|
Lamotrigine Level
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
978002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.25 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Aetna Managed Medicare |
$13.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$49.69
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.19
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.00
|
| Rate for Payer: Anthem Medicaid |
$13.69
|
| Rate for Payer: Anthem Medicare Advantage |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.25
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.69
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$94.01
|
| Rate for Payer: Dean Health Medicaid |
$13.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.25
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.29
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.25
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.69
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.25
|
| Rate for Payer: Managed Health Services Medicaid |
$14.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.25
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$19.88
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.69
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$109.20
|
| Rate for Payer: Quartz Medicare Advantage |
$13.25
|
| Rate for Payer: The Alliance Commercial |
$53.00
|
| Rate for Payer: United Healthcare Medicaid |
$13.69
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.25
|
| Rate for Payer: United Healthcare PPO |
$126.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: Wellcare Medicare |
$13.25
|
| Rate for Payer: WMAP Medicaid |
$13.69
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Lamotrigine Level
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
978002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$46.77 |
| Max. Negotiated Rate |
$159.60 |
| Rate for Payer: Aetna Commercial |
$159.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$159.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$84.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100.80
|
| Rate for Payer: Health EOS Commercial |
$152.88
|
| Rate for Payer: HFN Commercial |
$159.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.77
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$46.77
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: Preferred Network Access Commercial |
$159.60
|
| Rate for Payer: Quartz Beloit One Network |
$73.92
|
| Rate for Payer: Quartz Commercial |
$95.76
|
| Rate for Payer: The Alliance Commercial |
$84.00
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
Lamotrigine Level
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
978002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$82.32 |
| Max. Negotiated Rate |
$154.56 |
| Rate for Payer: Aetna Commercial |
$151.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$144.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$89.04
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$154.56
|
| Rate for Payer: Health EOS Commercial |
$149.52
|
| Rate for Payer: HFN Commercial |
$154.56
|
| Rate for Payer: Multiplan Commercial |
$134.40
|
| Rate for Payer: NAPHCARE Commercial |
$100.80
|
| Rate for Payer: Preferred Network Access Commercial |
$154.56
|
| Rate for Payer: Quartz Beloit One Network |
$82.32
|
| Rate for Payer: Quartz Commercial |
$100.80
|
| Rate for Payer: WEA Trust Commercial |
$92.40
|
| Rate for Payer: WPS Commercial |
$124.44
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960173
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.12 |
| Max. Negotiated Rate |
$28,916.00 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.35
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,421.75
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,698.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,337.40
|
| Rate for Payer: The Alliance Commercial |
$28,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960173
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,542.21 |
| Max. Negotiated Rate |
$6,650.68 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,337.40
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC ASSISTED COLON RESECTION
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960527
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.12 |
| Max. Negotiated Rate |
$28,916.00 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.35
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,421.75
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,698.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,337.40
|
| Rate for Payer: The Alliance Commercial |
$28,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC ASSISTED COLON RESECTION
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960527
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,542.21 |
| Max. Negotiated Rate |
$6,650.68 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,337.40
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC ASSISTED HEMICOLECTOMY/TRANSVERSE COLECTOMY/COLECTOMY
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,542.21 |
| Max. Negotiated Rate |
$6,650.68 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,337.40
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC ASSISTED HEMICOLECTOMY/TRANSVERSE COLECTOMY/COLECTOMY
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.12 |
| Max. Negotiated Rate |
$28,916.00 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.35
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,421.75
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,698.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,337.40
|
| Rate for Payer: The Alliance Commercial |
$28,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC ASSISTED PERITONEAL DIALYSIS CATHETER
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
4075903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.12 |
| Max. Negotiated Rate |
$28,916.00 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.35
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,421.75
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,698.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,337.40
|
| Rate for Payer: The Alliance Commercial |
$28,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC ASSISTED PERITONEAL DIALYSIS CATHETER
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
4075903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,542.21 |
| Max. Negotiated Rate |
$6,650.68 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,337.40
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY (LAVH)
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2950463
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.12 |
| Max. Negotiated Rate |
$28,916.00 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.35
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,421.75
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,698.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,337.40
|
| Rate for Payer: The Alliance Commercial |
$28,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY (LAVH)
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2950463
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,542.21 |
| Max. Negotiated Rate |
$6,650.68 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,337.40
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960177
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,542.21 |
| Max. Negotiated Rate |
$6,650.68 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,337.40
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960177
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.12 |
| Max. Negotiated Rate |
$28,916.00 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.35
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,421.75
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,698.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,337.40
|
| Rate for Payer: The Alliance Commercial |
$28,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$43,780.00
|
|
|
Service Code
|
MSDRG 418
|
| Min. Negotiated Rate |
$15,748.38 |
| Max. Negotiated Rate |
$43,780.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,748.38
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,197.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,212.03
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,903.14
|
| Rate for Payer: Anthem Medicare Advantage |
$15,748.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,748.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,748.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,748.38
