|
ESMARK BANDAGE 6 IN DYNJ05919/DYNJ05918 (SUB)/TRN99304 (SUB)
|
Facility
|
IP
|
$334.00
|
|
| Hospital Charge Code |
2965841
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$163.66 |
| Max. Negotiated Rate |
$307.28 |
| Rate for Payer: Aetna Commercial |
$300.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$287.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$177.02
|
| Rate for Payer: Cash Price |
$100.20
|
| Rate for Payer: Cigna Commercial |
$307.28
|
| Rate for Payer: Health EOS Commercial |
$297.26
|
| Rate for Payer: HFN Commercial |
$307.28
|
| Rate for Payer: Multiplan Commercial |
$267.20
|
| Rate for Payer: NAPHCARE Commercial |
$200.40
|
| Rate for Payer: Preferred Network Access Commercial |
$307.28
|
| Rate for Payer: Quartz Beloit One Network |
$163.66
|
| Rate for Payer: Quartz Commercial |
$200.40
|
| Rate for Payer: WEA Trust Commercial |
$183.70
|
| Rate for Payer: WPS Commercial |
$247.39
|
|
|
Esophageal Motility Study with Interp 9101026
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
CPT 91010 26
|
| Hospital Charge Code |
4602736
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$224.47 |
| Max. Negotiated Rate |
$736.25 |
| Rate for Payer: Aetna Commercial |
$736.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$736.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$387.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.00
|
| Rate for Payer: Health EOS Commercial |
$705.25
|
| Rate for Payer: HFN Commercial |
$736.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$224.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$224.47
|
| Rate for Payer: Multiplan Commercial |
$620.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.25
|
| Rate for Payer: Quartz Beloit One Network |
$341.00
|
| Rate for Payer: Quartz Commercial |
$441.75
|
| Rate for Payer: The Alliance Commercial |
$387.50
|
| Rate for Payer: WEA Trust Commercial |
$426.25
|
| Rate for Payer: WPS Commercial |
$574.04
|
|
|
Esophageal Motility Study With Interpretation 91010
|
Professional
|
Both
|
$775.00
|
|
|
Service Code
|
CPT 91010
|
| Hospital Charge Code |
2957660
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$171.75 |
| Max. Negotiated Rate |
$760.08 |
| Rate for Payer: Aetna Commercial |
$736.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$666.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cash Price |
$232.50
|
| Rate for Payer: Cigna Commercial |
$736.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$171.75
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$465.00
|
| Rate for Payer: Health EOS Commercial |
$705.25
|
| Rate for Payer: HFN Commercial |
$736.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$760.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$760.08
|
| Rate for Payer: Multiplan Commercial |
$620.00
|
| Rate for Payer: Preferred Network Access Commercial |
$736.25
|
| Rate for Payer: Quartz Beloit One Network |
$341.00
|
| Rate for Payer: Quartz Commercial |
$441.75
|
| Rate for Payer: The Alliance Commercial |
$387.50
|
| Rate for Payer: United Healthcare Medicaid |
$171.75
|
| Rate for Payer: WEA Trust Commercial |
$426.25
|
| Rate for Payer: WPS Commercial |
$574.04
|
|
|
ESOPHAGECTOMY (CERVICAL) RECONSTRUCTION
|
Facility
|
OP
|
$4,981.00
|
|
| Hospital Charge Code |
2960022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,394.68 |
| Max. Negotiated Rate |
$19,924.00 |
| Rate for Payer: Aetna Commercial |
$4,482.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,283.66
|
| Rate for Payer: Aetna Managed Medicare |
$1,394.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,237.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,490.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,390.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,639.93
|
| Rate for Payer: Cash Price |
$1,494.30
|
| Rate for Payer: Cigna Commercial |
$4,582.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,787.37
|
| Rate for Payer: Health EOS Commercial |
$4,433.09
|
| Rate for Payer: HFN Commercial |
$4,582.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,735.75
|
| Rate for Payer: Multiplan Commercial |
$3,984.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,988.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,582.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,440.69
|
| Rate for Payer: Quartz Commercial |
$3,237.65
|
| Rate for Payer: Quartz Medicare Advantage |
$2,988.60
|
| Rate for Payer: The Alliance Commercial |
$19,924.00
|
| Rate for Payer: WEA Trust Commercial |
$2,739.55
|
| Rate for Payer: WPS Commercial |
$3,689.43
|
|
|
ESOPHAGECTOMY (CERVICAL) RECONSTRUCTION
|
Facility
|
IP
|
$4,981.00
|
|
| Hospital Charge Code |
2960022
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,440.69 |
| Max. Negotiated Rate |
$4,582.52 |
| Rate for Payer: Aetna Commercial |
$4,482.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,283.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,639.93
|
| Rate for Payer: Cash Price |
$1,494.30
|
| Rate for Payer: Cigna Commercial |
$4,582.52
|
| Rate for Payer: Health EOS Commercial |
$4,433.09
|
| Rate for Payer: HFN Commercial |
$4,582.52
|
| Rate for Payer: Multiplan Commercial |
$3,984.80
|
| Rate for Payer: NAPHCARE Commercial |
$2,988.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,582.52
|
| Rate for Payer: Quartz Beloit One Network |
$2,440.69
|
| Rate for Payer: Quartz Commercial |
$2,988.60
|
| Rate for Payer: WEA Trust Commercial |
$2,739.55
|
| Rate for Payer: WPS Commercial |
$3,689.43
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITH MCC
|
Facility
|
IP
|
$34,236.00
|
|
|
Service Code
|
MSDRG 391
|
| Min. Negotiated Rate |
$12,315.16 |
| Max. Negotiated Rate |
$34,236.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,315.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,854.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,583.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,555.84
|
| Rate for Payer: Anthem Medicare Advantage |
