Rate for Payer: Quartz Medicare Advantage |
$2,227.06
|
| Rate for Payer: The Alliance Commercial |
$1,855.88
|
| Rate for Payer: WEA Trust Commercial |
$2,041.47
|
| Rate for Payer: WPS Commercial |
$2,749.20
|
|
|
ESOPHAGOSCOPY WITH ABLATION SURGERY/HALO PROCEDURE
|
Facility
|
IP
|
$3,569.00
|
|
| Hospital Charge Code |
2975904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,818.76 |
| Max. Negotiated Rate |
$3,414.82 |
| Rate for Payer: Aetna Commercial |
$3,340.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,192.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,967.23
|
| Rate for Payer: Cash Price |
$1,070.70
|
| Rate for Payer: Cigna Commercial |
$3,414.82
|
| Rate for Payer: Health EOS Commercial |
$3,303.47
|
| Rate for Payer: HFN Commercial |
$3,414.82
|
| Rate for Payer: Multiplan Commercial |
$2,969.41
|
| Rate for Payer: Preferred Network Access Commercial |
$3,414.82
|
| Rate for Payer: Quartz Beloit One Network |
$1,818.76
|
| Rate for Payer: Quartz Commercial |
$2,227.06
|
| Rate for Payer: WEA Trust Commercial |
$2,041.47
|
| Rate for Payer: WPS Commercial |
$2,749.20
|
|
|
ESOPHAGUS ENDOSCOPY 43200
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
3014649
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$76.47 |
| Max. Negotiated Rate |
$1,115.45 |
| Rate for Payer: Aetna Commercial |
$1,115.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,009.78
|
| Rate for Payer: Aetna Managed Medicare |
$76.47
|
| Rate for Payer: Anthem Medicare Advantage |
$76.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.47
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,115.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$191.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.47
|
| Rate for Payer: Health EOS Commercial |
$1,068.49
|
| Rate for Payer: HFN Commercial |
$1,115.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$300.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$300.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.47
|
| Rate for Payer: Multiplan Commercial |
$939.33
|
| Rate for Payer: NAPHCARE Commercial |
$114.71
|
| Rate for Payer: Preferred Network Access Commercial |
$1,115.45
|
| Rate for Payer: Quartz Beloit One Network |
$516.63
|
| Rate for Payer: Quartz Commercial |
$669.27
|
| Rate for Payer: Quartz Medicare Advantage |
$76.47
|
| Rate for Payer: The Alliance Commercial |
$325.00
|
| Rate for Payer: United Healthcare Medicaid |
$191.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.47
|
| Rate for Payer: WEA Trust Commercial |
$645.79
|
| Rate for Payer: WPS Commercial |
$344.12
|
|
|
ESOPHAGUS ENDOSCOPY, BIOPSY 43202
|
Professional
|
Both
|
$1,790.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
3014650
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$90.55 |
| Max. Negotiated Rate |
$1,768.52 |
| Rate for Payer: Aetna Commercial |
$1,768.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,600.98
|
| Rate for Payer: Aetna Managed Medicare |
$90.55
|
| Rate for Payer: Anthem Medicare Advantage |
$90.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$90.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$90.55
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,768.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$353.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.55
|
| Rate for Payer: Health EOS Commercial |
$1,694.06
|
| Rate for Payer: HFN Commercial |
$1,768.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$355.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$355.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$90.55
|
| Rate for Payer: Multiplan Commercial |
$1,489.28
|
| Rate for Payer: NAPHCARE Commercial |
$135.83
|
| Rate for Payer: Preferred Network Access Commercial |
$1,768.52
|
| Rate for Payer: Quartz Beloit One Network |
$819.10
|
| Rate for Payer: Quartz Commercial |
$1,061.11
|
| Rate for Payer: Quartz Medicare Advantage |
$90.55
|
| Rate for Payer: The Alliance Commercial |
$384.85
|
| Rate for Payer: United Healthcare Medicaid |
$353.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$90.55
|
| Rate for Payer: WEA Trust Commercial |
$1,023.88
|
| Rate for Payer: WPS Commercial |
$407.49
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$3,614.92
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$903.73 |
| Max. Negotiated Rate |
$3,614.92 |
| Rate for Payer: Aetna Managed Medicare |
$903.73
|
| Rate for Payer: Anthem Medicare Advantage |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$903.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$903.73
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$903.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$903.73
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,361.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$903.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$903.73
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$903.73
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$903.73
|