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,644.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,748.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,876.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,748.38
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,748.38
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,748.38
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,748.38
|
| Rate for Payer: NAPHCARE Commercial |
$23,622.57
|
| Rate for Payer: Quartz Medicare Advantage |
$15,748.38
|
| Rate for Payer: The Alliance Commercial |
$43,780.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,748.38
|
| Rate for Payer: United Healthcare PPO |
$24,816.38
|
| Rate for Payer: Wellcare Medicare |
$15,748.38
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH MCC
|
Facility
|
IP
|
$61,941.00
|
|
|
Service Code
|
MSDRG 417
|
| Min. Negotiated Rate |
$22,281.07 |
| Max. Negotiated Rate |
$61,941.00 |
| Rate for Payer: Aetna Managed Medicare |
$22,281.07
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$48,673.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$37,307.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35,444.96
|
| Rate for Payer: Anthem Medicare Advantage |
$22,281.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$22,281.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$22,281.07
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$22,281.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$39,347.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$22,281.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,197.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$22,281.07
|
| Rate for Payer: Independent Care Health Plan Medicare |
$22,281.07
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$22,281.07
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$22,281.07
|
| Rate for Payer: NAPHCARE Commercial |
$33,421.60
|
| Rate for Payer: Quartz Medicare Advantage |
$22,281.07
|
| Rate for Payer: The Alliance Commercial |
$61,941.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$22,281.07
|
| Rate for Payer: United Healthcare PPO |
$35,186.52
|
| Rate for Payer: Wellcare Medicare |
$22,281.07
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITHOUT CC/MCC
|
Facility
|
IP
|
$35,233.00
|
|
|
Service Code
|
MSDRG 419
|
| Min. Negotiated Rate |
$12,673.79 |
| Max. Negotiated Rate |
$35,233.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,673.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,483.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,066.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,014.18
|
| Rate for Payer: Anthem Medicare Advantage |
$12,673.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,673.79
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,673.79
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,673.79
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,217.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,673.79
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,607.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,673.79
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,673.79
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,673.79
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,673.79
|
| Rate for Payer: NAPHCARE Commercial |
$19,010.68
|
| Rate for Payer: Quartz Medicare Advantage |
$12,673.79
|
| Rate for Payer: The Alliance Commercial |
$35,233.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,673.79
|
| Rate for Payer: United Healthcare PPO |
$19,935.69
|
| Rate for Payer: Wellcare Medicare |
$12,673.79
|
|
|
LAPAROSCOPIC DIVERTING COLOSTOMY
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960178
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,542.21 |
| Max. Negotiated Rate |
$6,650.68 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,337.40
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC DIVERTING COLOSTOMY
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960178
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.12 |
| Max. Negotiated Rate |
$28,916.00 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.35
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,421.75
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,698.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,337.40
|
| Rate for Payer: The Alliance Commercial |
$28,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC GASTRIC BANDING
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960176
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,879.64 |
| Max. Negotiated Rate |
$26,852.00 |
| Rate for Payer: Aetna Commercial |
$6,041.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,773.18
|
| Rate for Payer: Aetna Managed Medicare |
$1,879.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,363.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,356.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,222.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,557.89
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,175.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,756.59
|
| Rate for Payer: Health EOS Commercial |
$5,974.57
|
| Rate for Payer: HFN Commercial |
$6,175.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,034.75
|
| Rate for Payer: Multiplan Commercial |
$5,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,175.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.37
|
| Rate for Payer: Quartz Commercial |
$4,363.45
|
| Rate for Payer: Quartz Medicare Advantage |
$4,027.80
|
| Rate for Payer: The Alliance Commercial |
$26,852.00
|
| Rate for Payer: WEA Trust Commercial |
$3,692.15
|
| Rate for Payer: WPS Commercial |
$4,972.32
|
|
|
LAPAROSCOPIC GASTRIC BANDING
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960176
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,289.37 |
| Max. Negotiated Rate |
$6,175.96 |
| Rate for Payer: Aetna Commercial |
$6,041.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,773.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,557.89
|
| Rate for Payer: Cash Price |
$2,013.90
|
| Rate for Payer: Cigna Commercial |
$6,175.96
|
| Rate for Payer: Health EOS Commercial |
$5,974.57
|
| Rate for Payer: HFN Commercial |
$6,175.96
|
| Rate for Payer: Multiplan Commercial |
$5,370.40
|
| Rate for Payer: NAPHCARE Commercial |
$4,027.80
|
| Rate for Payer: Preferred Network Access Commercial |
$6,175.96
|
| Rate for Payer: Quartz Beloit One Network |
$3,289.37
|
| Rate for Payer: Quartz Commercial |
$4,027.80
|
| Rate for Payer: WEA Trust Commercial |
$3,692.15
|
| Rate for Payer: WPS Commercial |
$4,972.32
|
|
|
LAPAROSCOPIC GASTROSTOMY TUBE PLACEMENT
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960187
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,542.21 |
| Max. Negotiated Rate |
$6,650.68 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,337.40
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC GASTROSTOMY TUBE PLACEMENT
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960187
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.12 |
| Max. Negotiated Rate |
$28,916.00 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.35
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,421.75
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,698.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,337.40
|
| Rate for Payer: The Alliance Commercial |
$28,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
|
LAPAROSCOPIC INCISIONAL HERNIA REPAIR
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960530
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,024.12 |
| Max. Negotiated Rate |
$28,916.00 |
| Rate for Payer: Aetna Commercial |
$6,506.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,216.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,024.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,698.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,614.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,469.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,831.37
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,650.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,045.35
|
| Rate for Payer: Health EOS Commercial |
$6,433.81
|
| Rate for Payer: HFN Commercial |
$6,650.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,421.75
|
| Rate for Payer: Multiplan Commercial |
$5,783.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,337.40
|
| Rate for Payer: Preferred Network Access Commercial |
$6,650.68
|
| Rate for Payer: Quartz Beloit One Network |
$3,542.21
|
| Rate for Payer: Quartz Commercial |
$4,698.85
|
| Rate for Payer: Quartz Medicare Advantage |
$4,337.40
|
| Rate for Payer: The Alliance Commercial |
$28,916.00
|
| Rate for Payer: WEA Trust Commercial |
$3,975.95
|
| Rate for Payer: WPS Commercial |
$5,354.52
|
|
