|
GARMENT TOES TO MID THIGH #LE-AF-C
|
Facility
|
IP
|
$5,186.00
|
|
| Hospital Charge Code |
2973567
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$2,642.79 |
| Max. Negotiated Rate |
$4,961.96 |
| Rate for Payer: Aetna Commercial |
$4,854.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,638.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,858.52
|
| Rate for Payer: Cash Price |
$1,555.80
|
| Rate for Payer: Cigna Commercial |
$4,961.96
|
| Rate for Payer: Health EOS Commercial |
$4,800.16
|
| Rate for Payer: HFN Commercial |
$4,961.96
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: Preferred Network Access Commercial |
$4,961.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,642.79
|
| Rate for Payer: Quartz Commercial |
$3,236.06
|
| Rate for Payer: WEA Trust Commercial |
$2,966.39
|
| Rate for Payer: WPS Commercial |
$3,994.78
|
|
|
GARMENT TOES TO MID THIGH #LE-AF-C
|
Facility
|
OP
|
$5,186.00
|
|
| Hospital Charge Code |
2973567
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$1,510.16 |
| Max. Negotiated Rate |
$4,961.96 |
| Rate for Payer: Aetna Commercial |
$4,854.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,638.36
|
| Rate for Payer: Aetna Managed Medicare |
$1,510.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,505.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,696.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,588.85
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,858.52
|
| Rate for Payer: Cash Price |
$1,555.80
|
| Rate for Payer: Cigna Commercial |
$4,961.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,018.25
|
| Rate for Payer: Health EOS Commercial |
$4,800.16
|
| Rate for Payer: HFN Commercial |
$4,961.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,045.08
|
| Rate for Payer: Multiplan Commercial |
$4,314.75
|
| Rate for Payer: NAPHCARE Commercial |
$3,236.06
|
| Rate for Payer: Preferred Network Access Commercial |
$4,961.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,642.79
|
| Rate for Payer: Quartz Commercial |
$3,505.74
|
| Rate for Payer: Quartz Medicare Advantage |
$3,236.06
|
| Rate for Payer: The Alliance Commercial |
$2,696.72
|
| Rate for Payer: WEA Trust Commercial |
$2,966.39
|
| Rate for Payer: WPS Commercial |
$3,994.78
|
|
|
Gast Occult Bld
|
Facility
|
IP
|
$81.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
633787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$41.28 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$50.54
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
Gast Occult Bld
|
Professional
|
Both
|
$81.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
633787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$80.03 |
| Rate for Payer: Aetna Commercial |
$80.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$5.53
|
| Rate for Payer: Anthem Medicare Advantage |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.53
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$80.03
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$42.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.53
|
| Rate for Payer: Health EOS Commercial |
$76.66
|
| Rate for Payer: HFN Commercial |
$80.03
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$19.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.53
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$8.30
|
| Rate for Payer: Preferred Network Access Commercial |
$80.03
|
| Rate for Payer: Quartz Beloit One Network |
$37.07
|
| Rate for Payer: Quartz Commercial |
$48.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5.53
|
| Rate for Payer: The Alliance Commercial |
$21.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.53
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: WPS Commercial |
$24.34
|
|
|
Gast Occult Bld
|
Facility
|
OP
|
$81.00
|
|
|
Service Code
|
CPT 82271
|
| Hospital Charge Code |
633787
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$5.53 |
| Max. Negotiated Rate |
$77.50 |
| Rate for Payer: Aetna Commercial |
$75.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$72.45
|
| Rate for Payer: Aetna Managed Medicare |
$5.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9.18
|
| Rate for Payer: Anthem Medicare Advantage |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$44.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5.53
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cash Price |
$24.30
|
| Rate for Payer: Cigna Commercial |
$77.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$47.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5.53
|
| Rate for Payer: Health EOS Commercial |
$74.97
|
| Rate for Payer: HFN Commercial |
$77.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5.53
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5.53
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5.53
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5.53
|
| Rate for Payer: Multiplan Commercial |
$67.39
|
| Rate for Payer: NAPHCARE Commercial |
$8.30
|
| Rate for Payer: Preferred Network Access Commercial |
$77.50
|
| Rate for Payer: Quartz Beloit One Network |
$41.28
|
| Rate for Payer: Quartz Commercial |
$54.76
|
| Rate for Payer: Quartz Medicare Advantage |
$5.53
|
| Rate for Payer: The Alliance Commercial |
$22.13
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5.53
|
| Rate for Payer: United Healthcare PPO |
$63.18
|
| Rate for Payer: WEA Trust Commercial |
$46.33
|
| Rate for Payer: Wellcare Medicare |
$5.53
|
| Rate for Payer: WPS Commercial |
$62.39
|
|
|
GASTRECTOMY/GASTRIC RESECTION
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2960083
|
|
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
|
|
|
GASTRECTOMY/GASTRIC RESECTION
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2960083
|
|
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
|
|
|
GASTRIC BAND ADJUSTMENT
|
Facility
|
OP
|
$3,784.00
|
|
| Hospital Charge Code |
2959781
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.90 |
