|
GASTROINTESTINAL HEMORRHAGE WITH MCC
|
Facility
|
IP
|
$47,917.00
|
|
|
Service Code
|
MSDRG 377
|
| Min. Negotiated Rate |
$17,236.44 |
| Max. Negotiated Rate |
$47,917.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,236.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,554.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,784.99
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,347.62
|
| Rate for Payer: Anthem Medicare Advantage |
$17,236.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,236.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,236.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,236.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,358.36
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,236.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,910.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,236.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,236.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,236.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,236.44
|
| Rate for Payer: NAPHCARE Commercial |
$25,854.66
|
| Rate for Payer: Quartz Medicare Advantage |
$17,236.44
|
| Rate for Payer: The Alliance Commercial |
$47,917.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,236.44
|
| Rate for Payer: United Healthcare PPO |
$27,178.54
|
| Rate for Payer: Wellcare Medicare |
$17,236.44
|
|
|
GASTROINTESTINAL HEMORRHAGE WITHOUT CC/MCC
|
Facility
|
IP
|
$17,155.00
|
|
|
Service Code
|
MSDRG 379
|
| Min. Negotiated Rate |
$6,170.74 |
| Max. Negotiated Rate |
$17,155.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,170.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,217.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,131.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,625.14
|
| Rate for Payer: Anthem Medicare Advantage |
$6,170.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,170.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,170.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,170.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,684.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,170.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,347.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,170.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,170.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,170.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,170.74
|
| Rate for Payer: NAPHCARE Commercial |
$9,256.11
|
| Rate for Payer: Quartz Medicare Advantage |
$6,170.74
|
| Rate for Payer: The Alliance Commercial |
$17,155.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,170.74
|
| Rate for Payer: United Healthcare PPO |
$9,612.61
|
| Rate for Payer: Wellcare Medicare |
$6,170.74
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH CC
|
Facility
|
IP
|
$21,493.00
|
|
|
Service Code
|
MSDRG 389
|
| Min. Negotiated Rate |
$7,731.46 |
| Max. Negotiated Rate |
$21,493.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,731.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,784.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,864.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,222.40
|
| Rate for Payer: Anthem Medicare Advantage |
$7,731.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,731.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,731.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,731.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,567.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,731.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,529.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,731.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,731.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,731.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,731.46
|
| Rate for Payer: NAPHCARE Commercial |
$11,597.19
|
| Rate for Payer: Quartz Medicare Advantage |
$7,731.46
|
| Rate for Payer: The Alliance Commercial |
$21,493.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,731.46
|
| Rate for Payer: United Healthcare PPO |
$12,090.15
|
| Rate for Payer: Wellcare Medicare |
$7,731.46
|
|
|
GASTROINTESTINAL OBSTRUCTION WITH MCC
|
Facility
|
IP
|
$38,963.00
|
|
|
Service Code
|
MSDRG 388
|
| Min. Negotiated Rate |
$14,015.51 |
| Max. Negotiated Rate |
$38,963.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,015.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,421.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,317.45
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,153.10
|
| Rate for Payer: Anthem Medicare Advantage |
$14,015.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,015.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,015.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,015.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,591.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,015.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,343.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,015.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,015.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,015.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,015.51
|
| Rate for Payer: NAPHCARE Commercial |
$21,023.26
|
| Rate for Payer: Quartz Medicare Advantage |
$14,015.51
|
| Rate for Payer: The Alliance Commercial |
$38,963.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,015.51
|
| Rate for Payer: United Healthcare PPO |
$22,065.58
|
| Rate for Payer: Wellcare Medicare |
$14,015.51
|
|
|
GASTROINTESTINAL OBSTRUCTION WITHOUT CC/MCC
