|
VACURETTE 7MM CURVE 21853/022107-10
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
2965916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VACURETTE 7MM CURVE 21853/022107-10
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
2965916
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$24.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$53.40
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VACURETTE 8MM CURVE 20317/022108-10
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
2965917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$24.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$53.40
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VACURETTE 8MM CURVE 20317/022108-10
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
2965917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VACURETTE 8MM STRAIGHT 21655/22208-10
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
2965918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.61 |
| Max. Negotiated Rate |
$81.88 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$53.40
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VACURETTE 8MM STRAIGHT 21655/22208-10
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
2965918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.92 |
| Max. Negotiated Rate |
$356.00 |
| Rate for Payer: Aetna Commercial |
$80.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.54
|
| Rate for Payer: Aetna Managed Medicare |
$24.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$57.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.17
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$81.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$49.80
|
| Rate for Payer: Health EOS Commercial |
$79.21
|
| Rate for Payer: HFN Commercial |
$81.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.75
|
| Rate for Payer: Multiplan Commercial |
$71.20
|
| Rate for Payer: NAPHCARE Commercial |
$53.40
|
| Rate for Payer: Preferred Network Access Commercial |
$81.88
|
| Rate for Payer: Quartz Beloit One Network |
$43.61
|
| Rate for Payer: Quartz Commercial |
$57.85
|
| Rate for Payer: Quartz Medicare Advantage |
$53.40
|
| Rate for Payer: The Alliance Commercial |
$356.00
|
| Rate for Payer: WEA Trust Commercial |
$48.95
|
| Rate for Payer: WPS Commercial |
$65.92
|
|
|
VACURETTE 9MM CURVE 21552/022109-10
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
2965919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$42.14 |
| Max. Negotiated Rate |
$79.12 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$51.60
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
VACURETTE 9MM CURVE 21552/022109-10
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
2965919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$24.08 |
| Max. Negotiated Rate |
$344.00 |
| Rate for Payer: Aetna Commercial |
$77.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$73.96
|
| Rate for Payer: Aetna Managed Medicare |
$24.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$45.58
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$79.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$48.13
|
| Rate for Payer: Health EOS Commercial |
$76.54
|
| Rate for Payer: HFN Commercial |
$79.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.50
|
| Rate for Payer: Multiplan Commercial |
$68.80
|
| Rate for Payer: NAPHCARE Commercial |
$51.60
|
| Rate for Payer: Preferred Network Access Commercial |
$79.12
|
| Rate for Payer: Quartz Beloit One Network |
$42.14
|
| Rate for Payer: Quartz Commercial |
$55.90
|
| Rate for Payer: Quartz Medicare Advantage |
$51.60
|
| Rate for Payer: The Alliance Commercial |
$344.00
|
| Rate for Payer: WEA Trust Commercial |
$47.30
|
| Rate for Payer: WPS Commercial |
$63.70
|
|
|
VACURETTE 9MM STRAIGHT 022209
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
2965920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.16 |
| Max. Negotiated Rate |
$88.00 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Aetna Managed Medicare |
$6.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.31
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.50
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$14.30
|
| Rate for Payer: Quartz Medicare Advantage |
$13.20
|
| Rate for Payer: The Alliance Commercial |
$88.00
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
VACURETTE 9MM STRAIGHT 022209
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
2965920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$10.78 |
| Max. Negotiated Rate |
$20.24 |
| Rate for Payer: Aetna Commercial |
$19.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11.66
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$20.24
|
| Rate for Payer: Health EOS Commercial |
$19.58
|
| Rate for Payer: HFN Commercial |
$20.24
|
| Rate for Payer: Multiplan Commercial |
$17.60
|
| Rate for Payer: NAPHCARE Commercial |
$13.20
|
| Rate for Payer: Preferred Network Access Commercial |
