|
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
|
$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
|
$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
|
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 AND RELATED BILIARY PROCEDURES
|
Facility
|
OP
|
$784.13
|
|
|
Service Code
|
EAPG 00107
|
| Min. Negotiated Rate |
$753.97 |
| Max. Negotiated Rate |
$784.13 |
| Rate for Payer: Anthem Medicaid |
$753.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$753.97
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$753.97
|
| Rate for Payer: Dean Health Medicaid |
$753.97
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$753.97
|
| Rate for Payer: Managed Health Services Medicaid |
$784.13
|
| Rate for Payer: Molina Healthcare Medicaid |
$753.97
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$753.97
|
| Rate for Payer: United Healthcare Medicaid |
$753.97
|
|
|
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
|
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, 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 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
|
$63.66
|
|
|
Service Code
|
EAPG 00638
|
| Min. Negotiated Rate |
$61.21 |
| Max. Negotiated Rate |
$63.66 |
| Rate for Payer: Anthem Medicaid |
$61.21
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$61.21
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$61.21
|
| Rate for Payer: Dean Health Medicaid |
$61.21
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$61.21
|
| Rate for Payer: Managed Health Services Medicaid |
$63.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$61.21
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$61.21
|
| Rate for Payer: United Healthcare Medicaid |
$61.21
|
|
|
CHOLEDOCHOSCOPY
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2959928
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,954.83 |
| 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: Aetna Managed Medicare |
$1,954.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,537.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,490.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,351.13
|
| 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: Dean Health DHI/DHP/ASO |
$3,906.97
|
| Rate for Payer: Health EOS Commercial |
$6,213.55
|
| Rate for Payer: HFN Commercial |
$6,423.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,236.14
|
| Rate for Payer: Multiplan Commercial |
$5,585.22
|
| Rate for Payer: NAPHCARE Commercial |
$4,188.91
|
| 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 |
$4,537.99
|
| Rate for Payer: Quartz Medicare Advantage |
$4,188.91
|
| Rate for Payer: The Alliance Commercial |
$3,490.76
|
| Rate for Payer: WEA Trust Commercial |
$3,839.84
|
| Rate for Payer: WPS Commercial |
$5,171.02
|
|
|
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
|
|
|
CHOLESTECH MULTI-ANALYTE CNTRL
|
Facility
|
IP
|
$1,395.00
|
|
| Hospital Charge Code |
2969875
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$710.89 |
| Max. Negotiated Rate |
$1,334.74 |
| Rate for Payer: Aetna Commercial |
$1,305.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,247.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$768.92
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna Commercial |
$1,334.74
|
| Rate for Payer: Health EOS Commercial |
$1,291.21
|
| Rate for Payer: HFN Commercial |
$1,334.74
|
| Rate for Payer: Multiplan Commercial |
$1,160.64
|
| Rate for Payer: Preferred Network Access Commercial |
$1,334.74
|
| Rate for Payer: Quartz Beloit One Network |
$710.89
|
| Rate for Payer: Quartz Commercial |
$870.48
|
| Rate for Payer: WEA Trust Commercial |
$797.94
|
| Rate for Payer: WPS Commercial |
$1,074.57
|
|
|
CHOLESTECH MULTI-ANALYTE CNTRL
|
Facility
|
OP
|
$1,395.00
|
|
| Hospital Charge Code |
2969875
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$406.22 |
| Max. Negotiated Rate |
$1,334.74 |
| Rate for Payer: Aetna Commercial |
$1,305.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,247.69
|
| Rate for Payer: Aetna Managed Medicare |
$406.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$943.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$725.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$696.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$768.92
|
| Rate for Payer: Cash Price |
$418.50
|
| Rate for Payer: Cigna Commercial |
$1,334.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$811.89
|
| Rate for Payer: Health EOS Commercial |
$1,291.21
|
| Rate for Payer: HFN Commercial |
$1,334.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,088.10
|
| Rate for Payer: Multiplan Commercial |
$1,160.64
|
| Rate for Payer: NAPHCARE Commercial |
$870.48
|
| Rate for Payer: Preferred Network Access Commercial |
$1,334.74
|
| Rate for Payer: Quartz Beloit One Network |
$710.89
|
| Rate for Payer: Quartz Commercial |
$943.02
|
| Rate for Payer: Quartz Medicare Advantage |
$870.48
|
| Rate for Payer: The Alliance Commercial |
