|
ABDOMINAL AORTIC ANEURSYMECTOMY
|
Facility
|
IP
|
$16,069.00
|
|
| Hospital Charge Code |
2960517
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,873.81 |
| Max. Negotiated Rate |
$14,783.48 |
| Rate for Payer: Aetna Commercial |
$14,462.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,819.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,516.57
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$14,783.48
|
| Rate for Payer: Health EOS Commercial |
$14,301.41
|
| Rate for Payer: HFN Commercial |
$14,783.48
|
| Rate for Payer: Multiplan Commercial |
$12,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,873.81
|
| Rate for Payer: Quartz Commercial |
$9,641.40
|
| Rate for Payer: WEA Trust Commercial |
$8,837.95
|
| Rate for Payer: WPS Commercial |
$11,902.31
|
|
|
ABDOMINAL AORTIC ANEURSYMECTOMY
|
Facility
|
OP
|
$16,069.00
|
|
| Hospital Charge Code |
2960517
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,499.32 |
| Max. Negotiated Rate |
$64,276.00 |
| Rate for Payer: Aetna Commercial |
$14,462.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,819.34
|
| Rate for Payer: Aetna Managed Medicare |
$4,499.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,444.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,034.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,713.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,516.57
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$14,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,992.21
|
| Rate for Payer: Health EOS Commercial |
$14,301.41
|
| Rate for Payer: HFN Commercial |
$14,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,051.75
|
| Rate for Payer: Multiplan Commercial |
$12,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,873.81
|
| Rate for Payer: Quartz Commercial |
$10,444.85
|
| Rate for Payer: Quartz Medicare Advantage |
$9,641.40
|
| Rate for Payer: The Alliance Commercial |
$64,276.00
|
| Rate for Payer: WEA Trust Commercial |
$8,837.95
|
| Rate for Payer: WPS Commercial |
$11,902.31
|
|
|
ABDOMINAL AORTIC ANEURYSM STENTING & ENDOVASCULAR REPAIR
|
Facility
|
OP
|
$17,306.00
|
|
| Hospital Charge Code |
2960516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,845.68 |
| Max. Negotiated Rate |
$69,224.00 |
| Rate for Payer: Aetna Commercial |
$15,575.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,883.16
|
| Rate for Payer: Aetna Managed Medicare |
$4,845.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,248.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,653.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,306.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,172.18
|
| Rate for Payer: Cash Price |
$5,191.80
|
| Rate for Payer: Cigna Commercial |
$15,921.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,684.44
|
| Rate for Payer: Health EOS Commercial |
$15,402.34
|
| Rate for Payer: HFN Commercial |
$15,921.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,979.50
|
| Rate for Payer: Multiplan Commercial |
$13,844.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,383.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,921.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,479.94
|
| Rate for Payer: Quartz Commercial |
$11,248.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,383.60
|
| Rate for Payer: The Alliance Commercial |
$69,224.00
|
| Rate for Payer: WEA Trust Commercial |
$9,518.30
|
| Rate for Payer: WPS Commercial |
$12,818.55
|
|
|
ABDOMINAL AORTIC ANEURYSM STENTING & ENDOVASCULAR REPAIR
|
Facility
|
IP
|
$17,306.00
|
|
| Hospital Charge Code |
2960516
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,479.94 |
| Max. Negotiated Rate |
$15,921.52 |
| Rate for Payer: Aetna Commercial |
$15,575.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,883.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,172.18
|
| Rate for Payer: Cash Price |
$5,191.80
|
| Rate for Payer: Cigna Commercial |
$15,921.52
|
| Rate for Payer: Health EOS Commercial |
$15,402.34
|
| Rate for Payer: HFN Commercial |
$15,921.52
|
| Rate for Payer: Multiplan Commercial |
$13,844.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,383.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,921.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,479.94
|
| Rate for Payer: Quartz Commercial |
$10,383.60
|
| Rate for Payer: WEA Trust Commercial |
$9,518.30
|
| Rate for Payer: WPS Commercial |
$12,818.55
|
|
|
ABDOMINAL HYSTERECTOMY, TOTAL
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960519
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
ABDOMINAL HYSTERECTOMY, TOTAL
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960519
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
ABDOMINAL PARACENTESIS
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960549
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
ABDOMINAL PARACENTESIS
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960549
|
|
Hospital Revenue Code
|
750
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
Abdominal Paracentesis w/imaging
|
Facility
|
IP
|
$1,824.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
