|
GASTROINTESTINAL OBSTRUCTION WITH MCC
|
Facility
|
IP
|
$40,521.52
|
|
|
Service Code
|
MSDRG 388
|
| Min. Negotiated Rate |
$11,816.41 |
| Max. Negotiated Rate |
$40,521.52 |
| Rate for Payer: Aetna Managed Medicare |
$11,816.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,222.59
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,698.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,465.05
|
| Rate for Payer: Anthem Medicare Advantage |
$11,816.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,816.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,816.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,816.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,048.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,816.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,476.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,816.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,816.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,816.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,816.41
|
| Rate for Payer: NAPHCARE Commercial |
$17,724.61
|
| Rate for Payer: Quartz Medicare Advantage |
$11,816.41
|
| Rate for Payer: The Alliance Commercial |
$40,521.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,816.41
|
| Rate for Payer: United Healthcare PPO |
$22,948.20
|
| Rate for Payer: Wellcare Medicare |
$11,816.41
|
|
|
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$15,789.28
|
|
|
Service Code
|
MSDRG 390
|
| Min. Negotiated Rate |
$4,672.84 |
| Max. Negotiated Rate |
$15,789.28 |
| Rate for Payer: Aetna Managed Medicare |
$4,672.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,869.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,097.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,643.68
|
| Rate for Payer: Anthem Medicare Advantage |
$4,672.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,672.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,672.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,672.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,595.28
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,672.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,336.52
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,672.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,672.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,672.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,672.84
|
| Rate for Payer: NAPHCARE Commercial |
$7,009.27
|
| Rate for Payer: Quartz Medicare Advantage |
$4,672.84
|
| Rate for Payer: The Alliance Commercial |
$15,789.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,672.84
|
| Rate for Payer: United Healthcare PPO |
$8,825.63
|
| Rate for Payer: Wellcare Medicare |
$4,672.84
|
|
|
Gastrointestinal Tract Imaging, Intraluminal 91110
|
Professional
|
Both
|
$1,492.00
|
|
|
Service Code
|
CPT 91110
|
| Hospital Charge Code |
1190816
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$682.74 |
| Max. Negotiated Rate |
$3,201.95 |
| Rate for Payer: Aetna Commercial |
$1,474.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,334.44
|
| Rate for Payer: Aetna Managed Medicare |
$800.49
|
| Rate for Payer: Anthem Medicare Advantage |
$800.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$800.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$800.49
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$1,474.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$847.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$800.49
|
| Rate for Payer: Health EOS Commercial |
$1,412.03
|
| Rate for Payer: HFN Commercial |
$1,474.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,072.84
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,072.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$800.49
|
| Rate for Payer: Multiplan Commercial |
$1,241.34
|
| Rate for Payer: NAPHCARE Commercial |
$1,200.73
|
| Rate for Payer: Preferred Network Access Commercial |
$1,474.10
|
| Rate for Payer: Quartz Beloit One Network |
$682.74
|
| Rate for Payer: Quartz Commercial |
$884.46
|
| Rate for Payer: Quartz Medicare Advantage |
$800.49
|
| Rate for Payer: The Alliance Commercial |
$2,001.22
|
| Rate for Payer: United Healthcare Medicaid |
$847.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$800.49
|
| Rate for Payer: WEA Trust Commercial |
$853.42
|
| Rate for Payer: WPS Commercial |
$3,201.95
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
OP
|
$104.82
|
|
|
Service Code
|
EAPG 00642
|
| Min. Negotiated Rate |
$100.79 |
| Max. Negotiated Rate |
$104.82 |
| Rate for Payer: Anthem Medicaid |
$100.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$100.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.79
|
| Rate for Payer: Dean Health Medicaid |
$100.79
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$100.79
|
| Rate for Payer: Managed Health Services Medicaid |
$104.82
|
| Rate for Payer: Molina Healthcare Medicaid |
$100.79
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$100.79
|
| Rate for Payer: United Healthcare Medicaid |
$100.79
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$16,922.84
|
|
|
Service Code
|
APR-DRG 2464
|
| Min. Negotiated Rate |
$15,031.92 |
| Max. Negotiated Rate |
$16,922.84 |
| Rate for Payer: Anthem Medicaid |
$16,204.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,204.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,204.55
|
| Rate for Payer: Dean Health Medicaid |
$16,204.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,031.92
|
| Rate for Payer: Managed Health Services Medicaid |
$16,922.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,204.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,204.55
|
| Rate for Payer: United Healthcare Medicaid |
$16,204.55
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$6,926.96
|
|
|
Service Code
|
APR-DRG 2462
|
| Min. Negotiated Rate |
$6,152.96 |
| Max. Negotiated Rate |
$6,926.96 |
| Rate for Payer: Anthem Medicaid |
$6,632.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,632.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,632.95
|
| Rate for Payer: Dean Health Medicaid |
$6,632.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$6,152.96
|
| Rate for Payer: Managed Health Services Medicaid |
$6,926.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,632.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,632.95
