Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

LAPAROSCOPIC VENTRAL HERNIA REPAIR

Facility

$7,229.00

Hospital Charge Code	2960541
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 VENTRAL HERNIA REPAIR

Facility

$7,229.00

Hospital Charge Code	2960541
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

LAPAROSCOPY, ABDOMEN, PERITONEUM, AND OMENTUM, DIAGNOSTIC, WITH OR WITHOUT COLLECTION OF SPECIMEN(S) BY BRUSHING OR WASHING (SEPARATE PROCEDURE)

Facility

$22,812.36

Service Code	CPT 49320
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

LAPAROSCOPY, GENERAL

Facility

$7,229.00

Hospital Charge Code	2950475
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

LAPAROSCOPY, GENERAL

Facility

$7,229.00

Hospital Charge Code	2950475
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

LAPAROSCOPY, GYNECOLOGICAL

Facility

$7,229.00

Hospital Charge Code	2950461
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

LAPAROSCOPY, GYNECOLOGICAL

Facility

$7,229.00

Hospital Charge Code	2950461
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

LAPAROSCOPY, SURGICAL, ABLATION OF UTERINE FIBROID(S) INCLUDING INTRAOPERATIVE ULTRASOUND GUIDANCE AND MONITORING, RADIOFREQUENCY

Facility

$40,697.48

Service Code	CPT 58674
Hospital Revenue Code	360
Min. Negotiated Rate	$7,795.33
Max. Negotiated Rate	$40,697.48
Rate for Payer: Dean Health DHI/DHP/ASO	$7,795.33
Rate for Payer: Aetna Managed Medicare	$10,174.37
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$18,649.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$18,649.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$17,230.00
Rate for Payer: Anthem Medicare Advantage	$10,174.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$10,174.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$10,174.37
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$10,174.37
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$10,174.37
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$37,848.66
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$10,174.37
Rate for Payer: Independent Care Health Plan Medicare	$10,174.37
Rate for Payer: Managed Health Services Medicare Advantage	$10,174.37
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$10,174.37
Rate for Payer: NAPHCARE Commercial	$15,261.56
Rate for Payer: Quartz Medicare Advantage	$10,174.37
Rate for Payer: The Alliance Commercial	$40,697.48
Rate for Payer: United Healthcare Medicare Advantage	$10,174.37
Rate for Payer: United Healthcare PPO	$9,596.00
Rate for Payer: Wellcare Medicare	$10,174.37

LAPAROSCOPY, SURGICAL, APPENDECTOMY

Facility

$22,812.36

Service Code	CPT 44970
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

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY

Facility

$22,812.36

Service Code	CPT 47562
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

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH CHOLANGIOGRAPHY

Facility

$22,812.36

Service Code	CPT 47563
Hospital Revenue Code	360
Min. Negotiated Rate	$5,266.00
Max. Negotiated Rate	$22,812.36
Rate for Payer: Wellcare Medicare	$5,703.09
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

LAPAROSCOPY, SURGICAL; CHOLECYSTECTOMY WITH EXPLORATION OF COMMON DUCT

Facility

$40,697.48

Service Code	CPT 47564
Hospital Revenue Code	360
Min. Negotiated Rate	$5,266.00
Max. Negotiated Rate	$40,697.48
Rate for Payer: Aetna Managed Medicare	$10,174.37
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$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	$10,174.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$10,174.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$10,174.37
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$10,174.37
Rate for Payer: Dean Health DHI/DHP/ASO	$12,009.73
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$10,174.37
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$37,848.66
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$10,174.37
Rate for Payer: Independent Care Health Plan Medicare	$10,174.37
Rate for Payer: Managed Health Services Medicare Advantage	$10,174.37
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$10,174.37
Rate for Payer: NAPHCARE Commercial	$15,261.56
Rate for Payer: Quartz Medicare Advantage	$10,174.37
Rate for Payer: The Alliance Commercial	$40,697.48
Rate for Payer: United Healthcare Medicare Advantage	$10,174.37
Rate for Payer: United Healthcare PPO	$5,266.00
Rate for Payer: Wellcare Medicare	$10,174.37

LAPAROSCOPY, SURGICAL, GASTRIC RESTRICTIVE PROCEDURE; REMOVAL OF ADJUSTABLE GASTRIC RESTRICTIVE DEVICE AND SUBCUTANEOUS PORT COMPONENTS

Facility

$15,141.44

Service Code	CPT 43774
Hospital Revenue Code	360
Min. Negotiated Rate	$3,785.36
Max. Negotiated Rate	$15,141.44
Rate for Payer: Aetna Managed Medicare	$3,785.36
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$9,907.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$8,043.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$7,639.00
Rate for Payer: Anthem Medicare Advantage	$3,785.36
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$3,785.36
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$3,785.36
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$3,785.36
Rate for Payer: Dean Health DHI/DHP/ASO	$12,009.73
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$3,785.36
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$14,081.54
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$3,785.36
Rate for Payer: Independent Care Health Plan Medicare	$3,785.36
Rate for Payer: Managed Health Services Medicare Advantage	$3,785.36
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$3,785.36
Rate for Payer: NAPHCARE Commercial	$5,678.04
Rate for Payer: Quartz Medicare Advantage	$3,785.36
Rate for Payer: The Alliance Commercial	$15,141.44
Rate for Payer: United Healthcare Medicare Advantage	$3,785.36
Rate for Payer: United Healthcare PPO	$4,103.00
Rate for Payer: Wellcare Medicare	$3,785.36