5605766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$893.76 |
| Max. Negotiated Rate |
$1,678.08 |
| Rate for Payer: Aetna Commercial |
$1,641.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.72
|
| Rate for Payer: Cash Price |
$547.20
|
| Rate for Payer: Cigna Commercial |
$1,678.08
|
| Rate for Payer: Health EOS Commercial |
$1,623.36
|
| Rate for Payer: HFN Commercial |
$1,678.08
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,094.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.08
|
| Rate for Payer: Quartz Beloit One Network |
$893.76
|
| Rate for Payer: Quartz Commercial |
$1,094.40
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
Abdominal Paracentesis w/imaging
|
Facility
|
OP
|
$1,824.00
|
|
|
Service Code
|
CPT 49083
|
| Hospital Charge Code |
5605766
|
|
Hospital Revenue Code
|
450
|
| Min. Negotiated Rate |
$301.00 |
| Max. Negotiated Rate |
$4,757.59 |
| Rate for Payer: Aetna Commercial |
$1,641.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,568.64
|
| Rate for Payer: Aetna Managed Medicare |
$895.97
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,185.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$912.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$875.52
|
| Rate for Payer: Anthem Medicare Advantage |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$966.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$895.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$895.97
|
| 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 |
$1,678.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$895.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$895.97
|
| Rate for Payer: Health EOS Commercial |
$1,623.36
|
| Rate for Payer: HFN Commercial |
$1,678.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,333.01
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$895.97
|
| Rate for Payer: Independent Care Health Plan Medicare |
$895.97
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$895.97
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$895.97
|
| Rate for Payer: Multiplan Commercial |
$1,459.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,343.96
|
| Rate for Payer: Preferred Network Access Commercial |
$1,678.08
|
| Rate for Payer: Quartz Beloit One Network |
$893.76
|
| Rate for Payer: Quartz Commercial |
$1,185.60
|
| Rate for Payer: Quartz Medicare Advantage |
$895.97
|
| Rate for Payer: The Alliance Commercial |
$3,583.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$895.97
|
| Rate for Payer: United Healthcare PPO |
$301.00
|
| Rate for Payer: WEA Trust Commercial |
$1,003.20
|
| Rate for Payer: Wellcare Medicare |
$895.97
|
| Rate for Payer: WPS Commercial |
$1,351.04
|
|
|
ABDOMINAL PERINEAL RESECTION
|
Facility
|
IP
|
$7,912.00
|
|
| Hospital Charge Code |
2959813
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,876.88 |
| Max. Negotiated Rate |
$7,279.04 |
| Rate for Payer: Aetna Commercial |
$7,120.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,804.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,193.36
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,279.04
|
| Rate for Payer: Health EOS Commercial |
$7,041.68
|
| Rate for Payer: HFN Commercial |
$7,279.04
|
| Rate for Payer: Multiplan Commercial |
$6,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,279.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.88
|
| Rate for Payer: Quartz Commercial |
$4,747.20
|
| Rate for Payer: WEA Trust Commercial |
$4,351.60
|
| Rate for Payer: WPS Commercial |
$5,860.42
|
|
|
ABDOMINAL PERINEAL RESECTION
|
Facility
|
OP
|
$7,912.00
|
|
| Hospital Charge Code |
2959813
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,215.36 |
| Max. Negotiated Rate |
$31,648.00 |
| Rate for Payer: Aetna Commercial |
$7,120.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,804.32
|
| Rate for Payer: Aetna Managed Medicare |
$2,215.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,142.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,956.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,797.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,193.36
|
| Rate for Payer: Cash Price |
$2,373.60
|
| Rate for Payer: Cigna Commercial |
$7,279.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,427.56
|
| Rate for Payer: Health EOS Commercial |
$7,041.68
|
| Rate for Payer: HFN Commercial |
$7,279.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,934.00
|
| Rate for Payer: Multiplan Commercial |
$6,329.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,747.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,279.04
|
| Rate for Payer: Quartz Beloit One Network |
$3,876.88
|
| Rate for Payer: Quartz Commercial |
$5,142.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,747.20
|
| Rate for Payer: The Alliance Commercial |
$31,648.00
|
| Rate for Payer: WEA Trust Commercial |
$4,351.60
|
| Rate for Payer: WPS Commercial |
$5,860.42
|
|
|
ABDOMINAL SACRAL COLPO SUSPENSION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960360
|
|
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
|
|
|
ABDOMINAL SACRAL COLPO SUSPENSION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960360
|
|
