|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY AND POLYECTOMY
|
Facility
|
IP
|
$8,649.00
|
|
| Hospital Charge Code |
4495006
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$4,238.01 |
| Max. Negotiated Rate |
$7,957.08 |
| Rate for Payer: Aetna Commercial |
$7,784.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,438.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,583.97
|
| Rate for Payer: Cash Price |
$2,594.70
|
| Rate for Payer: Cigna Commercial |
$7,957.08
|
| Rate for Payer: Health EOS Commercial |
$7,697.61
|
| Rate for Payer: HFN Commercial |
$7,957.08
|
| Rate for Payer: Multiplan Commercial |
$6,919.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,189.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,957.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,238.01
|
| Rate for Payer: Quartz Commercial |
$5,189.40
|
| Rate for Payer: WEA Trust Commercial |
$4,756.95
|
| Rate for Payer: WPS Commercial |
$6,406.31
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH BIOPSY AND POLYECTOMY
|
Facility
|
OP
|
$8,649.00
|
|
| Hospital Charge Code |
4495006
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,421.72 |
| Max. Negotiated Rate |
$34,596.00 |
| Rate for Payer: Aetna Commercial |
$7,784.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,438.14
|
| Rate for Payer: Aetna Managed Medicare |
$2,421.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,621.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,324.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,151.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,583.97
|
| Rate for Payer: Cash Price |
$2,594.70
|
| Rate for Payer: Cigna Commercial |
$7,957.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,839.98
|
| Rate for Payer: Health EOS Commercial |
$7,697.61
|
| Rate for Payer: HFN Commercial |
$7,957.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,486.75
|
| Rate for Payer: Multiplan Commercial |
$6,919.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,189.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,957.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,238.01
|
| Rate for Payer: Quartz Commercial |
$5,621.85
|
| Rate for Payer: Quartz Medicare Advantage |
$5,189.40
|
| Rate for Payer: The Alliance Commercial |
$34,596.00
|
| Rate for Payer: WEA Trust Commercial |
$4,756.95
|
| Rate for Payer: WPS Commercial |
$6,406.31
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH DILATATION
|
Facility
|
OP
|
$5,897.00
|
|
| Hospital Charge Code |
2960557
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,651.16 |
| Max. Negotiated Rate |
$23,588.00 |
| Rate for Payer: Aetna Commercial |
$5,307.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,071.42
|
| Rate for Payer: Aetna Managed Medicare |
$1,651.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,833.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,948.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,830.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,125.41
|
| Rate for Payer: Cash Price |
$1,769.10
|
| Rate for Payer: Cigna Commercial |
$5,425.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,299.96
|
| Rate for Payer: Health EOS Commercial |
$5,248.33
|
| Rate for Payer: HFN Commercial |
$5,425.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,422.75
|
| Rate for Payer: Multiplan Commercial |
$4,717.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,538.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,425.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,889.53
|
| Rate for Payer: Quartz Commercial |
$3,833.05
|
| Rate for Payer: Quartz Medicare Advantage |
$3,538.20
|
| Rate for Payer: The Alliance Commercial |
$23,588.00
|
| Rate for Payer: WEA Trust Commercial |
$3,243.35
|
| Rate for Payer: WPS Commercial |
$4,367.91
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH DILATATION
|
Facility
|
IP
|
$5,897.00
|
|
| Hospital Charge Code |
2960557
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,889.53 |
| Max. Negotiated Rate |
$5,425.24 |
| Rate for Payer: Aetna Commercial |
$5,307.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,071.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,125.41
|
| Rate for Payer: Cash Price |
$1,769.10
|
| Rate for Payer: Cigna Commercial |
$5,425.24
|
| Rate for Payer: Health EOS Commercial |
$5,248.33
|
| Rate for Payer: HFN Commercial |
$5,425.24
|
| Rate for Payer: Multiplan Commercial |
$4,717.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,538.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,425.24
|
| Rate for Payer: Quartz Beloit One Network |
$2,889.53
|
