|
Chloride Stool
|
Facility
|
IP
|
$145.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
2942897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$73.89 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$90.48
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Chloride Stool
|
Professional
|
Both
|
$145.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
2942897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$143.26 |
| Rate for Payer: Aetna Commercial |
$143.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Aetna Managed Medicare |
$5.20
|
| Rate for Payer: Anthem Medicare Advantage |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.20
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$143.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$75.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.20
|
| Rate for Payer: Health EOS Commercial |
$137.23
|
| Rate for Payer: HFN Commercial |
$143.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: NAPHCARE Commercial |
$7.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.26
|
| Rate for Payer: Quartz Beloit One Network |
$66.35
|
| Rate for Payer: Quartz Commercial |
$85.96
|
| Rate for Payer: Quartz Medicare Advantage |
$5.20
|
| Rate for Payer: The Alliance Commercial |
$20.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.20
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: WPS Commercial |
$22.88
|
|
|
Chloride Stool
|
Facility
|
OP
|
$145.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
2942897
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$138.74 |
| Rate for Payer: Aetna Commercial |
$135.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$129.69
|
| Rate for Payer: Aetna Managed Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.63
|
| Rate for Payer: Anthem Medicare Advantage |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$79.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.20
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cash Price |
$43.50
|
| Rate for Payer: Cigna Commercial |
$138.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$84.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.20
|
| Rate for Payer: Health EOS Commercial |
$134.21
|
| Rate for Payer: HFN Commercial |
$138.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$120.64
|
| Rate for Payer: NAPHCARE Commercial |
$7.80
|
| Rate for Payer: Preferred Network Access Commercial |
$138.74
|
| Rate for Payer: Quartz Beloit One Network |
$73.89
|
| Rate for Payer: Quartz Commercial |
$98.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5.20
|
| Rate for Payer: The Alliance Commercial |
$20.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.20
|
| Rate for Payer: United Healthcare PPO |
$113.10
|
| Rate for Payer: WEA Trust Commercial |
$82.94
|
| Rate for Payer: Wellcare Medicare |
$5.20
|
| Rate for Payer: WPS Commercial |
$111.69
|
|
|
Chloride, Stool
|
Professional
|
Both
|
$40.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
4732606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$39.52 |
| Rate for Payer: Aetna Commercial |
$39.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$5.20
|
| Rate for Payer: Anthem Medicare Advantage |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$39.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.20
|
| Rate for Payer: Health EOS Commercial |
$37.86
|
| Rate for Payer: HFN Commercial |
$39.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$7.80
|
| Rate for Payer: Preferred Network Access Commercial |
$39.52
|
| Rate for Payer: Quartz Beloit One Network |
$18.30
|
| Rate for Payer: Quartz Commercial |
$23.71
|
| Rate for Payer: Quartz Medicare Advantage |
$5.20
|
| Rate for Payer: The Alliance Commercial |
$20.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.20
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$22.88
|
|
|
Chloride, Stool
|
Facility
|
IP
|
$40.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
4732606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$20.38 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$24.96
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
Chloride, Stool
|
Facility
|
OP
|
$40.00
|
|
|
Service Code
|
CPT 82438
|
| Hospital Charge Code |
4732606
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.20 |
| Max. Negotiated Rate |
$38.27 |
| Rate for Payer: Aetna Commercial |
$37.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35.78
|
| Rate for Payer: Aetna Managed Medicare |
$5.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8.63
|
| Rate for Payer: Anthem Medicare Advantage |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.20
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cash Price |
$12.00
|
| Rate for Payer: Cigna Commercial |
$38.27
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.20
|
| Rate for Payer: Health EOS Commercial |
$37.02
|
| Rate for Payer: HFN Commercial |
$38.27
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.34
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.20
|
| Rate for Payer: Multiplan Commercial |
$33.28
|
| Rate for Payer: NAPHCARE Commercial |
$7.80
|
| Rate for Payer: Preferred Network Access Commercial |
$38.27
|
| Rate for Payer: Quartz Beloit One Network |
$20.38
|
| Rate for Payer: Quartz Commercial |
$27.04
|
| Rate for Payer: Quartz Medicare Advantage |
$5.20
|
| Rate for Payer: The Alliance Commercial |
$20.80
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.20
|
| Rate for Payer: United Healthcare PPO |
$31.20
|
| Rate for Payer: WEA Trust Commercial |
$22.88
|
| Rate for Payer: Wellcare Medicare |
$5.20
|
| Rate for Payer: WPS Commercial |
$30.81
|
|
|
Chloride, Urine
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
5474689
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$29.64 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.98
|
| Rate for Payer: Anthem Medicare Advantage |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.98