| Max. Negotiated Rate |
$3,620.53 |
| Rate for Payer: Aetna Commercial |
$3,541.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.41
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.74
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,620.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.29
|
| Rate for Payer: Health EOS Commercial |
$3,502.47
|
| Rate for Payer: HFN Commercial |
$3,620.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.52
|
| Rate for Payer: Multiplan Commercial |
$3,148.29
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.22
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.33
|
| Rate for Payer: Quartz Commercial |
$2,557.98
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.22
|
| Rate for Payer: The Alliance Commercial |
$1,967.68
|
| Rate for Payer: WEA Trust Commercial |
$2,164.45
|
| Rate for Payer: WPS Commercial |
$2,914.82
|
|
|
GASTRIC BAND ADJUSTMENT
|
Facility
|
IP
|
$3,784.00
|
|
| Hospital Charge Code |
2959781
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.33 |
| Max. Negotiated Rate |
$3,620.53 |
| Rate for Payer: Aetna Commercial |
$3,541.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.74
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,620.53
|
| Rate for Payer: Health EOS Commercial |
$3,502.47
|
| Rate for Payer: HFN Commercial |
$3,620.53
|
| Rate for Payer: Multiplan Commercial |
$3,148.29
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.53
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.33
|
| Rate for Payer: Quartz Commercial |
$2,361.22
|
| Rate for Payer: WEA Trust Commercial |
$2,164.45
|
| Rate for Payer: WPS Commercial |
$2,914.82
|
|
|
GASTRIC FUNDOPLICATION
|
Facility
|
IP
|
$21,219.31
|
|
|
Service Code
|
APR-DRG 2323
|
| Min. Negotiated Rate |
$18,848.32 |
| Max. Negotiated Rate |
$21,219.31 |
| Rate for Payer: Anthem Medicaid |
$20,318.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,318.66
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,318.66
|
| Rate for Payer: Dean Health Medicaid |
$20,318.66
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,848.32
|
| Rate for Payer: Managed Health Services Medicaid |
$21,219.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,318.66
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,318.66
|
| Rate for Payer: United Healthcare Medicaid |
$20,318.66
|
|
|
GASTRIC FUNDOPLICATION
|
Facility
|
IP
|
$10,697.34
|
|
|
Service Code
|
APR-DRG 2321
|
| Min. Negotiated Rate |
$9,502.04 |
| Max. Negotiated Rate |
$10,697.34 |
| Rate for Payer: Anthem Medicaid |
$10,243.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,243.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,243.29
|
| Rate for Payer: Dean Health Medicaid |
$10,243.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,502.04
|
| Rate for Payer: Managed Health Services Medicaid |
$10,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,243.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,243.29
|
| Rate for Payer: United Healthcare Medicaid |
$10,243.29
|
|
|
GASTRIC FUNDOPLICATION
|
Facility
|
IP
|
$34,021.04
|
|
|
Service Code
|
APR-DRG 2324
|
| Min. Negotiated Rate |
$30,219.61 |
| Max. Negotiated Rate |
$34,021.04 |
| Rate for Payer: Anthem Medicaid |
$32,577.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,577.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,577.02
|
| Rate for Payer: Dean Health Medicaid |
$32,577.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,219.61
|
| Rate for Payer: Managed Health Services Medicaid |
$34,021.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,577.02
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,577.02
|
| Rate for Payer: United Healthcare Medicaid |
$32,577.02
|
|
|
GASTRIC FUNDOPLICATION
|
Facility
|
IP
|
$13,327.83
|
|
|
Service Code
|
APR-DRG 2322
|
| Min. Negotiated Rate |
$11,838.61 |
| Max. Negotiated Rate |
$13,327.83 |
| Rate for Payer: Anthem Medicaid |
$12,762.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,762.13
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,762.13
|
| Rate for Payer: Dean Health Medicaid |
$12,762.13
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,838.61
|
| Rate for Payer: Managed Health Services Medicaid |
$13,327.83
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,762.13
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,762.13
|
| Rate for Payer: United Healthcare Medicaid |
$12,762.13
|
|
|
Gastric Lavage - Gastric Tube Activity
|
Facility
|
IP
|
$1,135.00
|
|
| Hospital Charge Code |
3000257
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$578.40 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$708.24
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
Gastric Lavage - Gastric Tube Activity
|
Facility
|
OP
|
$1,135.00
|
|
| Hospital Charge Code |
3000257
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$330.51 |
| Max. Negotiated Rate |
$1,085.97 |
| Rate for Payer: Aetna Commercial |
$1,062.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,015.14
|
| Rate for Payer: Aetna Managed Medicare |
$330.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$767.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$590.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$566.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$625.61
|
| Rate for Payer: Cash Price |
$340.50
|
| Rate for Payer: Cigna Commercial |
$1,085.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$660.57
|
| Rate for Payer: Health EOS Commercial |
$1,050.56
|
| Rate for Payer: HFN Commercial |
$1,085.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$885.30
|
| Rate for Payer: Multiplan Commercial |
$944.32
|
| Rate for Payer: NAPHCARE Commercial |
$708.24
|
| Rate for Payer: Preferred Network Access Commercial |
$1,085.97
|
| Rate for Payer: Quartz Beloit One Network |
$578.40
|
| Rate for Payer: Quartz Commercial |
$767.26
|
| Rate for Payer: Quartz Medicare Advantage |
$708.24
|
| Rate for Payer: The Alliance Commercial |
$590.20