$12,315.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,315.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,315.16
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,315.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,708.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,315.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24,876.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,315.16
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,315.16
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,315.16
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,315.16
|
| Rate for Payer: NAPHCARE Commercial |
$18,472.74
|
| Rate for Payer: Quartz Medicare Advantage |
$12,315.16
|
| Rate for Payer: The Alliance Commercial |
$34,236.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,315.16
|
| Rate for Payer: United Healthcare PPO |
$19,366.40
|
| Rate for Payer: Wellcare Medicare |
$12,315.16
|
|
|
ESOPHAGITIS, GASTROENTERITIS AND MISCELLANEOUS DIGESTIVE DISORDERS WITHOUT MCC
|
Facility
|
IP
|
$21,206.00
|
|
|
Service Code
|
MSDRG 392
|
| Min. Negotiated Rate |
$7,628.19 |
| Max. Negotiated Rate |
$21,206.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,628.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,574.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,703.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,069.62
|
| Rate for Payer: Anthem Medicare Advantage |
$7,628.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,628.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,628.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,628.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,398.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,628.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,319.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,628.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,628.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,628.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,628.19
|
| Rate for Payer: NAPHCARE Commercial |
$11,442.28
|
| Rate for Payer: Quartz Medicare Advantage |
$7,628.19
|
| Rate for Payer: The Alliance Commercial |
$21,206.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,628.19
|
| Rate for Payer: United Healthcare PPO |
$11,926.19
|
| Rate for Payer: Wellcare Medicare |
$7,628.19
|
|
|
ESOPHAGOGASTRODUODENOSCOPY
|
Facility
|
IP
|
$6,438.00
|
|
| Hospital Charge Code |
2960003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,154.62 |
| Max. Negotiated Rate |
$5,922.96 |
| Rate for Payer: Aetna Commercial |
$5,794.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,536.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,412.14
|
| Rate for Payer: Cash Price |
$1,931.40
|
| Rate for Payer: Cigna Commercial |
$5,922.96
|
| Rate for Payer: Health EOS Commercial |
$5,729.82
|
| Rate for Payer: HFN Commercial |
$5,922.96
|
| Rate for Payer: Multiplan Commercial |
$5,150.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,862.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,922.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,154.62
|
| Rate for Payer: Quartz Commercial |
$3,862.80
|
| Rate for Payer: WEA Trust Commercial |
$3,540.90
|
| Rate for Payer: WPS Commercial |
$4,768.63
|
|
|
ESOPHAGOGASTRODUODENOSCOPY
|
Facility
|
OP
|
$6,438.00
|
|
| Hospital Charge Code |
2960003
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,802.64 |
| Max. Negotiated Rate |
$25,752.00 |
| Rate for Payer: Aetna Commercial |
$5,794.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,536.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,802.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,184.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,219.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,090.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,412.14
|
| Rate for Payer: Cash Price |
$1,931.40
|
| Rate for Payer: Cigna Commercial |
$5,922.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,602.70
|
| Rate for Payer: Health EOS Commercial |
$5,729.82
|
| Rate for Payer: HFN Commercial |
$5,922.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,828.50
|
| Rate for Payer: Multiplan Commercial |
$5,150.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,862.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,922.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,154.62
|
| Rate for Payer: Quartz Commercial |
$4,184.70
|
| Rate for Payer: Quartz Medicare Advantage |
$3,862.80
|
| Rate for Payer: The Alliance Commercial |
$25,752.00
|
| Rate for Payer: WEA Trust Commercial |
$3,540.90
|
| Rate for Payer: WPS Commercial |
$4,768.63
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; DIAGNOSTIC, INCLUDING COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING, WHEN PERFORMED (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$4,218.22
|
|
|
Service Code
|
CPT 43235
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$895.97 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ABLATION OF TUMOR(S), POLYP(S), OR OTHER LESION(S) (INCLUDES PRE- AND POST-DILATION AND GUIDE WIRE PASSAGE, WHEN PERFORMED)
|
Facility
|
OP
|
$7,523.04
|
|
|
Service Code
|
CPT 43270
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,880.76 |
| Max. Negotiated Rate |
$7,523.04 |
| Rate for Payer: Aetna Managed Medicare |
$1,880.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,880.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,880.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,880.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,996.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,880.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,880.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,880.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,880.76
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.76
|
| Rate for Payer: The Alliance Commercial |
$7,523.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,880.76
