|
ABDOMINAL AORTIC ANEURSYMECTOMY
|
Facility
|
OP
|
$16,069.00
|
|
| Hospital Charge Code |
2960517
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,679.29 |
| Max. Negotiated Rate |
$15,374.82 |
| Rate for Payer: Aetna Commercial |
$15,040.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,372.11
|
| Rate for Payer: Aetna Managed Medicare |
$4,679.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,862.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,355.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,021.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,857.23
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$15,374.82
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,352.16
|
| Rate for Payer: Health EOS Commercial |
$14,873.47
|
| Rate for Payer: HFN Commercial |
$15,374.82
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,533.82
|
| Rate for Payer: Multiplan Commercial |
$13,369.41
|
| Rate for Payer: NAPHCARE Commercial |
$10,027.06
|
| Rate for Payer: Preferred Network Access Commercial |
$15,374.82
|
| Rate for Payer: Quartz Beloit One Network |
$8,188.76
|
| Rate for Payer: Quartz Commercial |
$10,862.64
|
| Rate for Payer: Quartz Medicare Advantage |
$10,027.06
|
| Rate for Payer: The Alliance Commercial |
$8,355.88
|
| Rate for Payer: WEA Trust Commercial |
$9,191.47
|
| Rate for Payer: WPS Commercial |
$12,377.95
|
|
|
ABDOMINAL AORTIC ANEURSYMECTOMY
|
Facility
|
IP
|
$16,069.00
|
|
| Hospital Charge Code |
2960517
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,188.76 |
| Max. Negotiated Rate |
$15,374.82 |
| Rate for Payer: Aetna Commercial |
$15,040.58
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,372.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,857.23
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$15,374.82
|
| Rate for Payer: Health EOS Commercial |
$14,873.47
|
| Rate for Payer: HFN Commercial |
$15,374.82
|
| Rate for Payer: Multiplan Commercial |
$13,369.41
|
| Rate for Payer: Preferred Network Access Commercial |
$15,374.82
|
| Rate for Payer: Quartz Beloit One Network |
$8,188.76
|
| Rate for Payer: Quartz Commercial |
$10,027.06
|
| Rate for Payer: WEA Trust Commercial |
$9,191.47
|
| Rate for Payer: WPS Commercial |
$12,377.95
|
|
|
ABDOMINAL AORTIC ANEURYSM STENTING & ENDOVASCULAR REPAIR
|
Facility
|
OP
|
$17,306.00
|
|
| Hospital Charge Code |
2960516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,039.51 |
| Max. Negotiated Rate |
$16,558.38 |
| Rate for Payer: Aetna Commercial |
$16,198.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,478.49
|
| Rate for Payer: Aetna Managed Medicare |
$5,039.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,698.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,999.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,639.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,539.07
|
| Rate for Payer: Cash Price |
$5,191.80
|
| Rate for Payer: Cigna Commercial |
$16,558.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,072.09
|
| Rate for Payer: Health EOS Commercial |
$16,018.43
|
| Rate for Payer: HFN Commercial |
$16,558.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,498.68
|
| Rate for Payer: Multiplan Commercial |
$14,398.59
|
| Rate for Payer: NAPHCARE Commercial |
$10,798.94
|
| Rate for Payer: Preferred Network Access Commercial |
$16,558.38
|
| Rate for Payer: Quartz Beloit One Network |
$8,819.14
|
| Rate for Payer: Quartz Commercial |
$11,698.86
|
| Rate for Payer: Quartz Medicare Advantage |
$10,798.94
|
| Rate for Payer: The Alliance Commercial |
$8,999.12
|
| Rate for Payer: WEA Trust Commercial |
$9,899.03
|
| Rate for Payer: WPS Commercial |
$13,330.81
|
|
|
ABDOMINAL AORTIC ANEURYSM STENTING & ENDOVASCULAR REPAIR
|
Facility
|
IP
|
$17,306.00
|
|
| Hospital Charge Code |
2960516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,819.14 |
| Max. Negotiated Rate |
$16,558.38 |
| Rate for Payer: Aetna Commercial |
$16,198.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,478.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,539.07
|
| Rate for Payer: Cash Price |
$5,191.80
|
| Rate for Payer: Cigna Commercial |
$16,558.38
|
| Rate for Payer: Health EOS Commercial |
$16,018.43
|
| Rate for Payer: HFN Commercial |
$16,558.38
|
| Rate for Payer: Multiplan Commercial |
$14,398.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,558.38
|
| Rate for Payer: Quartz Beloit One Network |
$8,819.14
|
| Rate for Payer: Quartz Commercial |
$10,798.94
|
| Rate for Payer: WEA Trust Commercial |
$9,899.03
|
| Rate for Payer: WPS Commercial |
$13,330.81
|
|
|
ABDOMINAL HERNIA REPAIR
|
Facility
|
OP