|
| Rate for Payer: United Healthcare Medicaid |
$6,632.95
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$10,521.97
|
|
|
Service Code
|
APR-DRG 2463
|
| Min. Negotiated Rate |
$9,346.27 |
| Max. Negotiated Rate |
$10,521.97 |
| Rate for Payer: Anthem Medicaid |
$10,075.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,075.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,075.37
|
| Rate for Payer: Dean Health Medicaid |
$10,075.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,346.27
|
| Rate for Payer: Managed Health Services Medicaid |
$10,521.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,075.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,075.37
|
| Rate for Payer: United Healthcare Medicaid |
$10,075.37
|
|
|
GASTROINTESTINAL VASCULAR INSUFFICIENCY
|
Facility
|
IP
|
$5,436.35
|
|
|
Service Code
|
APR-DRG 2461
|
| Min. Negotiated Rate |
$4,828.91 |
| Max. Negotiated Rate |
$5,436.35 |
| Rate for Payer: Anthem Medicaid |
$5,205.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,205.61
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,205.61
|
| Rate for Payer: Dean Health Medicaid |
$5,205.61
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,828.91
|
| Rate for Payer: Managed Health Services Medicaid |
$5,436.35
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,205.61
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,205.61
|
| Rate for Payer: United Healthcare Medicaid |
$5,205.61
|
|
|
GASTROPLASTY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
GASTROPLASTY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
GASTROSCOPY
|
Facility
|
OP
|
$3,784.00
|
|
| Hospital Charge Code |
2960086
|
|
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
|
|
|
GASTROSCOPY
|
Facility
|
IP
|
$3,784.00
|
|
| Hospital Charge Code |
2960086
|
|
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
|
|
|
GASTROSTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960087
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
GASTROSTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960087
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
GASTROSTOMY/JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
GASTROSTOMY/JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Gastrostomy tube - Tube Type
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
3025914
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$482.59 |
| Max. Negotiated Rate |
$906.09 |
| Rate for Payer: Aetna Commercial |
$886.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.99
|
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Cigna Commercial |
$906.09
|
| Rate for Payer: Health EOS Commercial |
$876.54
|
| Rate for Payer: HFN Commercial |
$906.09
|
| Rate for Payer: Multiplan Commercial |
$787.90
|
| Rate for Payer: Preferred Network Access Commercial |
$906.09
|
| Rate for Payer: Quartz Beloit One Network |
$482.59
|
| Rate for Payer: Quartz Commercial |
$590.93
|
| Rate for Payer: WEA Trust Commercial |
$541.68
|
| Rate for Payer: WPS Commercial |
$729.47
|
|
|
Gastrostomy tube - Tube Type
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
3025914
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$262.93 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Aetna Commercial |
$886.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$847.00
|
| Rate for Payer: Aetna Managed Medicare |
$262.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$640.17
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$492.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$472.74
|
| Rate for Payer: Anthem Medicare Advantage |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$521.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$262.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$262.93
|
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Cigna Commercial |
$906.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$262.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$262.93
|
| Rate for Payer: Health EOS Commercial |
$876.54
|
| Rate for Payer: HFN Commercial |
$906.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$978.11
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$262.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$262.93
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$262.93
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$262.93
|
| Rate for Payer: Multiplan Commercial |
$787.90
|
| Rate for Payer: NAPHCARE Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$906.09
|
| Rate for Payer: Quartz Beloit One Network |
$482.59
|
| Rate for Payer: Quartz Commercial |
$640.17
|
| Rate for Payer: Quartz Medicare Advantage |
$262.93
|
| Rate for Payer: The Alliance Commercial |
$1,051.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$262.93
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$541.68
|
| Rate for Payer: Wellcare Medicare |
$262.93
|
| Rate for Payer: WPS Commercial |
$729.47
|
|
|
Gastrostomy tube using urinary catheter - Tube Type
|
Facility
|
OP
|
$163.00
|
|
| Hospital Charge Code |
3025916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.47 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Aetna Managed Medicare |
$47.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$110.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$84.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.87
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$127.14
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: NAPHCARE Commercial |
$101.71
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$110.19
|
| Rate for Payer: Quartz Medicare Advantage |
$101.71
|
| Rate for Payer: The Alliance Commercial |
$84.76
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
Gastrostomy tube using urinary catheter - Tube Type
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
3025916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$83.06 |
| Max. Negotiated Rate |
$155.96 |
| Rate for Payer: Aetna Commercial |
$152.57
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$145.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.85
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$155.96
|
| Rate for Payer: Health EOS Commercial |
$150.87
|
| Rate for Payer: HFN Commercial |
$155.96
|
| Rate for Payer: Multiplan Commercial |
$135.62
|