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
|
|
|
ABDOMINOPLASTY/PANNICULECTOMY
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959775
|
|
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
|
|
|
ABDOMINOPLASTY/PANNICULECTOMY
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2959775
|
|
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
|
|
|
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 |
$125.19 |
| Max. Negotiated Rate |
$1,255.90 |
| Rate for Payer: Aetna Commercial |
$1,255.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,136.92
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cash Price |
$396.60
|
| Rate for Payer: Cigna Commercial |
$1,255.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$125.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$793.20
|
| Rate for Payer: Health EOS Commercial |
$1,203.02
|
| Rate for Payer: HFN Commercial |
$1,255.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$242.48
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$242.48
|
| Rate for Payer: Multiplan Commercial |
$1,057.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,255.90
|
| Rate for Payer: Quartz Beloit One Network |
$581.68
|
| Rate for Payer: Quartz Commercial |
$753.54
|
| Rate for Payer: The Alliance Commercial |
$661.00
|
| Rate for Payer: United Healthcare Medicaid |
$125.19
|
| Rate for Payer: WEA Trust Commercial |
$727.10
|
| Rate for Payer: WPS Commercial |
$979.21
|
|
|
ABLATE INF TURBINATE, SUPERF 30801
|
Professional
|
Both
|
$201.00
|
|
|
Service Code
|
CPT 30801
|
| Hospital Charge Code |
3014362
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$88.44 |
| Max. Negotiated Rate |
$516.02 |
| Rate for Payer: Aetna Commercial |
$190.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$172.86
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cash Price |
$60.30
|
| Rate for Payer: Cigna Commercial |
$190.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$100.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$120.60
|
| Rate for Payer: Health EOS Commercial |
$182.91
|
| Rate for Payer: HFN Commercial |
$190.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$516.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$516.02
|
| Rate for Payer: Multiplan Commercial |
$160.80
|
| Rate for Payer: Preferred Network Access Commercial |
$190.95
|
| Rate for Payer: Quartz Beloit One Network |
$88.44
|
| Rate for Payer: Quartz Commercial |
$114.57
|
| Rate for Payer: The Alliance Commercial |
$100.50
|
| Rate for Payer: United Healthcare Medicaid |
$100.52
|
| Rate for Payer: WEA Trust Commercial |
$110.55
|
| Rate for Payer: WPS Commercial |
$148.88
|
|
|
Ablate Inf Turbinate, Superf 3080150
|
Professional
|
Both
|
$401.00
|
|
|
Service Code
|
CPT 30801 50
|
| Hospital Charge Code |
3921395
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$176.44 |
| Max. Negotiated Rate |
$380.95 |
| Rate for Payer: Aetna Commercial |
$380.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$344.86
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cash Price |
$120.30
|
| Rate for Payer: Cigna Commercial |
$380.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$200.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$240.60
|
| Rate for Payer: Health EOS Commercial |
$364.91
|
| Rate for Payer: HFN Commercial |
$380.95
|
| Rate for Payer: Multiplan Commercial |
$320.80
|
| Rate for Payer: Preferred Network Access Commercial |
$380.95
|
| Rate for Payer: Quartz Beloit One Network |
$176.44
|
| Rate for Payer: Quartz Commercial |
$228.57
|
| Rate for Payer: The Alliance Commercial |
$200.50
|
| Rate for Payer: WEA Trust Commercial |
$220.55
|
| Rate for Payer: WPS Commercial |
$297.02
|
|
|
ABLATION, RENAL TUMOR(S), UNILATERAL, PERCUTANEOUS, CRYOTHERAPY
|
Facility
|
OP
|
$40,697.48
|
|
|
Service Code
|
CPT 50593
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,596.00 |
| Max. Negotiated Rate |
$40,697.48 |
| Rate for Payer: Aetna Managed Medicare |
$10,174.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,174.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,174.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,174.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,174.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,174.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,848.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,174.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,174.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,174.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,174.37
|
| Rate for Payer: NAPHCARE Commercial |
$15,261.56
|
| Rate for Payer: Quartz Medicare Advantage |
$10,174.37
|
| Rate for Payer: The Alliance Commercial |
$40,697.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,174.37
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: Wellcare Medicare |
$10,174.37
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); INTRAMURAL (IE, SUBMUCOSAL)
|
Facility
|
OP
|
$6,029.48
|
|
|
Service Code
|
CPT 30802
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,507.37 |
| Max. Negotiated Rate |