| Rate for Payer: Quartz Commercial |
$3,538.20
|
| Rate for Payer: WEA Trust Commercial |
$3,243.35
|
| Rate for Payer: WPS Commercial |
$4,367.91
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH LESION REMOVAL
|
Facility
|
OP
|
$5,488.00
|
|
| Hospital Charge Code |
2960559
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$1,536.64 |
| Max. Negotiated Rate |
$21,952.00 |
| Rate for Payer: Aetna Commercial |
$4,939.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,719.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,536.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,567.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,744.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,634.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,908.64
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cigna Commercial |
$5,048.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,071.08
|
| Rate for Payer: Health EOS Commercial |
$4,884.32
|
| Rate for Payer: HFN Commercial |
$5,048.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,116.00
|
| Rate for Payer: Multiplan Commercial |
$4,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,048.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,689.12
|
| Rate for Payer: Quartz Commercial |
$3,567.20
|
| Rate for Payer: Quartz Medicare Advantage |
$3,292.80
|
| Rate for Payer: The Alliance Commercial |
$21,952.00
|
| Rate for Payer: WEA Trust Commercial |
$3,018.40
|
| Rate for Payer: WPS Commercial |
$4,064.96
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH LESION REMOVAL
|
Facility
|
IP
|
$5,488.00
|
|
| Hospital Charge Code |
2960559
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,689.12 |
| Max. Negotiated Rate |
$5,048.96 |
| Rate for Payer: Aetna Commercial |
$4,939.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,719.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,908.64
|
| Rate for Payer: Cash Price |
$1,646.40
|
| Rate for Payer: Cigna Commercial |
$5,048.96
|
| Rate for Payer: Health EOS Commercial |
$4,884.32
|
| Rate for Payer: HFN Commercial |
$5,048.96
|
| Rate for Payer: Multiplan Commercial |
$4,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$3,292.80
|
| Rate for Payer: Preferred Network Access Commercial |
$5,048.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,689.12
|
| Rate for Payer: Quartz Commercial |
$3,292.80
|
| Rate for Payer: WEA Trust Commercial |
$3,018.40
|
| Rate for Payer: WPS Commercial |
$4,064.96
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH POLYECTOMY
|
Facility
|
OP
|
$8,195.00
|
|
| Hospital Charge Code |
4075905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$2,294.60 |
| Max. Negotiated Rate |
$32,780.00 |
| Rate for Payer: Aetna Commercial |
$7,375.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,047.70
|
| Rate for Payer: Aetna Managed Medicare |
$2,294.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,326.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,097.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,933.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,343.35
|
| Rate for Payer: Cash Price |
$2,458.50
|
| Rate for Payer: Cigna Commercial |
$7,539.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,585.92
|
| Rate for Payer: Health EOS Commercial |
$7,293.55
|
| Rate for Payer: HFN Commercial |
$7,539.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,146.25
|
| Rate for Payer: Multiplan Commercial |
$6,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,917.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,539.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,015.55
|
| Rate for Payer: Quartz Commercial |
$5,326.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,917.00
|
| Rate for Payer: The Alliance Commercial |
$32,780.00
|
| Rate for Payer: WEA Trust Commercial |
$4,507.25
|
| Rate for Payer: WPS Commercial |
$6,070.04
|
|
|
ESOPHAGOGASTRODUODENOSCOPY WITH POLYECTOMY
|
Facility
|
IP
|
$8,195.00
|
|
| Hospital Charge Code |
4075905
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$4,015.55 |
| Max. Negotiated Rate |
$7,539.40 |
| Rate for Payer: Aetna Commercial |
$7,375.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,047.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,343.35
|
| Rate for Payer: Cash Price |
$2,458.50
|
| Rate for Payer: Cigna Commercial |
$7,539.40
|
| Rate for Payer: Health EOS Commercial |
$7,293.55
|
| Rate for Payer: HFN Commercial |
$7,539.40
|
| Rate for Payer: Multiplan Commercial |
$6,556.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,917.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,539.40
|