$725.40
|
| Rate for Payer: WEA Trust Commercial |
$797.94
|
| Rate for Payer: WPS Commercial |
$1,074.57
|
|
|
CHOLESTEROL AND GLUCOSE TOTAL
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2971691
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
CHOLESTEROL AND GLUCOSE TOTAL
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2971691
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
Cholesterol High Density Lipid
|
Facility
|
IP
|
$129.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
633703
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$65.74 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$80.50
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
Cholesterol High Density Lipid
|
Facility
|
OP
|
$129.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
633703
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$123.43 |
| Rate for Payer: Aetna Commercial |
$120.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$8.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31.94
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14.14
|
| Rate for Payer: Anthem Medicare Advantage |
$8.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$71.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.52
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$123.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$75.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8.52
|
| Rate for Payer: Health EOS Commercial |
$119.40
|
| Rate for Payer: HFN Commercial |
$123.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31.69
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$12.78
|
| Rate for Payer: Preferred Network Access Commercial |
$123.43
|
| Rate for Payer: Quartz Beloit One Network |
$65.74
|
| Rate for Payer: Quartz Commercial |
$87.20
|
| Rate for Payer: Quartz Medicare Advantage |
$8.52
|
| Rate for Payer: The Alliance Commercial |
$34.07
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.52
|
| Rate for Payer: United Healthcare PPO |
$100.62
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: Wellcare Medicare |
$8.52
|
| Rate for Payer: WPS Commercial |
$99.37
|
|
|
Cholesterol High Density Lipid
|
Professional
|
Both
|
$129.00
|
|
|
Service Code
|
CPT 83718
|
| Hospital Charge Code |
633703
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.52 |
| Max. Negotiated Rate |
$127.45 |
| Rate for Payer: Aetna Commercial |
$127.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$115.38
|
| Rate for Payer: Aetna Managed Medicare |
$8.52
|
| Rate for Payer: Anthem Medicare Advantage |
$8.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.52
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cash Price |
$38.70
|
| Rate for Payer: Cigna Commercial |
$127.45
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$67.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8.52
|
| Rate for Payer: Health EOS Commercial |
$122.09
|
| Rate for Payer: HFN Commercial |
$127.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$30.07
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$30.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.52
|
| Rate for Payer: Multiplan Commercial |
$107.33
|
| Rate for Payer: NAPHCARE Commercial |
$12.78
|
| Rate for Payer: Preferred Network Access Commercial |
$127.45
|
| Rate for Payer: Quartz Beloit One Network |
$59.03
|
| Rate for Payer: Quartz Commercial |
$76.47
|
| Rate for Payer: Quartz Medicare Advantage |
$8.52
|
| Rate for Payer: The Alliance Commercial |
$33.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.52
|
| Rate for Payer: WEA Trust Commercial |
$73.79
|
| Rate for Payer: WPS Commercial |
$37.48
|
|
|
Cholesterol, Pleural Fluid
|
Professional
|
Both
|
$30.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
4163505
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$8.42 |
| Max. Negotiated Rate |
$37.07 |
| Rate for Payer: Aetna Commercial |
$29.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$26.83
|
| Rate for Payer: Aetna Managed Medicare |
$8.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8.42
|
| 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 |
$8.42
|
| Rate for Payer: Health EOS Commercial |
$28.39
|
| Rate for Payer: HFN Commercial |
$29.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29.73
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$29.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8.42
|
| Rate for Payer: Multiplan Commercial |
$24.96
|
| Rate for Payer: NAPHCARE Commercial |
$12.64
|
| 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 |
$8.42
|
| Rate for Payer: The Alliance Commercial |
$33.27
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8.42
|
| Rate for Payer: WEA Trust Commercial |
$17.16
|
| Rate for Payer: WPS Commercial |
$37.07
|
|
|
Cholesterol, Pleural Fluid
|
Facility
|
IP
|
$30.00
|
|
|
Service Code
|
CPT 84311
|
| Hospital Charge Code |
4163505
|
|
Hospital Revenue Code
|
300
|
| 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
|
|