| Rate for Payer: Preferred Network Access Commercial |
$155.96
|
| Rate for Payer: Quartz Beloit One Network |
$83.06
|
| Rate for Payer: Quartz Commercial |
$101.71
|
| Rate for Payer: WEA Trust Commercial |
$93.24
|
| Rate for Payer: WPS Commercial |
$125.56
|
|
|
GATED HEART, PLANAR, SINGLE 7847226
|
Professional
|
Both
|
$513.00
|
|
|
Service Code
|
CPT 78472 26
|
| Hospital Charge Code |
3015317
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$45.09 |
| Max. Negotiated Rate |
$506.84 |
| Rate for Payer: Aetna Commercial |
$506.84
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$458.83
|
| Rate for Payer: Aetna Managed Medicare |
$45.09
|
| Rate for Payer: Anthem Medicare Advantage |
$45.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45.09
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cash Price |
$153.90
|
| Rate for Payer: Cigna Commercial |
$506.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$266.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45.09
|
| Rate for Payer: Health EOS Commercial |
$485.50
|
| Rate for Payer: HFN Commercial |
$506.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45.09
|
| Rate for Payer: Multiplan Commercial |
$426.82
|
| Rate for Payer: NAPHCARE Commercial |
$67.64
|
| Rate for Payer: Preferred Network Access Commercial |
$506.84
|
| Rate for Payer: Quartz Beloit One Network |
$234.75
|
| Rate for Payer: Quartz Commercial |
$304.11
|
| Rate for Payer: Quartz Medicare Advantage |
$45.09
|
| Rate for Payer: The Alliance Commercial |
$171.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45.09
|
| Rate for Payer: WEA Trust Commercial |
$293.44
|
| Rate for Payer: WPS Commercial |
$225.47
|
|
|
Gaucher Disease DNA Mutation Analysis
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 81251
|
| Hospital Charge Code |
1039117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$251.23 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$307.63
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
Gaucher Disease DNA Mutation Analysis
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 81251
|
| Hospital Charge Code |
1039117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$471.70 |
| Rate for Payer: Aetna Commercial |
$461.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$49.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$184.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$86.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$81.57
|
| Rate for Payer: Anthem Medicare Advantage |
$49.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$271.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.14
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$471.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$49.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$286.93
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$49.14
|
| Rate for Payer: Health EOS Commercial |
$456.32
|
| Rate for Payer: HFN Commercial |
$471.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$182.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$49.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$49.14
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$73.71
|
| Rate for Payer: Preferred Network Access Commercial |
$471.70
|
| Rate for Payer: Quartz Beloit One Network |
$251.23
|
| Rate for Payer: Quartz Commercial |
$333.27
|
| Rate for Payer: Quartz Medicare Advantage |
$49.14
|
| Rate for Payer: The Alliance Commercial |
$196.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.14
|
| Rate for Payer: United Healthcare PPO |
$384.54
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: Wellcare Medicare |
$49.14
|
| Rate for Payer: WPS Commercial |
$379.76
|
|
|
Gaucher Disease DNA Mutation Analysis
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
CPT 81251
|
| Hospital Charge Code |
1039117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$49.14 |
| Max. Negotiated Rate |
$487.08 |
| Rate for Payer: Aetna Commercial |
$487.08
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$440.94
|
| Rate for Payer: Aetna Managed Medicare |
$49.14
|
| Rate for Payer: Anthem Medicare Advantage |
$49.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49.14
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$487.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.14
|
| Rate for Payer: Health EOS Commercial |
$466.58
|
| Rate for Payer: HFN Commercial |
$487.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$173.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$173.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49.14
|
| Rate for Payer: Multiplan Commercial |
$410.18
|
| Rate for Payer: NAPHCARE Commercial |
$73.71
|
| Rate for Payer: Preferred Network Access Commercial |
$487.08
|
| Rate for Payer: Quartz Beloit One Network |
$225.60
|
| Rate for Payer: Quartz Commercial |
$292.25
|
| Rate for Payer: Quartz Medicare Advantage |
$49.14
|
| Rate for Payer: The Alliance Commercial |
$194.10
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49.14
|
| Rate for Payer: WEA Trust Commercial |
$282.00
|
| Rate for Payer: WPS Commercial |
$216.22
|
|
|
Gauze dressing charge
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2844925
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$21.55 |
| Max. Negotiated Rate |
$70.80 |
| Rate for Payer: Aetna Commercial |
$69.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$66.19
|
| Rate for Payer: Aetna Managed Medicare |
$21.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$38.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$36.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$40.79
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$70.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43.07
|
| Rate for Payer: Health EOS Commercial |
$68.49
|
| Rate for Payer: HFN Commercial |
$70.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57.72
|
| Rate for Payer: Multiplan Commercial |
$61.57
|
| Rate for Payer: NAPHCARE Commercial |
$46.18
|
| Rate for Payer: Preferred Network Access Commercial |
$70.80
|
| Rate for Payer: Quartz Beloit One Network |
$37.71
|
| Rate for Payer: Quartz Commercial |
$50.02
|
| Rate for Payer: Quartz Medicare Advantage |
$46.18
|
| Rate for Payer: The Alliance Commercial |
$38.48
|
| Rate for Payer: WEA Trust Commercial |
$42.33
|
| Rate for Payer: WPS Commercial |
$57.00
|
|