| Rate for Payer: Quartz Beloit One Network |
$4,015.55
|
| Rate for Payer: Quartz Commercial |
$4,917.00
|
| Rate for Payer: WEA Trust Commercial |
$4,507.25
|
| Rate for Payer: WPS Commercial |
$6,070.04
|
|
|
ESOPHAGOGASTROSCOPY RIGID/FLEXIBLE
|
Facility
|
IP
|
$2,051.00
|
|
| Hospital Charge Code |
2960019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,004.99 |
| Max. Negotiated Rate |
$1,886.92 |
| Rate for Payer: Aetna Commercial |
$1,845.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,886.92
|
| Rate for Payer: Health EOS Commercial |
$1,825.39
|
| Rate for Payer: HFN Commercial |
$1,886.92
|
| Rate for Payer: Multiplan Commercial |
$1,640.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.99
|
| Rate for Payer: Quartz Commercial |
$1,230.60
|
| Rate for Payer: WEA Trust Commercial |
$1,128.05
|
| Rate for Payer: WPS Commercial |
$1,519.18
|
|
|
ESOPHAGOGASTROSCOPY RIGID/FLEXIBLE
|
Facility
|
OP
|
$2,051.00
|
|
| Hospital Charge Code |
2960019
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.28 |
| Max. Negotiated Rate |
$8,204.00 |
| Rate for Payer: Aetna Commercial |
$1,845.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.86
|
| Rate for Payer: Aetna Managed Medicare |
$574.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,333.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,025.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$984.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,886.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,147.74
|
| Rate for Payer: Health EOS Commercial |
$1,825.39
|
| Rate for Payer: HFN Commercial |
$1,886.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,538.25
|
| Rate for Payer: Multiplan Commercial |
$1,640.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.99
|
| Rate for Payer: Quartz Commercial |
$1,333.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,230.60
|
| Rate for Payer: The Alliance Commercial |
$8,204.00
|
| Rate for Payer: WEA Trust Commercial |
$1,128.05
|
| Rate for Payer: WPS Commercial |
$1,519.18
|
|
|
ESOPHAGOSCOPY & BIOPSY
|
Facility
|
OP
|
$2,051.00
|
|
| Hospital Charge Code |
2960021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$574.28 |
| Max. Negotiated Rate |
$8,204.00 |
| Rate for Payer: Aetna Commercial |
$1,845.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.86
|
| Rate for Payer: Aetna Managed Medicare |
$574.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,333.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,025.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$984.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,886.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,147.74
|
| Rate for Payer: Health EOS Commercial |
$1,825.39
|
| Rate for Payer: HFN Commercial |
$1,886.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,538.25
|
| Rate for Payer: Multiplan Commercial |
$1,640.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.99
|
| Rate for Payer: Quartz Commercial |
$1,333.15
|
| Rate for Payer: Quartz Medicare Advantage |
$1,230.60
|
| Rate for Payer: The Alliance Commercial |
$8,204.00
|
| Rate for Payer: WEA Trust Commercial |
$1,128.05
|
| Rate for Payer: WPS Commercial |
$1,519.18
|
|
|
ESOPHAGOSCOPY & BIOPSY
|
Facility
|
IP
|
$2,051.00
|
|
| Hospital Charge Code |
2960021
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,004.99 |
| Max. Negotiated Rate |
$1,886.92 |
| Rate for Payer: Aetna Commercial |
$1,845.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,763.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,087.03
|
| Rate for Payer: Cash Price |
$615.30
|
| Rate for Payer: Cigna Commercial |
$1,886.92
|
| Rate for Payer: Health EOS Commercial |
$1,825.39
|
| Rate for Payer: HFN Commercial |
$1,886.92
|
| Rate for Payer: Multiplan Commercial |
$1,640.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,230.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,886.92
|
| Rate for Payer: Quartz Beloit One Network |
$1,004.99
|
| Rate for Payer: Quartz Commercial |
$1,230.60
|
| Rate for Payer: WEA Trust Commercial |
$1,128.05
|
| Rate for Payer: WPS Commercial |
$1,519.18
|
|
|
ESOPHAGOSCOPY WITH ABLATION SURGERY/HALO PROCEDURE
|
Facility
|
IP
|
$3,569.00
|
|
| Hospital Charge Code |
2975904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,748.81 |
| Max. Negotiated Rate |
$3,283.48 |
| Rate for Payer: Aetna Commercial |
$3,212.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,069.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,891.57
|
| Rate for Payer: Cash Price |
$1,070.70
|
| Rate for Payer: Cigna Commercial |
$3,283.48
|
| Rate for Payer: Health EOS Commercial |