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$29.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$15.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.98
|
| Rate for Payer: Health EOS Commercial |
$28.39
|
| Rate for Payer: HFN Commercial |
$29.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$21.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$8.97
|
| Rate for Payer: Preferred Network Access Commercial |
$29.64
|
| Rate for Payer: Quartz Beloit One Network |
$13.73
|
| Rate for Payer: Quartz Commercial |
$17.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5.98
|
| Rate for Payer: The Alliance Commercial |
$23.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.98
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$26.31
|
|
|
Chloride, Urine
|
Facility
|
OP
|
$30.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
5474689
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$5.98 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$5.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.98
|
| Rate for Payer: Anthem Medicare Advantage |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.98
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.98
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.98
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$8.97
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$20.28
|
| Rate for Payer: Quartz Medicare Advantage |
$5.98
|
| Rate for Payer: The Alliance Commercial |
$23.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.98
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: Wellcare Medicare |
$5.98
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Chloride, Urine
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 82436
|
| Hospital Charge Code |
5474689
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$15.29 |
| Max. Negotiated Rate |
$28.70 |
| Rate for Payer: Aetna Commercial |
$28.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$16.54
|
| Rate for Payer: Cash Price |
$9.00
|
| Rate for Payer: Cigna Commercial |
$28.70
|
| Rate for Payer: Health EOS Commercial |
$27.77
|
| Rate for Payer: HFN Commercial |
$28.70
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: Preferred Network Access Commercial |
$28.70
|
| Rate for Payer: Quartz Beloit One Network |
$15.29
|
| Rate for Payer: Quartz Commercial |
$18.72
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$23.11
|
|
|
Cholangiography &/Pancreatography IntraOp RS&I 7430026
|
Professional
|
Both
|
$229.00
|
|
|
Service Code
|
CPT 74300 26
|
| Hospital Charge Code |
5284615
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$12.68 |
| Max. Negotiated Rate |
$226.25 |
| Rate for Payer: Aetna Commercial |
$226.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$204.82
|
| Rate for Payer: Aetna Managed Medicare |
$12.68
|
| Rate for Payer: Anthem Medicare Advantage |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.68
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cash Price |
$68.70
|
| Rate for Payer: Cigna Commercial |
$226.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$119.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.68
|
| Rate for Payer: Health EOS Commercial |
$216.73
|
| Rate for Payer: HFN Commercial |
$226.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.68
|
| Rate for Payer: Multiplan Commercial |
$190.53
|
| Rate for Payer: NAPHCARE Commercial |
$19.02
|
| Rate for Payer: Preferred Network Access Commercial |
$226.25
|
| Rate for Payer: Quartz Beloit One Network |
$104.79
|
| Rate for Payer: Quartz Commercial |
$135.75
|
| Rate for Payer: Quartz Medicare Advantage |
$12.68
|
| Rate for Payer: The Alliance Commercial |
$48.17
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.68
|
| Rate for Payer: WEA Trust Commercial |
$130.99
|
| Rate for Payer: WPS Commercial |
$63.39
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$10,609.66
|
|
|
Service Code
|
APR-DRG 2631
|
| Min. Negotiated Rate |
$9,424.16 |
| Max. Negotiated Rate |
$10,609.66 |
| Rate for Payer: Anthem Medicaid |
$10,159.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,159.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,159.33
|
| Rate for Payer: Dean Health Medicaid |
$10,159.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,424.16
|
| Rate for Payer: Managed Health Services Medicaid |
$10,609.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,159.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,159.33
|
| Rate for Payer: United Healthcare Medicaid |
$10,159.33
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$30,338.35
|
|
|
Service Code
|
APR-DRG 2634
|
| Min. Negotiated Rate |
$26,948.42 |
| Max. Negotiated Rate |
$30,338.35 |
| Rate for Payer: Anthem Medicaid |
$29,050.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$29,050.64
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$29,050.64
|
| Rate for Payer: Dean Health Medicaid |
$29,050.64
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$26,948.42
|
| Rate for Payer: Managed Health Services Medicaid |
$30,338.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$29,050.64
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$29,050.64
|
| Rate for Payer: United Healthcare Medicaid |
$29,050.64
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$13,064.78
|
|
|
Service Code
|
APR-DRG 2632
|
| Min. Negotiated Rate |
$11,604.95 |
| Max. Negotiated Rate |
$13,064.78 |
| Rate for Payer: Anthem Medicaid |
$12,510.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,510.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,510.25
|
| Rate for Payer: Dean Health Medicaid |
$12,510.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,604.95
|
| Rate for Payer: Managed Health Services Medicaid |
$13,064.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,510.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,510.25
|
| Rate for Payer: United Healthcare Medicaid |
$12,510.25
|
|
|
CHOLECYSTECTOMY
|
Facility
|
IP
|
$17,975.04
|
|
|
Service Code
|
APR-DRG 2633
|
| Min. Negotiated Rate |
$15,966.55 |
| Max. Negotiated Rate |
