|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH CC
|
Facility
|
IP
|
$47,829.60
|
|
|
Service Code
|
MSDRG 354
|
| Min. Negotiated Rate |
$13,390.94 |
| Max. Negotiated Rate |
$47,829.60 |
| Rate for Payer: Aetna Managed Medicare |
$13,390.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,708.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,136.86
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,731.86
|
| Rate for Payer: Anthem Medicare Advantage |
$13,390.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,390.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,390.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,390.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,674.81
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,390.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,836.98
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,390.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,390.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,390.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,390.94
|
| Rate for Payer: NAPHCARE Commercial |
$20,086.40
|
| Rate for Payer: Quartz Medicare Advantage |
$13,390.94
|
| Rate for Payer: The Alliance Commercial |
$47,829.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,390.94
|
| Rate for Payer: United Healthcare PPO |
$27,121.04
|
| Rate for Payer: Wellcare Medicare |
$13,390.94
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITH MCC
|
Facility
|
IP
|
$81,188.64
|
|
|
Service Code
|
MSDRG 353
|
| Min. Negotiated Rate |
$22,730.86 |
| Max. Negotiated Rate |
$81,188.64 |
| Rate for Payer: Aetna Managed Medicare |
$22,730.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$63,319.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48,533.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46,110.23
|
| Rate for Payer: Anthem Medicare Advantage |
$22,730.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,730.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,730.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,730.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51,186.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,730.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59,304.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,730.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,730.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,730.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,730.86
|
| Rate for Payer: NAPHCARE Commercial |
$34,096.30
|
| Rate for Payer: Quartz Medicare Advantage |
$22,730.86
|
| Rate for Payer: The Alliance Commercial |
$81,188.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,730.86
|
| Rate for Payer: United Healthcare PPO |
$46,169.55
|
| Rate for Payer: Wellcare Medicare |
$22,730.86
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL AND FEMORAL WITHOUT CC/MCC
|
Facility
|
IP
|
$38,007.84
|
|
|
Service Code
|
MSDRG 355
|
| Min. Negotiated Rate |
$10,807.06 |
| Max. Negotiated Rate |
$38,007.84 |
| Rate for Payer: Aetna Managed Medicare |
$10,807.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,346.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,494.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,370.87
|
| Rate for Payer: Anthem Medicare Advantage |
$10,807.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,807.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,807.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,807.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,723.62
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,807.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,633.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,807.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,807.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,807.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,807.06
|
| Rate for Payer: NAPHCARE Commercial |
$16,210.58
|
| Rate for Payer: Quartz Medicare Advantage |
$10,807.06
|
| Rate for Payer: The Alliance Commercial |
$38,007.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,807.06
|
| Rate for Payer: United Healthcare PPO |
$21,513.06
|
| Rate for Payer: Wellcare Medicare |
$10,807.06
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$10,697.34
|
|
|
Service Code
|
APR-DRG 2271
|
| Min. Negotiated Rate |
$9,502.04 |
| Max. Negotiated Rate |
$10,697.34 |
| Rate for Payer: Anthem Medicaid |
$10,243.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,243.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,243.29
|
| Rate for Payer: Dean Health Medicaid |
$10,243.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,502.04
|
| Rate for Payer: Managed Health Services Medicaid |
$10,697.34
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,243.29
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,243.29
|
| Rate for Payer: United Healthcare Medicaid |
$10,243.29
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$13,064.78
|
|
|
Service Code
|
APR-DRG 2272
|
| Min. Negotiated Rate |
$11,604.95 |
| Max. Negotiated Rate |
$13,064.78 |
| Rate for Payer: Anthem Medicaid |
$12,510.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,510.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,510.25
|
| Rate for Payer: Dean Health Medicaid |
$12,510.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,604.95
|
| Rate for Payer: Managed Health Services Medicaid |
$13,064.78
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,510.25
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,510.25
|
| Rate for Payer: United Healthcare Medicaid |
$12,510.25
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$34,021.04
|
|
|
Service Code
|
APR-DRG 2274
|
| Min. Negotiated Rate |
$30,219.61 |
| Max. Negotiated Rate |
$34,021.04 |
| Rate for Payer: Anthem Medicaid |
$32,577.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,577.02
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,577.02
|
| Rate for Payer: Dean Health Medicaid |
$32,577.02
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$30,219.61
|
| Rate for Payer: Managed Health Services Medicaid |
$34,021.04
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,577.02
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,577.02
|
| Rate for Payer: United Healthcare Medicaid |
$32,577.02
|
|
|
HERNIA PROCEDURES EXCEPT INGUINAL, FEMORAL AND UMBILICAL
|
Facility
|
IP
|
$19,377.97
|
|
|
Service Code
|
APR-DRG 2273
|
| Min. Negotiated Rate |
$17,212.72 |
| Max. Negotiated Rate |
$19,377.97 |
| Rate for Payer: Anthem Medicaid |
$18,555.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$18,555.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$18,555.47
|
| Rate for Payer: Dean Health Medicaid |
$18,555.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$17,212.72
|
| Rate for Payer: Managed Health Services Medicaid |