$3,176.41
|
| Rate for Payer: HFN Commercial |
$3,283.48
|
| Rate for Payer: Multiplan Commercial |
$2,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,141.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,283.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,748.81
|
| Rate for Payer: Quartz Commercial |
$2,141.40
|
| Rate for Payer: WEA Trust Commercial |
$1,962.95
|
| Rate for Payer: WPS Commercial |
$2,643.56
|
|
|
ESOPHAGOSCOPY WITH ABLATION SURGERY/HALO PROCEDURE
|
Facility
|
OP
|
$3,569.00
|
|
| Hospital Charge Code |
2975904
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$999.32 |
| Max. Negotiated Rate |
$14,276.00 |
| Rate for Payer: Aetna Commercial |
$3,212.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,069.34
|
| Rate for Payer: Aetna Managed Medicare |
$999.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,319.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,784.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,713.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,891.57
|
| Rate for Payer: Cash Price |
$1,070.70
|
| Rate for Payer: Cigna Commercial |
$3,283.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,997.21
|
| Rate for Payer: Health EOS Commercial |
$3,176.41
|
| Rate for Payer: HFN Commercial |
$3,283.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,676.75
|
| Rate for Payer: Multiplan Commercial |
$2,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,141.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,283.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,748.81
|
| Rate for Payer: Quartz Commercial |
$2,319.85
|
| Rate for Payer: Quartz Medicare Advantage |
$2,141.40
|
| Rate for Payer: The Alliance Commercial |
$14,276.00
|
| Rate for Payer: WEA Trust Commercial |
$1,962.95
|
| Rate for Payer: WPS Commercial |
$2,643.56
|
|
|
ESOPHAGUS ENDOSCOPY 43200
|
Professional
|
Both
|
$1,129.00
|
|
|
Service Code
|
CPT 43200
|
| Hospital Charge Code |
3014649
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$184.49 |
| Max. Negotiated Rate |
$1,072.55 |
| Rate for Payer: Aetna Commercial |
$1,072.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$970.94
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cash Price |
$338.70
|
| Rate for Payer: Cigna Commercial |
$1,072.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$677.40
|
| Rate for Payer: Health EOS Commercial |
$1,027.39
|
| Rate for Payer: HFN Commercial |
$1,072.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$289.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$289.32
|
| Rate for Payer: Multiplan Commercial |
$903.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,072.55
|
| Rate for Payer: Quartz Beloit One Network |
$496.76
|
| Rate for Payer: Quartz Commercial |
$643.53
|
| Rate for Payer: The Alliance Commercial |
$564.50
|
| Rate for Payer: United Healthcare Medicaid |
$184.49
|
| Rate for Payer: WEA Trust Commercial |
$620.95
|
| Rate for Payer: WPS Commercial |
$836.25
|
|
|
ESOPHAGUS ENDOSCOPY, BIOPSY 43202
|
Professional
|
Both
|
$1,790.00
|
|
|
Service Code
|
CPT 43202
|
| Hospital Charge Code |
3014650
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$339.58 |
| Max. Negotiated Rate |
$1,700.50 |
| Rate for Payer: Aetna Commercial |
$1,700.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,539.40
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cash Price |
$537.00
|
| Rate for Payer: Cigna Commercial |
$1,700.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$339.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,074.00
|
| Rate for Payer: Health EOS Commercial |
$1,628.90
|
| Rate for Payer: HFN Commercial |
$1,700.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$341.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$341.70
|
| Rate for Payer: Multiplan Commercial |
$1,432.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,700.50
|
| Rate for Payer: Quartz Beloit One Network |
$787.60
|
| Rate for Payer: Quartz Commercial |
$1,020.30
|
| Rate for Payer: The Alliance Commercial |
$895.00
|
| Rate for Payer: United Healthcare Medicaid |
$339.58
|
| Rate for Payer: WEA Trust Commercial |
$984.50
|
| Rate for Payer: WPS Commercial |
$1,325.85
|
|
|
ESOPHAGUS, GASTROESOPHAGEAL REFLUX TEST; WITH MUCOSAL ATTACHED TELEMETRY PH ELECTRODE PLACEMENT, RECORDING, ANALYSIS AND INTERPRETATION
|
Facility
|
OP
|
$2,119.08
|
|
|
Service Code
|
CPT 91035
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$529.77 |
| Max. Negotiated Rate |
$2,119.08 |
| Rate for Payer: Aetna Managed Medicare |
$529.77
|
| Rate for Payer: Anthem Medicare Advantage |