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,880.76
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH BIOPSY, SINGLE OR MULTIPLE
|
Facility
|
OP
|
$4,757.59
|
|
|
Service Code
|
CPT 43239
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$895.97 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH CONTROL OF BLEEDING, ANY METHOD
|
Facility
|
OP
|
$7,523.04
|
|
|
Service Code
|
CPT 43255
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,880.76 |
| Max. Negotiated Rate |
$7,523.04 |
| Rate for Payer: Aetna Managed Medicare |
$1,880.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,880.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,880.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,880.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,996.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,880.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,880.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,880.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,880.76
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.76
|
| Rate for Payer: The Alliance Commercial |
$7,523.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,880.76
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,880.76
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DILATION OF GASTRIC/DUODENAL STRICTURE(S) (EG, BALLOON, BOUGIE)
|
Facility
|
OP
|
$7,523.04
|
|
|
Service Code
|
CPT 43245
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,880.76 |
| Max. Negotiated Rate |
$7,523.04 |
| Rate for Payer: Aetna Managed Medicare |
$1,880.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,880.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,880.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,880.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,996.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,880.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,880.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,880.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,880.76
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.76
|
| Rate for Payer: The Alliance Commercial |
$7,523.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,880.76
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,880.76
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED PLACEMENT OF PERCUTANEOUS GASTROSTOMY TUBE
|
Facility
|
OP
|
$7,523.04
|
|
|
Service Code
|
CPT 43246
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,880.76 |
| Max. Negotiated Rate |
$7,523.04 |
| Rate for Payer: Aetna Managed Medicare |
$1,880.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,880.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,880.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,880.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,996.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,880.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,880.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,880.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,880.76
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.76
|
| Rate for Payer: The Alliance Commercial |
$7,523.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,880.76
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,880.76
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH DIRECTED SUBMUCOSAL INJECTION(S), ANY SUBSTANCE
|
Facility
|
OP
|
$4,757.59
|
|
|
Service Code
|
CPT 43236
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$895.97 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH ENDOSCOPIC MUCOSAL RESECTION
|
Facility
|
OP
|
$7,523.04
|
|
|
Service Code
|
CPT 43254
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,880.76 |
| Max. Negotiated Rate |
$7,523.04 |
| Rate for Payer: Aetna Managed Medicare |
$1,880.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,880.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,880.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,880.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,996.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,880.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,880.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,880.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,880.76
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.76
|
| Rate for Payer: The Alliance Commercial |
$7,523.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,880.76
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,880.76
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH INSERTION OF GUIDE WIRE FOLLOWED BY PASSAGE OF DILATOR(S) THROUGH ESOPHAGUS OVER GUIDE WIRE
|
Facility
|
OP
|
$4,757.59
|
|
|
Service Code
|
CPT 43248
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$895.97 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF FOREIGN BODY(S)
|
Facility
|
OP
|
$4,757.59
|
|
|
Service Code
|
CPT 43247
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$895.97 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,914.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,297.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,183.00
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$2,257.00
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH REMOVAL OF TUMOR(S), POLYP(S), OR OTHER LESION(S) BY SNARE TECHNIQUE
|
Facility
|
OP
|
$7,523.04
|
|
|
Service Code
|
CPT 43251
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,880.76 |
| Max. Negotiated Rate |
$7,523.04 |
| Rate for Payer: Aetna Managed Medicare |
$1,880.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,880.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,880.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,880.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,996.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,880.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,880.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,880.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,880.76
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.76
