|
LAPAROSCOPIC INCISIONAL HERNIA REPAIR
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960530
|
|
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 INGUINAL HERNIA REPAIR
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2950474
|
|
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 INGUINAL HERNIA REPAIR
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2950474
|
|
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 LIVER BIOPSY
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960180
|
|
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 LIVER BIOPSY
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960180
|
|
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 NEPHRECTOMY/RENAL CYSTECTOMY
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960181
|
|
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 NEPHRECTOMY/RENAL CYSTECTOMY
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960181
|
|
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 NISSEN FUNDOPLICATION/HIATAL HERNIA REPAIR
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960528
|
|
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 NISSEN FUNDOPLICATION/HIATAL HERNIA REPAIR
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960528
|
|
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 PEDIATRIC APPENDECTOMY
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960174
|
|
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 PEDIATRIC APPENDECTOMY
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960174
|
|
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 SALPINGO OOPHORECTOM
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960534
|
|
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 SALPINGO OOPHORECTOM
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960534
|
|
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 SIGMOID COLON RESECTION
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960184
|
|
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 SIGMOID COLON RESECTION
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960184
|
|
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 SPLENECTOMY
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2960185
|
|
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 SPLENECTOMY
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2960185
|
|
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 TOTAL ABDOMINAL/SUPRACERVICAL HYSTERECTOMY
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960539
|
|
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 TOTAL ABDOMINAL/SUPRACERVICAL HYSTERECTOMY
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960539
|
|
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 TREATMENT OF ECTOPIC PREGNANCY; WITHOUT SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$22,812.36
|
|
|
Service Code
|
CPT 59150
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,266.00 |
| Max. Negotiated Rate |
$22,812.36 |
| Rate for Payer: Aetna Managed Medicare |
$5,703.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,003.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,703.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,703.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,009.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,703.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,215.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,703.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,703.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,703.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,703.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,554.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5,703.09
|
| Rate for Payer: The Alliance Commercial |
$22,812.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,703.09
|
| Rate for Payer: United Healthcare PPO |
$5,266.00
|
| Rate for Payer: Wellcare Medicare |
$5,703.09
|
|
|
LAPAROSCOPIC TREATMENT OF ECTOPIC PREGNANCY; WITH SALPINGECTOMY AND/OR OOPHORECTOMY
|
Facility
|
OP
|
$22,812.36
|
|
|
Service Code
|
CPT 59151
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,266.00 |
| Max. Negotiated Rate |
$22,812.36 |
| Rate for Payer: Aetna Managed Medicare |
$5,703.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,635.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,003.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,703.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,703.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,703.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,009.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,703.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,215.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,703.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,703.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,703.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,703.09
|
| Rate for Payer: NAPHCARE Commercial |
$8,554.64
|
| Rate for Payer: Quartz Medicare Advantage |
$5,703.09
|
| Rate for Payer: The Alliance Commercial |
$22,812.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,703.09
|
| Rate for Payer: United Healthcare PPO |
$5,266.00
|
| Rate for Payer: Wellcare Medicare |
$5,703.09
|
|
|
LAPAROSCOPIC TUBAL LIGATION
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960186
|
|
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 TUBAL LIGATION
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960186
|
|
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 UMBILICAL HERNIA REPAIR
|
Facility
|
OP
|
$6,713.00
|
|
| Hospital Charge Code |
2950345
|
|
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 UMBILICAL HERNIA REPAIR
|
Facility
|
IP
|
$6,713.00
|
|
| Hospital Charge Code |
2950345
|
|
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
|
|