$529.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$529.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$529.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$529.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$529.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,970.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$529.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$529.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$529.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$529.77
|
| Rate for Payer: NAPHCARE Commercial |
$794.66
|
| Rate for Payer: Quartz Medicare Advantage |
$529.77
|
| Rate for Payer: The Alliance Commercial |
$2,119.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$529.77
|
| Rate for Payer: Wellcare Medicare |
$529.77
|
|
|
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 |
$111.83 |
| Max. Negotiated Rate |
$1,538.94 |
| Rate for Payer: Aetna Commercial |
$381.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$381.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$111.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.20
|
| Rate for Payer: Health EOS Commercial |
$365.82
|
| Rate for Payer: HFN Commercial |
$381.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,538.94
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,538.94
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$381.90
|
| Rate for Payer: Quartz Beloit One Network |
$176.88
|
| Rate for Payer: Quartz Commercial |
$229.14
|
| Rate for Payer: The Alliance Commercial |
$201.00
|
| Rate for Payer: United Healthcare Medicaid |
$111.83
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
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 |
$176.88 |
| Max. Negotiated Rate |
$381.90 |
| Rate for Payer: Aetna Commercial |
$381.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$345.72
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cash Price |
$120.60
|
| Rate for Payer: Cigna Commercial |
$381.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$201.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$241.20
|
| Rate for Payer: Health EOS Commercial |
$365.82
|
| Rate for Payer: HFN Commercial |
$381.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$192.63
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$192.63
|
| Rate for Payer: Multiplan Commercial |
$321.60
|
| Rate for Payer: Preferred Network Access Commercial |
$381.90
|
| Rate for Payer: Quartz Beloit One Network |
$176.88
|
| Rate for Payer: Quartz Commercial |
$229.14
|
| Rate for Payer: The Alliance Commercial |
$201.00
|
| Rate for Payer: WEA Trust Commercial |
$221.10
|
| Rate for Payer: WPS Commercial |
$297.76
|
|
|
ESOPH IMPED FUNCTION TEST 91037
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
CPT 91037
|
| Hospital Charge Code |
3015324
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$129.95 |
| Max. Negotiated Rate |
$597.03 |
| Rate for Payer: Aetna Commercial |
$521.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.14
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna Commercial |
$521.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$129.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.40
|
| Rate for Payer: Health EOS Commercial |
$499.59
|
| Rate for Payer: HFN Commercial |
$521.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$597.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$597.03
|
| Rate for Payer: Multiplan Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.55
|
| Rate for Payer: Quartz Beloit One Network |
$241.56
|
| Rate for Payer: Quartz Commercial |
$312.93
|
| Rate for Payer: The Alliance Commercial |
$274.50
|
| Rate for Payer: United Healthcare Medicaid |
$129.95
|
| Rate for Payer: WEA Trust Commercial |
$301.95
|
| Rate for Payer: WPS Commercial |
$406.64
|
|
|
ESOPH IMPED FUNCTION TEST 9103726
|
Professional
|
Both
|
$549.00
|
|
|
Service Code
|
CPT 91037 26
|
| Hospital Charge Code |
5472737
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$169.65 |
| Max. Negotiated Rate |
$521.55 |
| Rate for Payer: Aetna Commercial |
$521.55
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$472.14
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cash Price |
$164.70
|
| Rate for Payer: Cigna Commercial |
$521.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$274.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$329.40
|
| Rate for Payer: Health EOS Commercial |
$499.59
|
| Rate for Payer: HFN Commercial |
$521.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$169.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$169.65
|
| Rate for Payer: Multiplan Commercial |
$439.20
|
