|
Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral recess stenosis]), single vertebral segment; each additional vertebral segment, cervical, thoracic, or lumbar (list separately in addition to code for primary procedure)
|
Facility
|
OP
|
$8,673.35
|
|
|
Service Code
|
CPT 63048
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$667.14 |
| Max. Negotiated Rate |
$8,673.35 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: The Alliance Commercial |
$667.14
|
|
|
Laminectomy, facetectomy and foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s], [e.g., spinal or lateral recess stenosis]), single vertebral segment; lumbar
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 63047
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [e.g., spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; each additional vertebral segment (list separately in addition to code for primary procedure)
|
Facility
|
OP
|
$728.21
|
|
|
Service Code
|
CPT 63053
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$728.21 |
| Max. Negotiated Rate |
$728.21 |
| Rate for Payer: The Alliance Commercial |
$728.21
|
|
|
Laminectomy, facetectomy, or foraminotomy (unilateral or bilateral with decompression of spinal cord, cauda equina and/or nerve root[s] [e.g., spinal or lateral recess stenosis]), during posterior interbody arthrodesis, lumbar; single vertebral segment (list separately in addition to code for primary procedure)
|
Facility
|
OP
|
$818.06
|
|
|
Service Code
|
CPT 63052
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$818.06 |
| Max. Negotiated Rate |
$818.06 |
| Rate for Payer: The Alliance Commercial |
$818.06
|
|
|
LAMINECTOMY FOR EXCISION OR EVACUATION OF INTRASPINAL LESION OTHER THAN NEOPLASM, EXTRADURAL; LUMBAR
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 63267
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
LAMINOPLASTY, CERVICAL, WITH DECOMPRESSION OF THE SPINAL CORD, 2 OR MORE VERTEBRAL SEGMENTS;
|
Facility
|
OP
|
$18,182.32
|
|
|
Service Code
|
CPT 63050
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,090.63 |
| Max. Negotiated Rate |
$18,182.32 |
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: The Alliance Commercial |
$5,090.63
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc; 1 interspace, lumbar
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 63030
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
LAMINOTOMY (HEMILAMINECTOMY), WITH DECOMPRESSION OF NERVE ROOT(S), INCLUDING PARTIAL FACETECTOMY, FORAMINOTOMY AND/OR EXCISION OF HERNIATED INTERVERTEBRAL DISC; EACH ADDITIONAL INTERSPACE, CERVICAL OR LUMBAR (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$8,673.35
|
|
|
Service Code
|
CPT 63035
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$738.90 |
| Max. Negotiated Rate |
$8,673.35 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: The Alliance Commercial |
$738.90
|
|
|
Laminotomy (hemilaminectomy), with decompression of nerve root(s), including partial facetectomy, foraminotomy and/or excision of herniated intervertebral disc, reexploration, single interspace; lumbar
|
Facility
|
OP
|
$30,545.47
|
|
|
Service Code
|
CPT 63042
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,636.37 |
| Max. Negotiated Rate |
$30,545.47 |
| Rate for Payer: Aetna Managed Medicare |
$7,636.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,724.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,889.12
|
| Rate for Payer: Anthem Medicare Advantage |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,636.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,636.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,636.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,673.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,636.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,407.28
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,636.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,636.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,636.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,636.37
|
| Rate for Payer: NAPHCARE Commercial |
$11,454.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,636.37
|
| Rate for Payer: The Alliance Commercial |
$30,545.47
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,636.37
|
| Rate for Payer: United Healthcare PPO |
$8,790.08
|
| Rate for Payer: Wellcare Medicare |
$7,636.37
|
|
|
Lamotrigine Level
|
Facility
|
OP
|
$168.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
978002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.11
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.87
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$97.78
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.26
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.78
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.78
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$113.57
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$55.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: United Healthcare PPO |
$131.04
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: Wellcare Medicare |
$13.78
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
Lamotrigine Level
|
Professional
|
Both
|
$168.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
978002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.78 |
| Max. Negotiated Rate |
$165.98 |
| Rate for Payer: Aetna Commercial |
$165.98
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Aetna Managed Medicare |
$13.78
|
| Rate for Payer: Anthem Medicare Advantage |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.78
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$165.98
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$87.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13.78
|
| Rate for Payer: Health EOS Commercial |
$159.00
|
| Rate for Payer: HFN Commercial |