|
| Rate for Payer: WEA Trust Commercial |
$649.22
|
| Rate for Payer: WPS Commercial |
$874.29
|
|
|
Gastrin Level
|
Facility
|
OP
|
$312.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
633734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$298.52 |
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Aetna Managed Medicare |
$18.34
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$68.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$32.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30.44
|
| Rate for Payer: Anthem Medicare Advantage |
$18.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.34
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$298.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$181.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.34
|
| Rate for Payer: Health EOS Commercial |
$288.79
|
| Rate for Payer: HFN Commercial |
$298.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$68.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.34
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.34
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.34
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.34
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: NAPHCARE Commercial |
$27.50
|
| Rate for Payer: Preferred Network Access Commercial |
$298.52
|
| Rate for Payer: Quartz Beloit One Network |
$159.00
|
| Rate for Payer: Quartz Commercial |
$210.91
|
| Rate for Payer: Quartz Medicare Advantage |
$18.34
|
| Rate for Payer: The Alliance Commercial |
$73.34
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.34
|
| Rate for Payer: United Healthcare PPO |
$243.36
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: Wellcare Medicare |
$18.34
|
| Rate for Payer: WPS Commercial |
$240.33
|
|
|
Gastrin Level
|
Professional
|
Both
|
$312.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
633734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.34 |
| Max. Negotiated Rate |
$308.26 |
| Rate for Payer: Aetna Commercial |
$308.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Aetna Managed Medicare |
$18.34
|
| Rate for Payer: Anthem Medicare Advantage |
$18.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.34
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$308.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$162.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.34
|
| Rate for Payer: Health EOS Commercial |
$295.28
|
| Rate for Payer: HFN Commercial |
$308.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$64.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.34
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: NAPHCARE Commercial |
$27.50
|
| Rate for Payer: Preferred Network Access Commercial |
$308.26
|
| Rate for Payer: Quartz Beloit One Network |
$142.77
|
| Rate for Payer: Quartz Commercial |
$184.95
|
| Rate for Payer: Quartz Medicare Advantage |
$18.34
|
| Rate for Payer: The Alliance Commercial |
$72.42
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.34
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: WPS Commercial |
$80.67
|
|
|
Gastrin Level
|
Facility
|
IP
|
$312.00
|
|
|
Service Code
|
CPT 82941
|
| Hospital Charge Code |
633734
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$159.00 |
| Max. Negotiated Rate |
$298.52 |
| Rate for Payer: Aetna Commercial |
$292.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$279.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$171.97
|
| Rate for Payer: Cash Price |
$93.60
|
| Rate for Payer: Cigna Commercial |
$298.52
|
| Rate for Payer: Health EOS Commercial |
$288.79
|
| Rate for Payer: HFN Commercial |
$298.52
|
| Rate for Payer: Multiplan Commercial |
$259.58
|
| Rate for Payer: Preferred Network Access Commercial |
$298.52
|
| Rate for Payer: Quartz Beloit One Network |
$159.00
|
| Rate for Payer: Quartz Commercial |
$194.69
|
| Rate for Payer: WEA Trust Commercial |
$178.46
|
| Rate for Payer: WPS Commercial |
$240.33
|
|
|
GASTROCNEMIUS RECESSION (EG, STRAYER PROCEDURE)
|
Facility
|
OP
|
$13,773.68
|
|
|
Service Code
|
CPT 27687
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,443.42 |
| Max. Negotiated Rate |
$13,773.68 |
| Rate for Payer: Aetna Managed Medicare |
$3,443.42
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,443.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,443.42
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,443.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,807.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,443.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,809.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,443.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,443.42
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,443.42
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,443.42
|
| Rate for Payer: NAPHCARE Commercial |
$5,165.13
|
| Rate for Payer: Quartz Medicare Advantage |
$3,443.42
|
| Rate for Payer: The Alliance Commercial |
$13,773.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,443.42
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$3,443.42
|
|
|
GASTROINTESTINAL AND PERITONEAL INFECTION DIAGNOSES
|
Facility
|
OP
|
$96.96
|
|
|
Service Code
|
EAPG 00619
|
| Min. Negotiated Rate |
$93.23 |
| Max. Negotiated Rate |
$96.96 |
| Rate for Payer: Anthem Medicaid |
$93.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$93.23
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$93.23
|
| Rate for Payer: Dean Health Medicaid |
$93.23
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$93.23
|
| Rate for Payer: Managed Health Services Medicaid |
$96.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$93.23
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$93.23
|
| Rate for Payer: United Healthcare Medicaid |
$93.23
|
|
|
GASTROINTESTINAL HEMORRHAGE DIAGNOSES
|
Facility
|
OP
|
$98.27
|
|
|
Service Code
|
EAPG 00617
|
| Min. Negotiated Rate |
$94.49 |
| Max. Negotiated Rate |
$98.27 |