|
$1,555.33
|
|
|
Service Code
|
EAPG 03035
|
| Min. Negotiated Rate |
$1,495.50 |
| Max. Negotiated Rate |
$1,555.33 |
| Rate for Payer: Anthem Medicaid |
$1,495.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,495.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,495.50
|
| Rate for Payer: Dean Health Medicaid |
$1,495.50
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,495.50
|
| Rate for Payer: Managed Health Services Medicaid |
$1,555.33
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,495.50
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,495.50
|
| Rate for Payer: United Healthcare Medicaid |
$1,495.50
|
|
|
ABDOMINAL HYSTERECTOMY, TOTAL
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960519
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
ABDOMINAL HYSTERECTOMY, TOTAL
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960519
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$8,242.21
|
|
|
Service Code
|
APR-DRG 2513
|
| Min. Negotiated Rate |
$7,321.25 |
| Max. Negotiated Rate |
$8,242.21 |
| Rate for Payer: Anthem Medicaid |
$7,892.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,892.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,892.37
|
| Rate for Payer: Dean Health Medicaid |
$7,892.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,321.25
|
| Rate for Payer: Managed Health Services Medicaid |
$8,242.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,892.37
|
| Rate for Payer: United Healthcare Medicaid |
$7,892.37
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$12,977.10
|
|
|
Service Code
|
APR-DRG 2514
|
| Min. Negotiated Rate |
$11,527.07 |
| Max. Negotiated Rate |
$12,977.10 |
| Rate for Payer: Anthem Medicaid |
$12,426.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,426.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,426.29
|
| Rate for Payer: Dean Health Medicaid |
$12,426.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,527.07
|
| Rate for Payer: Managed Health Services Medicaid |
$12,977.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,426.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,426.29
|
| Rate for Payer: United Healthcare Medicaid |
$12,426.29
|
|
|
ABDOMINAL PAIN
|
Facility
|
OP
|
$100.89
|
|
|
Service Code
|
EAPG 00628
|
| Min. Negotiated Rate |
$97.01 |
| Max. Negotiated Rate |
$100.89 |
| Rate for Payer: Anthem Medicaid |
$97.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$97.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$97.01
|
| Rate for Payer: Dean Health Medicaid |
$97.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$97.01
|
| Rate for Payer: Managed Health Services Medicaid |
$100.89
|
| Rate for Payer: Molina Healthcare Medicaid |
$97.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$97.01
|
| Rate for Payer: United Healthcare Medicaid |
$97.01
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$6,313.18
|
|
|
Service Code
|
APR-DRG 2512
|
| Min. Negotiated Rate |
$5,607.76 |
| Max. Negotiated Rate |
$6,313.18 |
| Rate for Payer: Anthem Medicaid |
$6,045.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,045.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,045.22
|
| Rate for Payer: Dean Health Medicaid |
$6,045.22
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,607.76
|
| Rate for Payer: Managed Health Services Medicaid |
$6,313.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,045.22
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,045.22
|
| Rate for Payer: United Healthcare Medicaid |
$6,045.22
|
|
|
ABDOMINAL PAIN
|
Facility
|
IP
|
$4,997.94
|
|
|
Service Code
|
APR-DRG 2511
|
| Min. Negotiated Rate |
$4,439.48 |
| Max. Negotiated Rate |
$4,997.94 |
| Rate for Payer: Anthem Medicaid |
$4,785.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,785.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,785.80
|
| Rate for Payer: Dean Health Medicaid |
$4,785.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,439.48
|
| Rate for Payer: Managed Health Services Medicaid |
$4,997.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,785.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,785.80
|
| Rate for Payer: United Healthcare Medicaid |
$4,785.80
|
|
|
ABDOMINAL PARACENTESIS
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960549
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ABDOMINAL PARACENTESIS
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960549
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
ABDOMINAL PARACENTESIS AND RELATED PERITONEAL DRAINAGE PROCEDURES
|
Facility
|
OP
|
$431.09
|
|
|
Service Code
|
EAPG 00150
|
| Min. Negotiated Rate |
$414.51 |