$20.24
|
| Rate for Payer: Quartz Beloit One Network |
$10.78
|
| Rate for Payer: Quartz Commercial |
$13.20
|
| Rate for Payer: WEA Trust Commercial |
$12.10
|
| Rate for Payer: WPS Commercial |
$16.30
|
|
|
VACUTAINER STERILE 2/PKG
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2963467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$26.04 |
| Max. Negotiated Rate |
$372.00 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Aetna Managed Medicare |
$26.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$52.04
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.75
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$60.45
|
| Rate for Payer: Quartz Medicare Advantage |
$55.80
|
| Rate for Payer: The Alliance Commercial |
$372.00
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
VACUTAINER STERILE 2/PKG
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2963467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.57 |
| Max. Negotiated Rate |
$85.56 |
| Rate for Payer: Aetna Commercial |
$83.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.29
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$85.56
|
| Rate for Payer: Health EOS Commercial |
$82.77
|
| Rate for Payer: HFN Commercial |
$85.56
|
| Rate for Payer: Multiplan Commercial |
$74.40
|
| Rate for Payer: NAPHCARE Commercial |
$55.80
|
| Rate for Payer: Preferred Network Access Commercial |
$85.56
|
| Rate for Payer: Quartz Beloit One Network |
$45.57
|
| Rate for Payer: Quartz Commercial |
$55.80
|
| Rate for Payer: WEA Trust Commercial |
$51.15
|
| Rate for Payer: WPS Commercial |
$68.89
|
|
|
VACUUM CUP KIWI OMNICUP VAC-6000M
|
Facility
|
IP
|
$502.00
|
|
| Hospital Charge Code |
2963166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$245.98 |
| Max. Negotiated Rate |
$461.84 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$301.20
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$301.20
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
VACUUM CUP KIWI OMNICUP VAC-6000M
|
Facility
|
OP
|
$502.00
|
|
| Hospital Charge Code |
2963166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$140.56 |
| Max. Negotiated Rate |
$2,008.00 |
| Rate for Payer: Aetna Commercial |
$451.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$431.72
|
| Rate for Payer: Aetna Managed Medicare |
$140.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$326.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$251.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$240.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$266.06
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$461.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$280.92
|
| Rate for Payer: Health EOS Commercial |
$446.78
|
| Rate for Payer: HFN Commercial |
$461.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$376.50
|
| Rate for Payer: Multiplan Commercial |
$401.60
|
| Rate for Payer: NAPHCARE Commercial |
$301.20
|
| Rate for Payer: Preferred Network Access Commercial |
$461.84
|
| Rate for Payer: Quartz Beloit One Network |
$245.98
|
| Rate for Payer: Quartz Commercial |
$326.30
|
| Rate for Payer: Quartz Medicare Advantage |
$301.20
|
| Rate for Payer: The Alliance Commercial |
$2,008.00
|
| Rate for Payer: WEA Trust Commercial |
$276.10
|
| Rate for Payer: WPS Commercial |
$371.83
|
|
|
Vacuum Extraction-Kiwi - Individual Charges
|
Facility
|
OP
|
$1,161.00
|
|
| Hospital Charge Code |
3003918
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$325.08 |
| Max. Negotiated Rate |
$4,644.00 |
| Rate for Payer: Aetna Commercial |
$1,044.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$998.46
|
| Rate for Payer: Aetna Managed Medicare |
$325.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$754.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$580.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$557.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.33
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna Commercial |
$1,068.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$649.70
|
| Rate for Payer: Health EOS Commercial |
$1,033.29
|
| Rate for Payer: HFN Commercial |
$1,068.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$870.75
|
| Rate for Payer: Multiplan Commercial |
$928.80
|
| Rate for Payer: NAPHCARE Commercial |
$696.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.12
|
| Rate for Payer: Quartz Beloit One Network |
$568.89
|
| Rate for Payer: Quartz Commercial |
$754.65
|
| Rate for Payer: Quartz Medicare Advantage |
$696.60
|
| Rate for Payer: The Alliance Commercial |
$4,644.00
|
| Rate for Payer: United Healthcare PPO |
$870.75
|
| Rate for Payer: WEA Trust Commercial |
$638.55
|
| Rate for Payer: WPS Commercial |
$859.95
|
|
|
Vacuum Extraction-Kiwi - Individual Charges
|
Facility
|
IP
|
$1,161.00
|
|
| Hospital Charge Code |
3003918
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$568.89 |
| Max. Negotiated Rate |
$1,068.12 |
| Rate for Payer: Aetna Commercial |