$17,975.04 |
| Rate for Payer: Anthem Medicaid |
$17,212.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$17,212.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17,212.09
|
| Rate for Payer: Dean Health Medicaid |
$17,212.09
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,966.55
|
| Rate for Payer: Managed Health Services Medicaid |
$17,975.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$17,212.09
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17,212.09
|
| Rate for Payer: United Healthcare Medicaid |
$17,212.09
|
|
|
CHOLECYSTECTOMY AND RELATED BILIARY PROCEDURES
|
Facility
|
OP
|
$1,927.45
|
|
|
Service Code
|
EAPG 00107
|
| Min. Negotiated Rate |
$1,853.31 |
| Max. Negotiated Rate |
$1,927.45 |
| Rate for Payer: Anthem Medicaid |
$1,853.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,853.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,853.31
|
| Rate for Payer: Dean Health Medicaid |
$1,853.31
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,853.31
|
| Rate for Payer: Managed Health Services Medicaid |
$1,927.45
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,853.31
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,853.31
|
| Rate for Payer: United Healthcare Medicaid |
$1,853.31
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$54,962.96
|
|
|
Service Code
|
MSDRG 415
|
| Min. Negotiated Rate |
$16,333.97 |
| Max. Negotiated Rate |
$54,962.96 |
| Rate for Payer: Aetna Managed Medicare |
$16,333.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,093.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,563.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,838.04
|
| Rate for Payer: Anthem Medicare Advantage |
$16,333.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,333.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,333.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,333.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,453.24
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,333.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,069.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,333.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,333.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,333.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,333.97
|
| Rate for Payer: NAPHCARE Commercial |
$24,500.95
|
| Rate for Payer: Quartz Medicare Advantage |
$16,333.97
|
| Rate for Payer: The Alliance Commercial |
$54,962.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,333.97
|
| Rate for Payer: United Healthcare PPO |
$31,194.40
|
| Rate for Payer: Wellcare Medicare |
$16,333.97
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$97,802.64
|
|
|
Service Code
|
MSDRG 414
|
| Min. Negotiated Rate |
$27,789.88 |
| Max. Negotiated Rate |
$97,802.64 |
| Rate for Payer: Aetna Managed Medicare |
$27,789.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77,733.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59,581.78
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,606.58
|
| Rate for Payer: Anthem Medicare Advantage |
$27,789.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,789.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,789.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,789.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62,838.49
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,789.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$71,491.06
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,789.88
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,789.88
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,789.88
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,789.88
|
| Rate for Payer: NAPHCARE Commercial |
$41,684.82
|
| Rate for Payer: Quartz Medicare Advantage |
$27,789.88
|
| Rate for Payer: The Alliance Commercial |
$97,802.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,789.88
|
| Rate for Payer: United Healthcare PPO |
$55,656.70
|
| Rate for Payer: Wellcare Medicare |
$27,789.88
|
|
|
CHOLECYSTECTOMY EXCEPT BY LAPAROSCOPE WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$37,360.96
|
|
|
Service Code
|
MSDRG 416
|
| Min. Negotiated Rate |
$10,947.20 |
| Max. Negotiated Rate |
$37,360.96 |
| Rate for Payer: Aetna Managed Medicare |
$10,947.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,746.12
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,800.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,661.64
|
| Rate for Payer: Anthem Medicare Advantage |
$10,947.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,947.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,947.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,947.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,046.40
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,947.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,158.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,947.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,947.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,947.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,947.20
|
| Rate for Payer: NAPHCARE Commercial |
$16,420.79
|
| Rate for Payer: Quartz Medicare Advantage |
$10,947.20
|
| Rate for Payer: The Alliance Commercial |
$37,360.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,947.20
|
| Rate for Payer: United Healthcare PPO |
$21,143.62
|
| Rate for Payer: Wellcare Medicare |
$10,947.20
|
|
|
CHOLECYSTECTOMY, OPEN W/COMMON BILE DUCT
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2959927
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,398.63 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,398.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,246.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,497.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,397.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,795.35
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,746.34
