|
Laparoscopy, surgical, gastric restrictive procedure; removal of adjustable gastric restrictive device and subcutaneous port components
|
Facility
|
OP
|
$16,229.82
|
|
|
Service Code
|
CPT 43774
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,057.46 |
| Max. Negotiated Rate |
$16,229.82 |
| Rate for Payer: Aetna Managed Medicare |
$4,057.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,303.28
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$4,057.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,057.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,057.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,057.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,057.46
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,093.74
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,057.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,057.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,057.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,057.46
|
| Rate for Payer: NAPHCARE Commercial |
$6,086.18
|
| Rate for Payer: Quartz Medicare Advantage |
$4,057.46
|
| Rate for Payer: The Alliance Commercial |
$16,229.82
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,057.46
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: Wellcare Medicare |
$4,057.46
|
|
|
Laparoscopy, surgical, myomectomy, excision; 1 to 4 intramural myomas with total weight of 250 g or less and/or removal of surface myomas
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 58545
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
Laparoscopy, surgical; repair initial inguinal hernia
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 49650
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
Laparoscopy, surgical; repair recurrent inguinal hernia
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 49651
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
Laparoscopy, surgical, supracervical hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
|
Facility
|
OP
|
$44,746.87
|
|
|
Service Code
|
CPT 58542
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,979.84 |
| Max. Negotiated Rate |
$44,746.87 |
| Rate for Payer: Wellcare Medicare |
$11,186.72
|
| Rate for Payer: Aetna Managed Medicare |
$11,186.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,186.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,186.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,186.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,614.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,186.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,186.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,186.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,186.72
|
| Rate for Payer: NAPHCARE Commercial |
$16,780.08
|
| Rate for Payer: Quartz Medicare Advantage |
$11,186.72
|
| Rate for Payer: The Alliance Commercial |
$44,746.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,186.72
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
|
|
Laparoscopy, surgical; with aspiration of cavity or cyst (e.g., ovarian cyst) (single or multiple)
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 49322
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
LAPAROSCOPY, SURGICAL; WITH BIOPSY (SINGLE OR MULTIPLE)
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 49321
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
Laparoscopy, surgical; with fulguration of oviducts (with or without transection)
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 58670
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
Laparoscopy, surgical; with fulguration or excision of lesions of the ovary, pelvic viscera, or peritoneal surface by any method
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 58662
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
LAPAROSCOPY, SURGICAL; WITH INSERTION OF TUNNELED INTRAPERITONEAL CATHETER
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 49324
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
LAPAROSCOPY, SURGICAL; WITH LYSIS OF ADHESIONS (SALPINGOLYSIS, OVARIOLYSIS) (SEPARATE PROCEDURE)
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 58660
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
LAPAROSCOPY, SURGICAL; WITH PLACEMENT OF INTERSTITIAL DEVICE(S) FOR RADIATION THERAPY GUIDANCE (EG, FIDUCIAL MARKERS, DOSIMETER), INTRA-ABDOMINAL, INTRAPELVIC, AND/OR RETROPERITONEUM, INCLUDING IMAGING GUIDANCE, IF PERFORMED, SINGLE OR MULTIPLE (LIST SEPARATELY IN ADDITION TO CODE FOR PRIMARY PROCEDURE)
|
Facility
|
OP
|
$4,386.95
|
|
|
Service Code
|
CPT 49327
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$422.99 |
| Max. Negotiated Rate |
$4,386.95 |
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: The Alliance Commercial |
$422.99
|
|
|
Laparoscopy, surgical; with removal of adnexal structures (partial or total oophorectomy and/or salpingectomy)
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 58661
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
LAPAROSCOPY, SURGICAL; WITH REVISION OF PREVIOUSLY PLACED INTRAPERITONEAL CANNULA OR CATHETER, WITH REMOVAL OF INTRALUMINAL OBSTRUCTIVE MATERIAL IF PERFORMED
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 49325
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less;
|
Facility
|
OP
|
$44,746.87
|
|
|
Service Code
|
CPT 58570
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,107.14 |
| Max. Negotiated Rate |
$44,746.87 |
| Rate for Payer: Aetna Managed Medicare |
$11,186.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,186.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,186.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,186.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,614.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,186.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,186.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,186.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,186.72
|
| Rate for Payer: NAPHCARE Commercial |
$16,780.08
|
| Rate for Payer: Quartz Medicare Advantage |
$11,186.72
|
| Rate for Payer: The Alliance Commercial |
$44,746.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,186.72
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$11,186.72
|
|
|
Laparoscopy, surgical, with total hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
|
Facility
|
OP
|
$44,746.87
|
|
|
Service Code
|
CPT 58571
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,107.14 |
| Max. Negotiated Rate |
$44,746.87 |
| Rate for Payer: Aetna Managed Medicare |
$11,186.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,186.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,186.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,186.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,614.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,186.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,186.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,186.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,186.72
|
| Rate for Payer: NAPHCARE Commercial |