|
Facility
|
IP
|
$15,182.00
|
|
|
Service Code
|
MSDRG 390
|
| Min. Negotiated Rate |
$5,461.15 |
| Max. Negotiated Rate |
$15,182.00 |
| Rate for Payer: Aetna Managed Medicare |
$5,461.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,748.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,005.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,555.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,461.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,461.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,461.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,461.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,497.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,461.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,900.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,461.15
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,461.15
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,461.15
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,461.15
|
| Rate for Payer: NAPHCARE Commercial |
$8,191.72
|
| Rate for Payer: Quartz Medicare Advantage |
$5,461.15
|
| Rate for Payer: The Alliance Commercial |
$15,182.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,461.15
|
| Rate for Payer: United Healthcare PPO |
$8,486.18
|
| Rate for Payer: Wellcare Medicare |
$5,461.15
|
|
|
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 |
$656.48 |
| Max. Negotiated Rate |
$2,954.65 |
| Rate for Payer: Aetna Commercial |
$1,417.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,283.12
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cash Price |
$447.60
|
| Rate for Payer: Cigna Commercial |
$1,417.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$814.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$895.20
|
| Rate for Payer: Health EOS Commercial |
$1,357.72
|
| Rate for Payer: HFN Commercial |
$1,417.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,954.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,954.65
|
| Rate for Payer: Multiplan Commercial |
$1,193.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,417.40
|
| Rate for Payer: Quartz Beloit One Network |
$656.48
|
| Rate for Payer: Quartz Commercial |
$850.44
|
| Rate for Payer: The Alliance Commercial |
$746.00
|
| Rate for Payer: United Healthcare Medicaid |
$814.60
|
| Rate for Payer: WEA Trust Commercial |
$820.60
|
| Rate for Payer: WPS Commercial |
$1,105.12
|
|
|
GASTROPLASTY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
GASTROPLASTY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960085
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
GASTROSCOPY
|
Facility
|
IP
|
$3,784.00
|
|
| Hospital Charge Code |
2960086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,854.16 |
| Max. Negotiated Rate |
$3,481.28 |
| Rate for Payer: Aetna Commercial |
$3,405.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,254.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,005.52
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,481.28
|
| Rate for Payer: Health EOS Commercial |
$3,367.76
|
| Rate for Payer: HFN Commercial |
$3,481.28
|
| Rate for Payer: Multiplan Commercial |
$3,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,481.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,854.16
|
| Rate for Payer: Quartz Commercial |
$2,270.40
|
| Rate for Payer: WEA Trust Commercial |
$2,081.20
|
| Rate for Payer: WPS Commercial |
$2,802.81
|
|
|
GASTROSCOPY
|
Facility
|
OP
|
$3,784.00
|
|
| Hospital Charge Code |
2960086
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,059.52 |
| Max. Negotiated Rate |
$15,136.00 |
| Rate for Payer: Aetna Commercial |
$3,405.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,254.24
|
| Rate for Payer: Aetna Managed Medicare |
$1,059.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,459.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,892.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,816.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,005.52
|
| Rate for Payer: Cash Price |
$1,135.20
|
| Rate for Payer: Cigna Commercial |
$3,481.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,117.53
|
| Rate for Payer: Health EOS Commercial |
$3,367.76
|
| Rate for Payer: HFN Commercial |
$3,481.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,838.00
|
| Rate for Payer: Multiplan Commercial |
$3,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$2,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$3,481.28
|
| Rate for Payer: Quartz Beloit One Network |
$1,854.16
|
| Rate for Payer: Quartz Commercial |
$2,459.60
|
| Rate for Payer: Quartz Medicare Advantage |
$2,270.40
|
| Rate for Payer: The Alliance Commercial |
$15,136.00
|
| Rate for Payer: WEA Trust Commercial |
$2,081.20
|
| Rate for Payer: WPS Commercial |
$2,802.81
|
|
|
GASTROSTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960087
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
GASTROSTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960087
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
GASTROSTOMY/JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
GASTROSTOMY/JEJUNOSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960092
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Gastrostomy tube - Tube Type
|
Facility
|
IP
|
$947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
3025914
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$464.03 |
| Max. Negotiated Rate |
$871.24 |
| Rate for Payer: Aetna Commercial |