| Rate for Payer: Preferred Network Access Commercial |
$521.55
|
| Rate for Payer: Quartz Beloit One Network |
$241.56
|
| Rate for Payer: Quartz Commercial |
$312.93
|
| Rate for Payer: The Alliance Commercial |
$274.50
|
| Rate for Payer: WEA Trust Commercial |
$301.95
|
| Rate for Payer: WPS Commercial |
$406.64
|
|
|
ESTABLISH ACCESS TO ARTERY 36140
|
Professional
|
Both
|
$2,444.00
|
|
|
Service Code
|
CPT 36140
|
| Hospital Charge Code |
3014509
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$70.99 |
| Max. Negotiated Rate |
$2,321.80 |
| Rate for Payer: Aetna Commercial |
$2,321.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,101.84
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cash Price |
$733.20
|
| Rate for Payer: Cigna Commercial |
$2,321.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$70.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,466.40
|
| Rate for Payer: Health EOS Commercial |
$2,224.04
|
| Rate for Payer: HFN Commercial |
$2,321.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$286.78
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$286.78
|
| Rate for Payer: Multiplan Commercial |
$1,955.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,321.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,075.36
|
| Rate for Payer: Quartz Commercial |
$1,393.08
|
| Rate for Payer: The Alliance Commercial |
$1,222.00
|
| Rate for Payer: United Healthcare Medicaid |
$70.99
|
| Rate for Payer: WEA Trust Commercial |
$1,344.20
|
| Rate for Payer: WPS Commercial |
$1,810.27
|
|
|
Establish Access To Artery 3614022
|
Professional
|
Both
|
$2,932.00
|
|
|
Service Code
|
CPT 36140 22
|
| Hospital Charge Code |
5492669
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$1,290.08 |
| Max. Negotiated Rate |
$2,785.40 |
| Rate for Payer: Aetna Commercial |
$2,785.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,521.52
|
| Rate for Payer: Cash Price |
$879.60
|
| Rate for Payer: Cash Price |
$879.60
|
| Rate for Payer: Cigna Commercial |
$2,785.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,466.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,759.20
|
| Rate for Payer: Health EOS Commercial |
$2,668.12
|
| Rate for Payer: HFN Commercial |
$2,785.40
|
| Rate for Payer: Multiplan Commercial |
$2,345.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,785.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,290.08
|
| Rate for Payer: Quartz Commercial |
$1,671.24
|
| Rate for Payer: The Alliance Commercial |
$1,466.00
|
| Rate for Payer: WEA Trust Commercial |
$1,612.60
|
| Rate for Payer: WPS Commercial |
$2,171.73
|
|
|
Established major dressing charge
|
Facility
|
OP
|
$150.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3165538
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$42.00 |
| Max. Negotiated Rate |
$600.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Aetna Managed Medicare |
$42.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$97.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$75.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$72.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.50
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$138.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83.94
|
| Rate for Payer: Health EOS Commercial |
$133.50
|
| Rate for Payer: HFN Commercial |
$138.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$112.50
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.00
|
| Rate for Payer: Preferred Network Access Commercial |
$138.00
|
| Rate for Payer: Quartz Beloit One Network |
$73.50
|
| Rate for Payer: Quartz Commercial |
$97.50
|
| Rate for Payer: Quartz Medicare Advantage |
$90.00
|
| Rate for Payer: The Alliance Commercial |
$600.00
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
|
Established major dressing charge
|
Facility
|
IP
|
$150.00
|
|
|
Service Code
|
CPT 99212
|
| Hospital Charge Code |
3165538
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$73.50 |
| Max. Negotiated Rate |
$138.00 |
| Rate for Payer: Aetna Commercial |
$135.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.50
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$138.00
|
| Rate for Payer: Health EOS Commercial |
$133.50
|
| Rate for Payer: HFN Commercial |
$138.00
|
| Rate for Payer: Multiplan Commercial |
$120.00
|
| Rate for Payer: NAPHCARE Commercial |
$90.00
|
| Rate for Payer: Preferred Network Access Commercial |
$138.00
|
| Rate for Payer: Quartz Beloit One Network |
$73.50
|
| Rate for Payer: Quartz Commercial |
$90.00
|
| Rate for Payer: WEA Trust Commercial |
$82.50
|
| Rate for Payer: WPS Commercial |
$111.10
|
|