$1,044.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$998.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$615.33
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna Commercial |
$1,068.12
|
| Rate for Payer: Health EOS Commercial |
$1,033.29
|
| Rate for Payer: HFN Commercial |
$1,068.12
|
| Rate for Payer: Multiplan Commercial |
$928.80
|
| Rate for Payer: NAPHCARE Commercial |
$696.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,068.12
|
| Rate for Payer: Quartz Beloit One Network |
$568.89
|
| Rate for Payer: Quartz Commercial |
$696.60
|
| Rate for Payer: WEA Trust Commercial |
$638.55
|
| Rate for Payer: WPS Commercial |
$859.95
|
|
|
VACUUM LINE CELL SAVER ELITE SMARTSUCTION FILTERED NON-STERILE HAR-A-1000
|
Facility
|
OP
|
$246.00
|
|
| Hospital Charge Code |
5804220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$68.88 |
| Max. Negotiated Rate |
$984.00 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Aetna Managed Medicare |
$68.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$159.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$123.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$118.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137.66
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$184.50
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$159.90
|
| Rate for Payer: Quartz Medicare Advantage |
$147.60
|
| Rate for Payer: The Alliance Commercial |
$984.00
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
VACUUM LINE CELL SAVER ELITE SMARTSUCTION FILTERED NON-STERILE HAR-A-1000
|
Facility
|
IP
|
$246.00
|
|
| Hospital Charge Code |
5804220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$120.54 |
| Max. Negotiated Rate |
$226.32 |
| Rate for Payer: Aetna Commercial |
$221.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$211.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$130.38
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$226.32
|
| Rate for Payer: Health EOS Commercial |
$218.94
|
| Rate for Payer: HFN Commercial |
$226.32
|
| Rate for Payer: Multiplan Commercial |
$196.80
|
| Rate for Payer: NAPHCARE Commercial |
$147.60
|
| Rate for Payer: Preferred Network Access Commercial |
$226.32
|
| Rate for Payer: Quartz Beloit One Network |
$120.54
|
| Rate for Payer: Quartz Commercial |
$147.60
|
| Rate for Payer: WEA Trust Commercial |
$135.30
|
| Rate for Payer: WPS Commercial |
$182.21
|
|
|
VAGAL NERVE STIMULATOR, INSERTION
|
Facility
|
IP
|
$4,048.00
|
|
| Hospital Charge Code |
2960486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,983.52 |
| Max. Negotiated Rate |
$3,724.16 |
| Rate for Payer: Aetna Commercial |
$3,643.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,481.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,145.44
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$3,724.16
|
| Rate for Payer: Health EOS Commercial |
$3,602.72
|
| Rate for Payer: HFN Commercial |
$3,724.16
|
| Rate for Payer: Multiplan Commercial |
$3,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,428.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,724.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,983.52
|
| Rate for Payer: Quartz Commercial |
$2,428.80
|
| Rate for Payer: WEA Trust Commercial |
$2,226.40
|
| Rate for Payer: WPS Commercial |
$2,998.35
|
|
|
VAGAL NERVE STIMULATOR, INSERTION
|
Facility
|
OP
|
$4,048.00
|
|
| Hospital Charge Code |
2960486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,133.44 |
| Max. Negotiated Rate |
$16,192.00 |
| Rate for Payer: Aetna Commercial |
$3,643.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,481.28
|
| Rate for Payer: Aetna Managed Medicare |
$1,133.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,631.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,024.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,943.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,145.44
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$3,724.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,265.26
|
| Rate for Payer: Health EOS Commercial |
$3,602.72
|
| Rate for Payer: HFN Commercial |
$3,724.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,036.00
|
| Rate for Payer: Multiplan Commercial |
$3,238.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,428.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,724.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,983.52
|
| Rate for Payer: Quartz Commercial |
$2,631.20
|
| Rate for Payer: Quartz Medicare Advantage |
$2,428.80
|
| Rate for Payer: The Alliance Commercial |
$16,192.00
|
| Rate for Payer: WEA Trust Commercial |
$2,226.40
|
| Rate for Payer: WPS Commercial |
$2,998.35
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$44,881.00
|
|
|
Service Code
|
MSDRG 746
|
| Min. Negotiated Rate |
$16,144.30 |
| Max. Negotiated Rate |