$852.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$814.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.91
|
| Rate for Payer: Cash Price |
$284.10
|
| Rate for Payer: Cigna Commercial |
$871.24
|
| Rate for Payer: Health EOS Commercial |
$842.83
|
| Rate for Payer: HFN Commercial |
$871.24
|
| Rate for Payer: Multiplan Commercial |
$757.60
|
| Rate for Payer: NAPHCARE Commercial |
$568.20
|
| Rate for Payer: Preferred Network Access Commercial |
$871.24
|
| Rate for Payer: Quartz Beloit One Network |
$464.03
|
| Rate for Payer: Quartz Commercial |
$568.20
|
| Rate for Payer: WEA Trust Commercial |
$520.85
|
| Rate for Payer: WPS Commercial |
$701.44
|
|
|
Gastrostomy tube - Tube Type
|
Facility
|
OP
|
$947.00
|
|
|
Service Code
|
CPT 43762
|
| Hospital Charge Code |
3025914
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$244.28 |
| Max. Negotiated Rate |
$4,218.22 |
| Rate for Payer: Aetna Commercial |
$852.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$814.42
|
| Rate for Payer: Aetna Managed Medicare |
$244.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$615.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$473.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$454.56
|
| Rate for Payer: Anthem Medicare Advantage |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$501.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$244.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$244.28
|
| 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 |
$871.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$244.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$244.28
|
| Rate for Payer: Health EOS Commercial |
$842.83
|
| Rate for Payer: HFN Commercial |
$871.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$908.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.28
|
| Rate for Payer: Independent Care Health Plan Medicare |
$244.28
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$244.28
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$244.28
|
| Rate for Payer: Multiplan Commercial |
$757.60
|
| Rate for Payer: NAPHCARE Commercial |
$366.42
|
| Rate for Payer: Preferred Network Access Commercial |
$871.24
|
| Rate for Payer: Quartz Beloit One Network |
$464.03
|
| Rate for Payer: Quartz Commercial |
$615.55
|
| Rate for Payer: Quartz Medicare Advantage |
$244.28
|
| Rate for Payer: The Alliance Commercial |
$977.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$244.28
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$520.85
|
| Rate for Payer: Wellcare Medicare |
$244.28
|
| Rate for Payer: WPS Commercial |
$701.44
|
|
|
Gastrostomy tube using urinary catheter - Tube Type
|
Facility
|
IP
|
$163.00
|
|
| Hospital Charge Code |
3025916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$79.87 |
| Max. Negotiated Rate |
$149.96 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$97.80
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
Gastrostomy tube using urinary catheter - Tube Type
|
Facility
|
OP
|
$163.00
|
|
| Hospital Charge Code |
3025916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.64 |
| Max. Negotiated Rate |
$652.00 |
| Rate for Payer: Aetna Commercial |
$146.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$140.18
|
| Rate for Payer: Aetna Managed Medicare |
$45.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$86.39
|
| Rate for Payer: Cash Price |
$48.90
|
| Rate for Payer: Cigna Commercial |
$149.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$91.21
|
| Rate for Payer: Health EOS Commercial |
$145.07
|
| Rate for Payer: HFN Commercial |
$149.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$122.25
|
| Rate for Payer: Multiplan Commercial |
$130.40
|
| Rate for Payer: NAPHCARE Commercial |
$97.80
|
| Rate for Payer: Preferred Network Access Commercial |
$149.96
|
| Rate for Payer: Quartz Beloit One Network |
$79.87
|
| Rate for Payer: Quartz Commercial |
$105.95
|
| Rate for Payer: Quartz Medicare Advantage |
$97.80
|
| Rate for Payer: The Alliance Commercial |
$652.00
|
| Rate for Payer: WEA Trust Commercial |
$89.65
|
| Rate for Payer: WPS Commercial |
$120.73
|
|
|
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 |
$160.47 |
| Max. Negotiated Rate |
$487.35 |
| Rate for Payer: Aetna Commercial |
$487.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$441.18
|
| 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 |
$487.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$256.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$307.80
|
| Rate for Payer: Health EOS Commercial |
$466.83
|
| Rate for Payer: HFN Commercial |
$487.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$160.47
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$160.47
|
| Rate for Payer: Multiplan Commercial |
$410.40
|
| Rate for Payer: Preferred Network Access Commercial |
$487.35
|
| Rate for Payer: Quartz Beloit One Network |
$225.72
|
| Rate for Payer: Quartz Commercial |
$292.41
|
| Rate for Payer: The Alliance Commercial |
$256.50
|
| Rate for Payer: WEA Trust Commercial |
$282.15
|
| Rate for Payer: WPS Commercial |
$379.98
|
|
|
Gaucher Disease DNA Mutation Analysis
|
Facility
|
IP
|
$493.00
|
|
|
Service Code
|
CPT 81251
|
| Hospital Charge Code |
1039117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$241.57 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$295.80
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$295.80
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Gaucher Disease DNA Mutation Analysis
|
Professional
|
Both
|
$493.00
|
|
|
Service Code
|
CPT 81251
|
| Hospital Charge Code |