|
| Rate for Payer: The Alliance Commercial |
$7,523.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,880.76
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,880.76
|
|
|
ESOPHAGOGASTRODUODENOSCOPY, FLEXIBLE, TRANSORAL; WITH TRANSENDOSCOPIC BALLOON DILATION OF ESOPHAGUS (LESS THAN 30 MM DIAMETER)
|
Facility
|
OP
|
$7,523.04
|
|
|
Service Code
|
CPT 43249
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,880.76 |
| Max. Negotiated Rate |
$7,523.04 |
| Rate for Payer: Aetna Managed Medicare |
$1,880.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,880.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,880.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,880.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,880.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,996.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,880.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,880.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,880.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,880.76
|
| Rate for Payer: NAPHCARE Commercial |
$2,821.14
|
| Rate for Payer: Quartz Medicare Advantage |
$1,880.76
|
| Rate for Payer: The Alliance Commercial |
$7,523.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,880.76
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,880.76
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY
|
Facility
|
IP
|
$6,686.00
|
|
| Hospital Charge Code |
2960556
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$3,276.14 |
| Max. Negotiated Rate |
$6,151.12 |
| Rate for Payer: Aetna Commercial |
$6,017.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,749.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,543.58
|
| Rate for Payer: Cash Price |
$2,005.80
|
| Rate for Payer: Cigna Commercial |
$6,151.12
|
| Rate for Payer: Health EOS Commercial |
$5,950.54
|
| Rate for Payer: HFN Commercial |
$6,151.12
|
| Rate for Payer: Multiplan Commercial |
$5,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,011.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,151.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,276.14
|
| Rate for Payer: Quartz Commercial |
$4,011.60
|
| Rate for Payer: WEA Trust Commercial |
$3,677.30
|
| Rate for Payer: WPS Commercial |
$4,952.32
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY
|
Facility
|
OP
|
$6,686.00
|
|
| Hospital Charge Code |
2960556
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,872.08 |
| Max. Negotiated Rate |
$26,744.00 |
| Rate for Payer: Aetna Commercial |
$6,017.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,749.96
|
| Rate for Payer: Aetna Managed Medicare |
$1,872.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,345.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,343.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,209.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,543.58
|
| Rate for Payer: Cash Price |
$2,005.80
|
| Rate for Payer: Cigna Commercial |
$6,151.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,741.49
|
| Rate for Payer: Health EOS Commercial |
$5,950.54
|
| Rate for Payer: HFN Commercial |
$6,151.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,014.50
|
| Rate for Payer: Multiplan Commercial |
$5,348.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,011.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,151.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,276.14
|
| Rate for Payer: Quartz Commercial |
$4,345.90
|
| Rate for Payer: Quartz Medicare Advantage |
$4,011.60
|
| Rate for Payer: The Alliance Commercial |
$26,744.00
|
| Rate for Payer: WEA Trust Commercial |
$3,677.30
|
| Rate for Payer: WPS Commercial |
$4,952.32
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY AND DILATATION
|
Facility
|
IP
|
$5,970.00
|
|
| Hospital Charge Code |
2975903
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,925.30 |
| Max. Negotiated Rate |
$5,492.40 |
| Rate for Payer: Aetna Commercial |
$5,373.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,134.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,164.10
|
| Rate for Payer: Cash Price |
$1,791.00
|
| Rate for Payer: Cigna Commercial |
$5,492.40
|
| Rate for Payer: Health EOS Commercial |
$5,313.30
|
| Rate for Payer: HFN Commercial |
$5,492.40
|
| Rate for Payer: Multiplan Commercial |
$4,776.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,582.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,492.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,925.30
|
| Rate for Payer: Quartz Commercial |
$3,582.00
|
| Rate for Payer: WEA Trust Commercial |
$3,283.50
|
| Rate for Payer: WPS Commercial |
$4,421.98
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY AND DILATATION
|
Facility
|
OP
|
$5,970.00
|
|
| Hospital Charge Code |
2975903
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,671.60 |
| Max. Negotiated Rate |
$23,880.00 |
| Rate for Payer: Aetna Commercial |
$5,373.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,134.20
|
| Rate for Payer: Aetna Managed Medicare |
$1,671.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,880.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,865.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,164.10
|
| Rate for Payer: Cash Price |
$1,791.00
|
| Rate for Payer: Cigna Commercial |
$5,492.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,340.81
|
| Rate for Payer: Health EOS Commercial |
$5,313.30
|
| Rate for Payer: HFN Commercial |
$5,492.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,477.50
|
| Rate for Payer: Multiplan Commercial |
$4,776.00
|
| Rate for Payer: NAPHCARE Commercial |
$3,582.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,492.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,925.30
|
| Rate for Payer: Quartz Commercial |
$3,880.50
|
| Rate for Payer: Quartz Medicare Advantage |
$3,582.00
|
| Rate for Payer: The Alliance Commercial |
$23,880.00
|
| Rate for Payer: WEA Trust Commercial |
$3,283.50
|
| Rate for Payer: WPS Commercial |
$4,421.98
|
|