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,997.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$3,246.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,997.07
|
| Rate for Payer: The Alliance Commercial |
$2,497.56
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
CHOLECYSTECTOMY, OPEN W/COMMON BILE DUCT
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2959927
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,447.61 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$2,997.07
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH CC
|
Facility
|
IP
|
$57,460.00
|
|
|
Service Code
|
MSDRG 412
|
| Min. Negotiated Rate |
$16,608.13 |
| Max. Negotiated Rate |
$57,460.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,608.13
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$45,874.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35,162.71
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33,406.87
|
| Rate for Payer: Anthem Medicare Advantage |
$16,608.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,608.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,608.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,608.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$37,084.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,608.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,482.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,608.13
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,608.13
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,608.13
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,608.13
|
| Rate for Payer: NAPHCARE Commercial |
$24,912.20
|
| Rate for Payer: Quartz Medicare Advantage |
$16,608.13
|
| Rate for Payer: The Alliance Commercial |
$57,460.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,608.13
|
| Rate for Payer: United Healthcare PPO |
$32,294.85
|
| Rate for Payer: Wellcare Medicare |
$16,608.13
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITH MCC
|
Facility
|
IP
|
$84,398.08
|
|
|
Service Code
|
MSDRG 411
|
| Min. Negotiated Rate |
$25,804.10 |
| Max. Negotiated Rate |
$84,398.08 |
| Rate for Payer: Aetna Managed Medicare |
$25,804.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$72,075.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$55,245.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$52,486.53
|
| Rate for Payer: Anthem Medicare Advantage |
$25,804.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,804.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,804.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,804.10
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$58,264.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,804.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58,416.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,804.10
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,804.10
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,804.10
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,804.10
|
| Rate for Payer: NAPHCARE Commercial |
$38,706.14
|
| Rate for Payer: Quartz Medicare Advantage |
$25,804.10
|
| Rate for Payer: The Alliance Commercial |
$84,398.08
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,804.10
|
| Rate for Payer: United Healthcare PPO |
$45,478.02
|
| Rate for Payer: Wellcare Medicare |
$25,804.10
|
|
|
CHOLECYSTECTOMY WITH C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$42,073.20
|
|
|
Service Code
|
MSDRG 413
|
| Min. Negotiated Rate |
$13,223.20 |
| Max. Negotiated Rate |
$42,073.20 |
| Rate for Payer: Aetna Managed Medicare |
$13,223.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,230.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,770.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,383.88
|
| Rate for Payer: Anthem Medicare Advantage |
$13,223.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,223.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,223.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,223.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,288.53
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,223.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30,614.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,223.20
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,223.20
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,223.20
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,223.20
|
| Rate for Payer: NAPHCARE Commercial |
$19,834.81
|
| Rate for Payer: Quartz Medicare Advantage |
$13,223.20
|
| Rate for Payer: The Alliance Commercial |
$42,073.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,223.20
|
| Rate for Payer: United Healthcare PPO |
$23,833.93
|
| Rate for Payer: Wellcare Medicare |
$13,223.20
|
|
|
CHOLECYSTITIS
|
Facility
|
OP
|
$82.55
|
|
|
Service Code
|
EAPG 00638
|
| Min. Negotiated Rate |
$79.37 |
| Max. Negotiated Rate |
$82.55 |
| Rate for Payer: Anthem Medicaid |
$79.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$79.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$79.37
|
| Rate for Payer: Dean Health Medicaid |
$79.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$79.37
|
| Rate for Payer: Managed Health Services Medicaid |
$82.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$79.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$79.37
|
| Rate for Payer: United Healthcare Medicaid |
$79.37
|
|
|
CHOLEDOCHOSCOPY
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2959928
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,420.94 |
| Max. Negotiated Rate |
$6,423.00 |
| Rate for Payer: Aetna Commercial |
$6,283.37
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,004.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,700.21
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,423.00
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: Preferred Network Access Commercial |
$6,423.00
|
| Rate for Payer: Quartz Beloit One Network |
$3,420.94
|
| Rate for Payer: Quartz Commercial |
$4,188.91
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