1039117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$166.79 |
| Max. Negotiated Rate |
$468.35 |
| Rate for Payer: Aetna Commercial |
$468.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$468.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$246.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$295.80
|
| Rate for Payer: Health EOS Commercial |
$448.63
|
| Rate for Payer: HFN Commercial |
$468.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$166.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$166.79
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: Preferred Network Access Commercial |
$468.35
|
| Rate for Payer: Quartz Beloit One Network |
$216.92
|
| Rate for Payer: Quartz Commercial |
$281.01
|
| Rate for Payer: The Alliance Commercial |
$246.50
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Gaucher Disease DNA Mutation Analysis
|
Facility
|
OP
|
$493.00
|
|
|
Service Code
|
CPT 81251
|
| Hospital Charge Code |
1039117
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.25 |
| Max. Negotiated Rate |
$453.56 |
| Rate for Payer: Aetna Commercial |
$443.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$423.98
|
| Rate for Payer: Aetna Managed Medicare |
$47.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$177.19
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$82.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$78.44
|
| Rate for Payer: Anthem Medicaid |
$48.82
|
| Rate for Payer: Anthem Medicare Advantage |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47.25
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cash Price |
$147.90
|
| Rate for Payer: Cigna Commercial |
$453.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$47.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$48.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$275.88
|
| Rate for Payer: Dean Health Medicaid |
$48.82
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$47.25
|
| Rate for Payer: Health EOS Commercial |
$438.77
|
| Rate for Payer: HFN Commercial |
$453.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$175.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$48.82
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47.25
|
| Rate for Payer: Managed Health Services Medicaid |
$50.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$47.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$47.25
|
| Rate for Payer: Multiplan Commercial |
$394.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.88
|
| Rate for Payer: Preferred Network Access Commercial |
$453.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$48.82
|
| Rate for Payer: Quartz Beloit One Network |
$241.57
|
| Rate for Payer: Quartz Commercial |
$320.45
|
| Rate for Payer: Quartz Medicare Advantage |
$47.25
|
| Rate for Payer: The Alliance Commercial |
$189.00
|
| Rate for Payer: United Healthcare Medicaid |
$48.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47.25
|
| Rate for Payer: United Healthcare PPO |
$369.75
|
| Rate for Payer: WEA Trust Commercial |
$271.15
|
| Rate for Payer: Wellcare Medicare |
$47.25
|
| Rate for Payer: WMAP Medicaid |
$48.82
|
| Rate for Payer: WPS Commercial |
$365.17
|
|
|
Gauze dressing charge
|
Facility
|
OP
|
$74.00
|
|
| Hospital Charge Code |
2844925
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$20.72 |
| Max. Negotiated Rate |
$296.00 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Aetna Managed Medicare |
$20.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41.41
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$55.50
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$48.10
|
| Rate for Payer: Quartz Medicare Advantage |
$44.40
|
| Rate for Payer: The Alliance Commercial |
$296.00
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
Gauze dressing charge
|
Facility
|
IP
|
$74.00
|
|
| Hospital Charge Code |
2844925
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$36.26 |
| Max. Negotiated Rate |
$68.08 |
| Rate for Payer: Aetna Commercial |
$66.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$63.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$39.22
|
| Rate for Payer: Cash Price |
$22.20
|
| Rate for Payer: Cigna Commercial |
$68.08
|
| Rate for Payer: Health EOS Commercial |
$65.86
|
| Rate for Payer: HFN Commercial |
$68.08
|
| Rate for Payer: Multiplan Commercial |
$59.20
|
| Rate for Payer: NAPHCARE Commercial |
$44.40
|
| Rate for Payer: Preferred Network Access Commercial |
$68.08
|
| Rate for Payer: Quartz Beloit One Network |
$36.26
|
| Rate for Payer: Quartz Commercial |
$44.40
|
| Rate for Payer: WEA Trust Commercial |
$40.70
|
| Rate for Payer: WPS Commercial |
$54.81
|
|
|
GAUZE OWENS 3 X 8
|
Facility
|
IP
|
$104.00
|
|
| Hospital Charge Code |
2963333
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$50.96 |
| Max. Negotiated Rate |
$95.68 |
| Rate for Payer: Aetna Commercial |
$93.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$89.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$55.12
|
| Rate for Payer: Cash Price |
$31.20
|
| Rate for Payer: Cigna Commercial |
$95.68
|
| Rate for Payer: Health EOS Commercial |
$92.56
|
| Rate for Payer: HFN Commercial |
$95.68
|
| Rate for Payer: Multiplan Commercial |
$83.20
|
| Rate for Payer: NAPHCARE Commercial |
$62.40
|
| Rate for Payer: Preferred Network Access Commercial |
$95.68
|
| Rate for Payer: Quartz Beloit One Network |
$50.96
|
| Rate for Payer: Quartz Commercial |
$62.40
|
| Rate for Payer: WEA Trust Commercial |
$57.20
|
| Rate for Payer: WPS Commercial |
$77.03
|
|