$6,029.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,507.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,507.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,507.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,507.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,607.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,507.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,507.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,507.37
|
| Rate for Payer: NAPHCARE Commercial |
$2,261.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,507.37
|
| Rate for Payer: The Alliance Commercial |
$6,029.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,507.37
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,507.37
|
|
|
ABLATION, SOFT TISSUE OF INFERIOR TURBINATES, UNILATERAL OR BILATERAL, ANY METHOD (EG, ELECTROCAUTERY, RADIOFREQUENCY ABLATION, OR TISSUE VOLUME REDUCTION); SUPERFICIAL
|
Facility
|
OP
|
$6,029.48
|
|
|
Service Code
|
CPT 30801
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,507.37 |
| Max. Negotiated Rate |
$6,029.48 |
| Rate for Payer: Aetna Managed Medicare |
$1,507.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$1,507.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$1,507.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$1,507.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$1,507.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,607.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,507.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$1,507.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$1,507.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$1,507.37
|
| Rate for Payer: NAPHCARE Commercial |
$2,261.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,507.37
|
| Rate for Payer: The Alliance Commercial |
$6,029.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$1,507.37
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$1,507.37
|
|
|
ABLATOR 4MM 90DEG ASPIR AR-9803A-90
|
Facility
|
OP
|
$2,877.00
|
|
| Hospital Charge Code |
2964710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$805.56 |
| Max. Negotiated Rate |
$11,508.00 |
| Rate for Payer: Aetna Commercial |
$2,589.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,474.22
|
| Rate for Payer: Aetna Managed Medicare |
$805.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,870.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,438.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,380.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,524.81
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna Commercial |
$2,646.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,609.97
|
| Rate for Payer: Health EOS Commercial |
$2,560.53
|
| Rate for Payer: HFN Commercial |
$2,646.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,157.75
|
| Rate for Payer: Multiplan Commercial |
$2,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,726.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,646.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,409.73
|
| Rate for Payer: Quartz Commercial |
$1,870.05
|
| Rate for Payer: Quartz Medicare Advantage |
$1,726.20
|
| Rate for Payer: The Alliance Commercial |
$11,508.00
|
| Rate for Payer: WEA Trust Commercial |
$1,582.35
|
| Rate for Payer: WPS Commercial |
$2,130.99
|
|
|
ABLATOR 4MM 90DEG ASPIR AR-9803A-90
|
Facility
|
IP
|
$2,877.00
|
|
| Hospital Charge Code |
2964710
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,409.73 |
| Max. Negotiated Rate |
$2,646.84 |
| Rate for Payer: Aetna Commercial |
$2,589.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,474.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,524.81
|
| Rate for Payer: Cash Price |
$863.10
|
| Rate for Payer: Cigna Commercial |
$2,646.84
|
| Rate for Payer: Health EOS Commercial |
$2,560.53
|
| Rate for Payer: HFN Commercial |
$2,646.84
|
| Rate for Payer: Multiplan Commercial |
$2,301.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,726.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,646.84
|
| Rate for Payer: Quartz Beloit One Network |
$1,409.73
|
| Rate for Payer: Quartz Commercial |
$1,726.20
|
| Rate for Payer: WEA Trust Commercial |
$1,582.35
|
| Rate for Payer: WPS Commercial |
$2,130.99
|
|
|
ABLATOR APOLLO ASPIRATING ARTHREX AR-9821
|
Facility
|
IP
|
$2,896.00
|
|
| Hospital Charge Code |
5206680
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,419.04 |
| Max. Negotiated Rate |
$2,664.32 |
| Rate for Payer: Aetna Commercial |
$2,606.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,490.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,534.88
|
| Rate for Payer: Cash Price |
$868.80
|
| Rate for Payer: Cigna Commercial |
$2,664.32
|
| Rate for Payer: Health EOS Commercial |
$2,577.44
|
| Rate for Payer: HFN Commercial |
$2,664.32
|
| Rate for Payer: Multiplan Commercial |
$2,316.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,737.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,664.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,419.04
|
| Rate for Payer: Quartz Commercial |
$1,737.60
|
| Rate for Payer: WEA Trust Commercial |
$1,592.80
|
| Rate for Payer: WPS Commercial |
$2,145.07
|
|