LAPAROSCOPY, SURGICAL, MYOMECTOMY, EXCISION; 1 TO 4 INTRAMURAL MYOMAS WITH TOTAL WEIGHT OF 250 G OR LESS AND/OR REMOVAL OF SURFACE MYOMAS

Facility

$22,812.36

Service Code	CPT 58545
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

LAPAROSCOPY, SURGICAL; REPAIR INITIAL INGUINAL HERNIA

Facility

$22,812.36

Service Code	CPT 49650
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

LAPAROSCOPY, SURGICAL; REPAIR RECURRENT INGUINAL HERNIA

Facility

$22,812.36

Service Code	CPT 49651
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

LAPAROSCOPY, SURGICAL; WITH ASPIRATION OF CAVITY OR CYST (EG, OVARIAN CYST) (SINGLE OR MULTIPLE)

Facility

$22,812.36

Service Code	CPT 49322
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

LAPAROSCOPY, SURGICAL; WITH FULGURATION OF OVIDUCTS (WITH OR WITHOUT TRANSECTION)

Facility

$22,812.36

Service Code	CPT 58670
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

LAPAROSCOPY, SURGICAL; WITH FULGURATION OR EXCISION OF LESIONS OF THE OVARY, PELVIC VISCERA, OR PERITONEAL SURFACE BY ANY METHOD

Facility

$22,812.36

Service Code	CPT 58662
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

LAPAROSCOPY, SURGICAL; WITH INSERTION OF TUNNELED INTRAPERITONEAL CATHETER

Facility

$22,812.36

Service Code	CPT 49324
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

LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)

Facility

$22,812.36

Service Code	CPT 58660
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

LAPAROSCOPY, SURGICAL; WITH REMOVAL OF ADNEXAL STRUCTURES (PARTIAL OR TOTAL OOPHORECTOMY AND/OR SALPINGECTOMY)

Facility

$22,812.36

Service Code	CPT 58661
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

LAPAROSCOPY, SURGICAL; WITH REVISION OF PREVIOUSLY PLACED INTRAPERITONEAL CANNULA OR CATHETER, WITH REMOVAL OF INTRALUMINAL OBSTRUCTIVE MATERIAL IF PERFORMED

Facility

$22,812.36

Service Code	CPT 49325
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

LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;

Facility

$40,697.48

Service Code	CPT 58570
Hospital Revenue Code	360
Min. Negotiated Rate	$7,795.33
Max. Negotiated Rate	$40,697.48
Rate for Payer: Aetna Managed Medicare	$10,174.37
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$18,649.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$18,649.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$17,230.00
Rate for Payer: Anthem Medicare Advantage	$10,174.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$10,174.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$10,174.37
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$10,174.37
Rate for Payer: Dean Health DHI/DHP/ASO	$7,795.33
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$10,174.37
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$37,848.66
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$10,174.37
Rate for Payer: Independent Care Health Plan Medicare	$10,174.37
Rate for Payer: Managed Health Services Medicare Advantage	$10,174.37
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$10,174.37
Rate for Payer: NAPHCARE Commercial	$15,261.56
Rate for Payer: Quartz Medicare Advantage	$10,174.37
Rate for Payer: The Alliance Commercial	$40,697.48
Rate for Payer: United Healthcare Medicare Advantage	$10,174.37
Rate for Payer: United Healthcare PPO	$9,596.00
Rate for Payer: Wellcare Medicare	$10,174.37

LAPAROSCOPY, SURGICAL, WITH TOTAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS; WITH REMOVAL OF TUBE(S) AND/OR OVARY(S)

Facility

$40,697.48

Service Code	CPT 58571
Hospital Revenue Code	360
Min. Negotiated Rate	$7,795.33
Max. Negotiated Rate	$40,697.48
Rate for Payer: Aetna Managed Medicare	$10,174.37
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$18,649.00
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$18,649.00
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$17,230.00
Rate for Payer: Anthem Medicare Advantage	$10,174.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$10,174.37
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$10,174.37
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$10,174.37
Rate for Payer: Dean Health DHI/DHP/ASO	$7,795.33
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$10,174.37
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$37,848.66
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$10,174.37
Rate for Payer: Independent Care Health Plan Medicare	$10,174.37
Rate for Payer: Managed Health Services Medicare Advantage	$10,174.37
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$10,174.37
Rate for Payer: NAPHCARE Commercial	$15,261.56
Rate for Payer: Quartz Medicare Advantage	$10,174.37
Rate for Payer: The Alliance Commercial	$40,697.48
Rate for Payer: United Healthcare Medicare Advantage	$10,174.37
Rate for Payer: United Healthcare PPO	$9,596.00
Rate for Payer: Wellcare Medicare	$10,174.37

Know your out-of-pocket cost for care.

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