| Max. Negotiated Rate |
$431.09 |
| Rate for Payer: Anthem Medicaid |
$414.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$414.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$414.51
|
| Rate for Payer: Dean Health Medicaid |
$414.51
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$414.51
|
| Rate for Payer: Managed Health Services Medicaid |
$431.09
|
| Rate for Payer: Molina Healthcare Medicaid |
$414.51
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$414.51
|
| Rate for Payer: United Healthcare Medicaid |
$414.51
|
|
|
Abdominal Paracentesis w/imaging
|
Facility
|
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
5605766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$929.51 |
| Max. Negotiated Rate |
$1,745.20 |
| Rate for Payer: Aetna Commercial |
$1,707.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.39
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,745.20
|
| Rate for Payer: Health EOS Commercial |
$1,688.29
|
| Rate for Payer: HFN Commercial |
$1,745.20
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.20
|
| Rate for Payer: Quartz Beloit One Network |
$929.51
|
| Rate for Payer: Quartz Commercial |
$1,138.18
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
Abdominal Paracentesis w/imaging
|
Facility
|
OP
|
$1,824.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
5605766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$313.04 |
| Max. Negotiated Rate |
$4,947.89 |
| Rate for Payer: Aetna Commercial |
$1,707.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,631.39
|
| Rate for Payer: Aetna Managed Medicare |
$954.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,233.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$948.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$910.54
|
| Rate for Payer: Anthem Medicare Advantage |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,005.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$954.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$954.50
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,745.20
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$954.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,947.89
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$954.50
|
| Rate for Payer: Health EOS Commercial |
$1,688.29
|
| Rate for Payer: HFN Commercial |
$1,745.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,550.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$954.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$954.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$954.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$954.50
|
| Rate for Payer: Multiplan Commercial |
$1,517.57
|
| Rate for Payer: NAPHCARE Commercial |
$1,431.75
|
| Rate for Payer: Preferred Network Access Commercial |
$1,745.20
|
| Rate for Payer: Quartz Beloit One Network |
$929.51
|
| Rate for Payer: Quartz Commercial |
$1,233.02
|
| Rate for Payer: Quartz Medicare Advantage |
$954.50
|
| Rate for Payer: The Alliance Commercial |
$3,818.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$954.50
|
| Rate for Payer: United Healthcare PPO |
$313.04
|
| Rate for Payer: WEA Trust Commercial |
$1,043.33
|
| Rate for Payer: Wellcare Medicare |
$954.50
|
| Rate for Payer: WPS Commercial |
$1,405.03
|
|
|
ABDOMINAL PERINEAL RESECTION
|
Facility
|
IP
|
$7,912.00
|
|
| Hospital Charge Code |
2959813
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,031.96 |
| Max. Negotiated Rate |
$7,570.20 |
| Rate for Payer: Aetna Commercial |
$7,405.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,361.09
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,570.20
|
| Rate for Payer: Health EOS Commercial |
$7,323.35
|
| Rate for Payer: HFN Commercial |
$7,570.20
|
| Rate for Payer: Multiplan Commercial |
$6,582.78
|
| Rate for Payer: Preferred Network Access Commercial |
$7,570.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.96
|
| Rate for Payer: Quartz Commercial |
$4,937.09
|
| Rate for Payer: WEA Trust Commercial |
$4,525.66
|
| Rate for Payer: WPS Commercial |
$6,094.61
|
|
|
ABDOMINAL PERINEAL RESECTION
|
Facility
|
OP
|
$7,912.00
|
|
| Hospital Charge Code |
2959813
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,303.97 |
| Max. Negotiated Rate |
$7,570.20 |
| Rate for Payer: Aetna Commercial |
$7,405.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,076.49
|
| Rate for Payer: Aetna Managed Medicare |
$2,303.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,348.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,114.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,949.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,361.09