| Rate for Payer: Anthem Medicaid |
$94.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$94.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.49
|
| Rate for Payer: Dean Health Medicaid |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$94.49
|
| Rate for Payer: Managed Health Services Medicaid |
$98.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$94.49
|
| Rate for Payer: United Healthcare Medicaid |
$94.49
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH CC
|
Facility
|
IP
|
$27,535.04
|
|
|
Service Code
|
MSDRG 378
|
| Min. Negotiated Rate |
$8,017.17 |
| Max. Negotiated Rate |
$27,535.04 |
| Rate for Payer: Aetna Managed Medicare |
$8,017.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21,398.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,401.46
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,582.46
|
| Rate for Payer: Anthem Medicare Advantage |
$8,017.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,017.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,017.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,017.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,297.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,017.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,951.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,017.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,017.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,017.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,017.17
|
| Rate for Payer: NAPHCARE Commercial |
$12,025.76
|
| Rate for Payer: Quartz Medicare Advantage |
$8,017.17
|
| Rate for Payer: The Alliance Commercial |
$27,535.04
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,017.17
|
| Rate for Payer: United Healthcare PPO |
$15,532.47
|
| Rate for Payer: Wellcare Medicare |
$8,017.17
|
|
|
GASTROINTESTINAL HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$49,833.68
|
|
|
Service Code
|
MSDRG 377
|
| Min. Negotiated Rate |
$14,505.96 |
| Max. Negotiated Rate |
$49,833.68 |
| Rate for Payer: Aetna Managed Medicare |
$14,505.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,885.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,571.91
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29,045.31
|
| Rate for Payer: Anthem Medicare Advantage |
$14,505.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,505.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,505.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,505.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$32,242.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,505.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,307.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,505.96
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,505.96
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,505.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,505.96
|
| Rate for Payer: NAPHCARE Commercial |
$21,758.94
|
| Rate for Payer: Quartz Medicare Advantage |
$14,505.96
|
| Rate for Payer: The Alliance Commercial |
$49,833.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,505.96
|
| Rate for Payer: United Healthcare PPO |
$28,265.68
|
| Rate for Payer: Wellcare Medicare |
$14,505.96
|
|
|
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$17,841.20
|
|
|
Service Code
|
MSDRG 379
|
| Min. Negotiated Rate |
$5,523.92 |
| Max. Negotiated Rate |
$17,841.20 |
| Rate for Payer: Aetna Managed Medicare |
$5,523.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,754.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,542.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,016.50
|
| Rate for Payer: Anthem Medicare Advantage |
$5,523.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,523.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,523.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,523.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,119.23
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,523.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,841.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,523.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,523.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,523.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,523.92
|
| Rate for Payer: NAPHCARE Commercial |
$8,285.88
|
| Rate for Payer: Quartz Medicare Advantage |
$5,523.92
|
| Rate for Payer: The Alliance Commercial |
$17,841.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,523.92
|
| Rate for Payer: United Healthcare PPO |
$9,997.11
|
| Rate for Payer: Wellcare Medicare |
$5,523.92
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH CC
|
Facility
|
IP
|
$22,352.72
|
|
|
Service Code
|
MSDRG 389
|
| Min. Negotiated Rate |
$6,776.19 |
| Max. Negotiated Rate |
$22,352.72 |
| Rate for Payer: Aetna Managed Medicare |
$6,776.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,232.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,208.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,549.23
|
| Rate for Payer: Anthem Medicare Advantage |
$6,776.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,776.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,776.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,776.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,930.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,776.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,150.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,776.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,776.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,776.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,776.19
|
| Rate for Payer: NAPHCARE Commercial |
$10,164.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6,776.19
|
| Rate for Payer: The Alliance Commercial |
$22,352.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,776.19
|
| Rate for Payer: United Healthcare PPO |
$12,573.76
|
| Rate for Payer: Wellcare Medicare |
$6,776.19
|
|