$165.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$48.64
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$48.64
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.78
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: NAPHCARE Commercial |
$20.67
|
| Rate for Payer: Preferred Network Access Commercial |
$165.98
|
| Rate for Payer: Quartz Beloit One Network |
$76.88
|
| Rate for Payer: Quartz Commercial |
$99.59
|
| Rate for Payer: Quartz Medicare Advantage |
$13.78
|
| Rate for Payer: The Alliance Commercial |
$54.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.78
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$60.63
|
|
|
Lamotrigine Level
|
Facility
|
IP
|
$168.00
|
|
|
Service Code
|
CPT 80175
|
| Hospital Charge Code |
978002
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$85.61 |
| Max. Negotiated Rate |
$160.74 |
| Rate for Payer: Aetna Commercial |
$157.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$150.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$92.60
|
| Rate for Payer: Cash Price |
$50.40
|
| Rate for Payer: Cigna Commercial |
$160.74
|
| Rate for Payer: Health EOS Commercial |
$155.50
|
| Rate for Payer: HFN Commercial |
$160.74
|
| Rate for Payer: Multiplan Commercial |
$139.78
|
| Rate for Payer: Preferred Network Access Commercial |
$160.74
|
| Rate for Payer: Quartz Beloit One Network |
$85.61
|
| Rate for Payer: Quartz Commercial |
$104.83
|
| Rate for Payer: WEA Trust Commercial |
$96.10
|
| Rate for Payer: WPS Commercial |
$129.41
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960173
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC APPENDECTOMY
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960173
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED COLON RESECTION
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960527
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED COLON RESECTION
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960527
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED HEMICOLECTOMY/TRANSVERSE COLECTOMY/COLECTOMY
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED HEMICOLECTOMY/TRANSVERSE COLECTOMY/COLECTOMY
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960522
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED PERITONEAL DIALYSIS CATHETER
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
4075903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED PERITONEAL DIALYSIS CATHETER
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
4075903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY (LAVH)
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2950463
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC ASSISTED VAGINAL HYSTERECTOMY (LAVH)
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2950463
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY
|
Facility
|
OP
|
$7,229.00
|
|
| Hospital Charge Code |
2960177
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,105.08 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,105.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,886.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,759.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,608.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,207.28
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,638.62
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: NAPHCARE Commercial |
$4,510.90
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,886.80
|
| Rate for Payer: Quartz Medicare Advantage |
$4,510.90
|
| Rate for Payer: The Alliance Commercial |
$3,759.08
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY
|
Facility
|
IP
|
$7,229.00
|
|
| Hospital Charge Code |
2960177
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,683.90 |
| Max. Negotiated Rate |
$6,916.71 |
| Rate for Payer: Aetna Commercial |
$6,766.34
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,465.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,984.62
|
| Rate for Payer: Cash Price |
$2,168.70
|
| Rate for Payer: Cigna Commercial |
$6,916.71
|
| Rate for Payer: Health EOS Commercial |
$6,691.16
|
| Rate for Payer: HFN Commercial |
$6,916.71
|
| Rate for Payer: Multiplan Commercial |
$6,014.53
|
| Rate for Payer: Preferred Network Access Commercial |
$6,916.71
|
| Rate for Payer: Quartz Beloit One Network |
$3,683.90
|
| Rate for Payer: Quartz Commercial |
$4,510.90
|
| Rate for Payer: WEA Trust Commercial |
$4,134.99
|
| Rate for Payer: WPS Commercial |
$5,568.50
|
|
|
LAPAROSCOPIC CHOLECYSTECTOMY WITHOUT C.D.E. WITH CC
|
Facility
|
IP
|
$45,531.20
|
|
|
Service Code
|
MSDRG 418
|
| Min. Negotiated Rate |
$17,732.50 |
| Max. Negotiated Rate |
$45,531.20 |
| Rate for Payer: Aetna Managed Medicare |
$17,732.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,909.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,290.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,878.04
|
| Rate for Payer: Anthem Medicare Advantage |
$17,732.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,732.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,732.50
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,732.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,837.08
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,732.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,151.72
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,732.50
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,732.50
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,732.50
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,732.50
|
| Rate for Payer: NAPHCARE Commercial |
$26,598.75
|
| Rate for Payer: Quartz Medicare Advantage |
$17,732.50
|
| Rate for Payer: The Alliance Commercial |
$45,531.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,732.50
|
| Rate for Payer: United Healthcare PPO |
$25,809.04
|
| Rate for Payer: Wellcare Medicare |
$17,732.50
|
|