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,570.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,604.78
|
| Rate for Payer: Health EOS Commercial |
$7,323.35
|
| Rate for Payer: HFN Commercial |
$7,570.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,171.36
|
| Rate for Payer: Multiplan Commercial |
$6,582.78
|
| Rate for Payer: NAPHCARE Commercial |
$4,937.09
|
| Rate for Payer: Preferred Network Access Commercial |
$7,570.20
|
| Rate for Payer: Quartz Beloit One Network |
$4,031.96
|
| Rate for Payer: Quartz Commercial |
$5,348.51
|
| Rate for Payer: Quartz Medicare Advantage |
$4,937.09
|
| Rate for Payer: The Alliance Commercial |
$4,114.24
|
| Rate for Payer: WEA Trust Commercial |
$4,525.66
|
| Rate for Payer: WPS Commercial |
$6,094.61
|
|
|
ABDOMINAL SACRAL COLPO SUSPENSION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960360
|
|
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
|
|
|
ABDOMINAL SACRAL COLPO SUSPENSION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960360
|
|
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
|
|
|
ABDOMINOPLASTY/PANNICULECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959775
|
|
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
|
|
|
ABDOMINOPLASTY/PANNICULECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959775
|
|
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
|
|
|
Abd Paracentesis w/o Imagins Guid 49082
|
Professional
|
Both
|
$1,322.00
|
|
|
Service Code
|
CPT 49082
|
| Hospital Charge Code |
3872053
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$68.13 |
| Max. Negotiated Rate |
$1,306.14 |
| Rate for Payer: Aetna Commercial |
$1,306.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,182.40
|
| Rate for Payer: Aetna Managed Medicare |
$68.13
|
| Rate for Payer: Anthem Medicare Advantage |
$68.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$68.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$68.13
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,306.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$130.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68.13
|
| Rate for Payer: Health EOS Commercial |
$1,251.14
|
| Rate for Payer: HFN Commercial |
$1,306.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$252.18
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$252.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$68.13
|
| Rate for Payer: Multiplan Commercial |
$1,099.90
|
| Rate for Payer: NAPHCARE Commercial |
$102.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,306.14
|
| Rate for Payer: Quartz Beloit One Network |
$604.95
|
| Rate for Payer: Quartz Commercial |
$783.68
|
| Rate for Payer: Quartz Medicare Advantage |
$68.13
|
| Rate for Payer: The Alliance Commercial |
$289.55
|
| Rate for Payer: United Healthcare Medicaid |
$130.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$68.13
|
| Rate for Payer: WEA Trust Commercial |
$756.18
|
| Rate for Payer: WPS Commercial |
$306.59
|
|
|
ABLATE INF TURBINATE, SUPERF 30801
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
CPT 30801
|
| Hospital Charge Code |
3014362
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$91.98 |
| Max. Negotiated Rate |
$620.01 |
| Rate for Payer: Aetna Commercial |
$198.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$179.77
|
| Rate for Payer: Aetna Managed Medicare |
$137.78
|
| Rate for Payer: Anthem Medicare Advantage |
$137.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$137.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$137.78
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$198.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$104.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.78
|
| Rate for Payer: Health EOS Commercial |
$190.23
|
| Rate for Payer: HFN Commercial |
$198.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$536.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$536.66
|
| Rate for Payer: Independent Care Health Plan Medicare |
$137.78
|
| Rate for Payer: Multiplan Commercial |
$167.23
|
| Rate for Payer: NAPHCARE Commercial |
$206.67
|
| Rate for Payer: Preferred Network Access Commercial |
$198.59
|
| Rate for Payer: Quartz Beloit One Network |
$91.98
|
| Rate for Payer: Quartz Commercial |
$119.15
|
| Rate for Payer: Quartz Medicare Advantage |
$137.78
|
| Rate for Payer: The Alliance Commercial |
$585.56
|
| Rate for Payer: United Healthcare Medicaid |
$104.54
|
| Rate for Payer: United Healthcare Medicare Advantage |
$137.78
|
| Rate for Payer: WEA Trust Commercial |
$114.97
|
| Rate for Payer: WPS Commercial |
$620.01
|
|