$44,881.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,144.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,246.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,016.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,667.04
|
| Rate for Payer: Anthem Medicare Advantage |
$16,144.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,144.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,144.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,144.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,492.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,144.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,683.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,144.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,144.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,144.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,144.30
|
| Rate for Payer: NAPHCARE Commercial |
$24,216.45
|
| Rate for Payer: Quartz Medicare Advantage |
$16,144.30
|
| Rate for Payer: The Alliance Commercial |
$44,881.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,144.30
|
| Rate for Payer: United Healthcare PPO |
$25,444.87
|
| Rate for Payer: Wellcare Medicare |
$16,144.30
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$23,907.00
|
|
|
Service Code
|
MSDRG 747
|
| Min. Negotiated Rate |
$8,599.81 |
| Max. Negotiated Rate |
$23,907.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,599.81
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,672.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,312.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,597.42
|
| Rate for Payer: Anthem Medicare Advantage |
$8,599.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,599.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,599.81
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,599.81
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,094.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,599.81
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,300.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,599.81
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,599.81
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,599.81
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,599.81
|
| Rate for Payer: NAPHCARE Commercial |
$12,899.72
|
| Rate for Payer: Quartz Medicare Advantage |
$8,599.81
|
| Rate for Payer: The Alliance Commercial |
$23,907.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,599.81
|
| Rate for Payer: United Healthcare PPO |
$13,468.58
|
| Rate for Payer: Wellcare Medicare |
$8,599.81
|
|
|
VAGINAL CONDYLOMA, CAUTERY OF
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959949
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$603.60
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
VAGINAL CONDYLOMA, CAUTERY OF
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959949
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$281.68 |
| Max. Negotiated Rate |
$4,024.00 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$865.16
|
| Rate for Payer: Aetna Managed Medicare |
$281.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$503.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$533.18
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$925.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.96
|
| Rate for Payer: Health EOS Commercial |
$895.34
|
| Rate for Payer: HFN Commercial |
$925.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$754.50
|
| Rate for Payer: Multiplan Commercial |
$804.80
|
| Rate for Payer: NAPHCARE Commercial |
$603.60
|
| Rate for Payer: Preferred Network Access Commercial |
$925.52
|
| Rate for Payer: Quartz Beloit One Network |
$492.94
|
| Rate for Payer: Quartz Commercial |
$653.90
|
| Rate for Payer: Quartz Medicare Advantage |
$603.60
|
| Rate for Payer: The Alliance Commercial |
$4,024.00
|
| Rate for Payer: WEA Trust Commercial |
$553.30
|
| Rate for Payer: WPS Commercial |
$745.14
|
|
|
VAGINAL DELIVERY IN OPERATING ROOM
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2960488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$75.60 |
| Max. Negotiated Rate |
$1,080.00 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| Rate for Payer: Aetna Managed Medicare |
$75.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$175.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$129.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$143.10
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$248.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$151.09
|
| Rate for Payer: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$202.50
|
| Rate for Payer: Multiplan Commercial |
$216.00
|
| Rate for Payer: NAPHCARE Commercial |
$162.00
|
| Rate for Payer: Preferred Network Access Commercial |
$248.40
|
| Rate for Payer: Quartz Beloit One Network |
$132.30
|
| Rate for Payer: Quartz Commercial |
$175.50
|
| Rate for Payer: Quartz Medicare Advantage |
$162.00
|
| Rate for Payer: The Alliance Commercial |
$1,080.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