$19,377.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$18,555.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$18,555.47
|
| Rate for Payer: United Healthcare Medicaid |
$18,555.47
|
|
|
HERNIA REPAIR, HIATAL/DIAPHRAGMATIC/NISSEN FUNDOPLICATION
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
HERNIA REPAIR, HIATAL/DIAPHRAGMATIC/NISSEN FUNDOPLICATION
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960110
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
HERNIA REPAIR, INCISIONAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
HERNIA REPAIR, INCISIONAL
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960111
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
HERNIA REPAIR, INGUINAL/FEMORAL/SPIGELIAN
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960112
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
HERNIA REPAIR, INGUINAL/FEMORAL/SPIGELIAN
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960112
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
HERNIA REPAIR, INGUINAL PEDIATRIC
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960117
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
HERNIA REPAIR, INGUINAL PEDIATRIC
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960117
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
HERNIA REPAIR, PERISTOMAL
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960113
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
HERNIA REPAIR, PERISTOMAL
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960113
|
|
Hospital Revenue Code
|
360
|
| 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
|
|
|
HERNIA REPAIR, UMBILICAL
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
HERNIA REPAIR, UMBILICAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960115
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
HERNIA REPAIR, VENTRAL
|
Facility
|
OP
|
$1,084.00
|
|
| Hospital Charge Code |
2960116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$315.66 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Aetna Managed Medicare |
$315.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$732.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$563.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$541.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$630.89
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$845.52
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: NAPHCARE Commercial |
$676.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$732.78
|
| Rate for Payer: Quartz Medicare Advantage |
$676.42
|
| Rate for Payer: The Alliance Commercial |
$563.68
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
HERNIA REPAIR, VENTRAL
|
Facility
|
IP
|
$1,084.00
|
|
| Hospital Charge Code |
2960116
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$552.41 |
| Max. Negotiated Rate |
$1,037.17 |
| Rate for Payer: Aetna Commercial |
$1,014.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$969.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$597.50
|
| Rate for Payer: Cash Price |
$325.20
|
| Rate for Payer: Cigna Commercial |
$1,037.17
|
| Rate for Payer: Health EOS Commercial |
$1,003.35
|
| Rate for Payer: HFN Commercial |
$1,037.17
|
| Rate for Payer: Multiplan Commercial |
$901.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,037.17
|
| Rate for Payer: Quartz Beloit One Network |
$552.41
|
| Rate for Payer: Quartz Commercial |
$676.42
|
| Rate for Payer: WEA Trust Commercial |
$620.05
|
| Rate for Payer: WPS Commercial |
$835.01
|
|
|
.Herpes Simplex 1 IgM Titer
|
Facility
|
IP
|
$9.10
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3119331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$8.71 |
| Rate for Payer: Aetna Commercial |
$8.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.02
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna Commercial |
$8.71
|
| Rate for Payer: Health EOS Commercial |
$8.42
|
| Rate for Payer: HFN Commercial |
$8.71
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: Preferred Network Access Commercial |
$8.71
|
| Rate for Payer: Quartz Beloit One Network |
$4.64
|
| Rate for Payer: Quartz Commercial |
$5.68
|
| Rate for Payer: WEA Trust Commercial |
$5.21
|
| Rate for Payer: WPS Commercial |
$7.01
|
|
|
.Herpes Simplex 1 IgM Titer
|
Professional
|
Both
|
$9.10
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3119331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.16 |
| Max. Negotiated Rate |
$60.36 |
| Rate for Payer: Aetna Commercial |
$8.99
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna Commercial |
$8.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.73
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$8.61
|
| Rate for Payer: HFN Commercial |
$8.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$8.99
|
| Rate for Payer: Quartz Beloit One Network |
$4.16
|
| Rate for Payer: Quartz Commercial |
$5.39
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.18
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: WEA Trust Commercial |
$5.21
|
| Rate for Payer: WPS Commercial |
$60.36
|
|
|
.Herpes Simplex 1 IgM Titer
|
Facility
|
OP
|
$9.10
|
|
|
Service Code
|
CPT 86695
|
| Hospital Charge Code |
3119331
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.64 |
| Max. Negotiated Rate |
$54.87 |
| Rate for Payer: Aetna Commercial |
$8.52
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8.14
|
| Rate for Payer: Aetna Managed Medicare |
$13.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.44
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.77
|
| Rate for Payer: Anthem Medicare Advantage |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.72
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cash Price |
$2.73
|
| Rate for Payer: Cigna Commercial |
$8.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5.30
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.72
|
| Rate for Payer: Health EOS Commercial |
$8.42
|
| Rate for Payer: HFN Commercial |
$8.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.03
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.72
|
| Rate for Payer: Multiplan Commercial |
$7.57
|
| Rate for Payer: NAPHCARE Commercial |
$20.58
|
| Rate for Payer: Preferred Network Access Commercial |
$8.71
|
| Rate for Payer: Quartz Beloit One Network |
$4.64
|
| Rate for Payer: Quartz Commercial |
$6.15
|
| Rate for Payer: Quartz Medicare Advantage |
$13.72
|
| Rate for Payer: The Alliance Commercial |
$54.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.72
|
| Rate for Payer: United Healthcare PPO |
$7.10
|
| Rate for Payer: WEA Trust Commercial |
$5.21
|
| Rate for Payer: Wellcare Medicare |
$13.72
|
| Rate for Payer: WPS Commercial |
$7.01
|
|
|
.Herpes Simplex 2 IgM Titer
|
Facility
|
IP
|
$66.00
|
|
|
Service Code
|
CPT 86696
|
| Hospital Charge Code |
3376967
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