| Rate for Payer: NAPHCARE Commercial |
$1,355.59
|
| Rate for Payer: Quartz Medicare Advantage |
$903.73
|
| Rate for Payer: The Alliance Commercial |
$3,614.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$903.73
|
| Rate for Payer: Wellcare Medicare |
$903.73
|
|
|
Esoph Imped Function Test >1H 91038
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
CPT 91038
|
| Hospital Charge Code |
3475520
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$116.30 |
| Max. Negotiated Rate |
$1,776.24 |
| Rate for Payer: Aetna Commercial |
$397.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$359.55
|
| Rate for Payer: Aetna Managed Medicare |
$444.06
|
| Rate for Payer: Anthem Medicare Advantage |
$444.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$444.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$444.06
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$397.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$116.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$444.06
|
| Rate for Payer: Health EOS Commercial |
$380.45
|
| Rate for Payer: HFN Commercial |
$397.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,600.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,600.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$444.06
|
| Rate for Payer: Multiplan Commercial |
$334.46
|
| Rate for Payer: NAPHCARE Commercial |
$666.09
|
| Rate for Payer: Preferred Network Access Commercial |
$397.18
|
| Rate for Payer: Quartz Beloit One Network |
$183.96
|
| Rate for Payer: Quartz Commercial |
$238.31
|
| Rate for Payer: Quartz Medicare Advantage |
$444.06
|
| Rate for Payer: The Alliance Commercial |
$1,110.15
|
| Rate for Payer: United Healthcare Medicaid |
$116.30
|
| Rate for Payer: United Healthcare Medicare Advantage |
$444.06
|
| Rate for Payer: WEA Trust Commercial |
$229.94
|
| Rate for Payer: WPS Commercial |
$1,776.24
|
|
|
Esoph Imped Function Test >1H 9103826
|
Professional
|
Both
|
$402.00
|
|
|
Service Code
|
CPT 91038 26
|
| Hospital Charge Code |
5472751
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$54.02 |
| Max. Negotiated Rate |
$397.18 |
| Rate for Payer: Aetna Commercial |
$397.18
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$359.55
|
| Rate for Payer: Aetna Managed Medicare |
$59.82
|
| Rate for Payer: Anthem Medicare Advantage |
$59.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59.82
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$397.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$54.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.82
|
| Rate for Payer: Health EOS Commercial |
$380.45
|
| Rate for Payer: HFN Commercial |
$397.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$200.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$200.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59.82
|
| Rate for Payer: Multiplan Commercial |
$334.46
|
| Rate for Payer: NAPHCARE Commercial |
$89.73
|
| Rate for Payer: Preferred Network Access Commercial |
$397.18
|
| Rate for Payer: Quartz Beloit One Network |
$183.96
|
| Rate for Payer: Quartz Commercial |
$238.31
|
| Rate for Payer: Quartz Medicare Advantage |
$59.82
|
| Rate for Payer: The Alliance Commercial |
$149.55
|
| Rate for Payer: United Healthcare Medicaid |
$54.02
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59.82
|
| Rate for Payer: WEA Trust Commercial |
$229.94
|
| Rate for Payer: WPS Commercial |
$239.28
|
|
|
ESOPH IMPED FUNCTION TEST 91037
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
3015324
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$135.15 |
| Max. Negotiated Rate |
$745.97 |
| Rate for Payer: Aetna Commercial |
$542.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$491.03
|
| Rate for Payer: Aetna Managed Medicare |
$186.49
|
| Rate for Payer: Anthem Medicare Advantage |
$186.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$186.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$186.49
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna Commercial |
$542.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$135.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$186.49
|
| Rate for Payer: Health EOS Commercial |
$519.57
|
| Rate for Payer: HFN Commercial |
$542.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.91
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.91
|
| Rate for Payer: Independent Care Health Plan Medicare |
$186.49
|
| Rate for Payer: Multiplan Commercial |
$456.77
|
| Rate for Payer: NAPHCARE Commercial |
$279.74
|
| Rate for Payer: Preferred Network Access Commercial |
$542.41
|
| Rate for Payer: Quartz Beloit One Network |
$251.22
|
| Rate for Payer: Quartz Commercial |
$325.45
|
| Rate for Payer: Quartz Medicare Advantage |
$186.49
|
| Rate for Payer: The Alliance Commercial |
$466.23
|
| Rate for Payer: United Healthcare Medicaid |
$135.15
|
| Rate for Payer: United Healthcare Medicare Advantage |
$186.49
|
| Rate for Payer: WEA Trust Commercial |
$314.03
|
| Rate for Payer: WPS Commercial |
$745.97
|
|