$16,780.08
|
| Rate for Payer: Quartz Medicare Advantage |
$11,186.72
|
| Rate for Payer: The Alliance Commercial |
$44,746.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,186.72
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$11,186.72
|
|
|
Laparoscopy, surgical, with total hysterectomy, for uterus greater than 250 g; with removal of tube(s) and/or ovary(s)
|
Facility
|
OP
|
$44,746.87
|
|
|
Service Code
|
CPT 58573
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,107.14 |
| Max. Negotiated Rate |
$44,746.87 |
| Rate for Payer: Aetna Managed Medicare |
$11,186.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,186.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,186.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,107.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,186.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,614.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,186.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,186.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,186.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,186.72
|
| Rate for Payer: NAPHCARE Commercial |
$16,780.08
|
| Rate for Payer: Quartz Medicare Advantage |
$11,186.72
|
| Rate for Payer: The Alliance Commercial |
$44,746.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,186.72
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$11,186.72
|
|
|
LAPAROSCOPY, SURGICAL, WITH VAGINAL HYSTERECTOMY, FOR UTERUS 250 G OR LESS;
|
Facility
|
OP
|
$25,449.01
|
|
|
Service Code
|
CPT 58550
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,476.64 |
| Max. Negotiated Rate |
$25,449.01 |
| Rate for Payer: Aetna Managed Medicare |
$6,362.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,758.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$12,483.12
|
| Rate for Payer: Anthem Medicare Advantage |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,362.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,362.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,362.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,362.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,667.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,362.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,362.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,362.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,362.25
|
| Rate for Payer: NAPHCARE Commercial |
$9,543.38
|
| Rate for Payer: Quartz Medicare Advantage |
$6,362.25
|
| Rate for Payer: The Alliance Commercial |
$25,449.01
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,362.25
|
| Rate for Payer: United Healthcare PPO |
$5,476.64
|
| Rate for Payer: Wellcare Medicare |
$6,362.25
|
|
|
Laparoscopy, surgical, with vaginal hysterectomy, for uterus 250 g or less; with removal of tube(s) and/or ovary(s)
|
Facility
|
OP
|
$44,746.87
|
|
|
Service Code
|
CPT 58552
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,979.84 |
| Max. Negotiated Rate |
$44,746.87 |
| Rate for Payer: Aetna Managed Medicare |
$11,186.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Anthem Medicare Advantage |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,186.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,186.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,186.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,490.12
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,186.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,614.59
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,186.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,186.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,186.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,186.72
|
| Rate for Payer: NAPHCARE Commercial |
$16,780.08
|
| Rate for Payer: Quartz Medicare Advantage |
$11,186.72
|
| Rate for Payer: The Alliance Commercial |
$44,746.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,186.72
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: Wellcare Medicare |
$11,186.72
|
|
|
LAPAROTOMY, GENERAL, EXPLORATORY
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2960038
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,447.61 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$2,997.07
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
LAPAROTOMY, GENERAL, EXPLORATORY
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2960038
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,398.63 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,398.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,246.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,497.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,397.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,795.35
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,746.34
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,997.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$3,246.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,997.07
|
| Rate for Payer: The Alliance Commercial |
$2,497.56
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
LAPAROTOMY, GYNE, EXPLORATORY
|
Facility
|
IP
|
$4,803.00
|
|
| Hospital Charge Code |
2960039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,447.61 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$2,997.07
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
LAPAROTOMY, GYNE, EXPLORATORY
|
Facility
|
OP
|
$4,803.00
|
|
| Hospital Charge Code |
2960039
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,398.63 |
| Max. Negotiated Rate |
$4,595.51 |
| Rate for Payer: Aetna Commercial |
$4,495.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,295.80
|
| Rate for Payer: Aetna Managed Medicare |
$1,398.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,246.83
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,497.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,397.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,647.41
|
| Rate for Payer: Cash Price |
$1,440.90
|
| Rate for Payer: Cigna Commercial |
$4,595.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,795.35
|
| Rate for Payer: Health EOS Commercial |
$4,445.66
|
| Rate for Payer: HFN Commercial |
$4,595.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,746.34
|
| Rate for Payer: Multiplan Commercial |
$3,996.10
|
| Rate for Payer: NAPHCARE Commercial |
$2,997.07
|
| Rate for Payer: Preferred Network Access Commercial |
$4,595.51
|
| Rate for Payer: Quartz Beloit One Network |
$2,447.61
|
| Rate for Payer: Quartz Commercial |
$3,246.83
|
| Rate for Payer: Quartz Medicare Advantage |
$2,997.07
|
| Rate for Payer: The Alliance Commercial |
$2,497.56
|
| Rate for Payer: WEA Trust Commercial |
$2,747.32
|
| Rate for Payer: WPS Commercial |
$3,699.75
|
|
|
LAP-BAND PORT ADJUSTMENT
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960175
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
LAP-BAND PORT ADJUSTMENT
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960175
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
