|
VAGINAL DELIVERY IN OPERATING ROOM
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2960488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$132.30 |
| Max. Negotiated Rate |
$248.40 |
| Rate for Payer: Aetna Commercial |
$243.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$232.20
|
| 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: Health EOS Commercial |
$240.30
|
| Rate for Payer: HFN Commercial |
$248.40
|
| 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 |
$162.00
|
| Rate for Payer: WEA Trust Commercial |
$148.50
|
| Rate for Payer: WPS Commercial |
$199.99
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$32,705.00
|
|
|
Service Code
|
MSDRG 768
|
| Min. Negotiated Rate |
$7,639.00 |
| Max. Negotiated Rate |
$32,705.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,764.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,324.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$11,764.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,764.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,764.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,764.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,691.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,764.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,752.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,764.32
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,764.32
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,764.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,764.32
|
| Rate for Payer: NAPHCARE Commercial |
$17,646.48
|
| Rate for Payer: Quartz Medicare Advantage |
$11,764.32
|
| Rate for Payer: The Alliance Commercial |
$32,705.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,764.32
|
| Rate for Payer: United Healthcare PPO |
$10,189.00
|
| Rate for Payer: Wellcare Medicare |
$11,764.32
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
|
IP
|
$20,172.00
|
|
|
Service Code
|
MSDRG 806
|
| Min. Negotiated Rate |
$7,256.18 |
| Max. Negotiated Rate |
$20,172.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,256.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,324.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,256.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,256.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,256.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,256.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,719.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,256.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,560.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,256.18
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,256.18
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,256.18
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,256.18
|
| Rate for Payer: NAPHCARE Commercial |
$10,884.27
|
| Rate for Payer: Quartz Medicare Advantage |
$7,256.18
|
| Rate for Payer: The Alliance Commercial |
$20,172.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,256.18
|
| Rate for Payer: United Healthcare PPO |
$11,335.65
|
| Rate for Payer: Wellcare Medicare |
$7,256.18
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$27,124.00
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$7,639.00 |
| Max. Negotiated Rate |
$27,124.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,756.99
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,324.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9,756.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,756.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,756.99
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,756.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,129.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,756.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,659.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,756.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,756.99
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,756.99
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,756.99
|
| Rate for Payer: NAPHCARE Commercial |
$14,635.48
|
| Rate for Payer: Quartz Medicare Advantage |
$9,756.99
|
| Rate for Payer: The Alliance Commercial |
$27,124.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,756.99
|
| Rate for Payer: United Healthcare PPO |
$15,305.48
|
| Rate for Payer: Wellcare Medicare |
$9,756.99
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$17,716.00
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$6,372.54 |
| Max. Negotiated Rate |
$17,716.00 |
| Rate for Payer: Aetna Managed Medicare |
$6,372.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,324.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$6,372.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,372.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,372.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,372.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,023.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,372.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,758.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,372.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,372.54
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,372.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,372.54
|
| Rate for Payer: NAPHCARE Commercial |
$9,558.81
|
| Rate for Payer: Quartz Medicare Advantage |
$6,372.54
|
| Rate for Payer: The Alliance Commercial |
$17,716.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,372.54
|
| Rate for Payer: United Healthcare PPO |
$9,932.93
|
| Rate for Payer: Wellcare Medicare |
$6,372.54
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$26,797.00
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$7,639.00 |
| Max. Negotiated Rate |
$26,797.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,639.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,324.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9,639.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,639.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,639.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,639.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,959.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,639.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,420.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,639.36
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,639.36
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,639.36
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,639.36
|
| Rate for Payer: NAPHCARE Commercial |
$14,459.04
|
| Rate for Payer: Quartz Medicare Advantage |
$9,639.36
|
| Rate for Payer: The Alliance Commercial |
$26,797.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,639.36
|
| Rate for Payer: United Healthcare PPO |
$15,118.76
|
| Rate for Payer: Wellcare Medicare |
$9,639.36
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$38,030.00
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$7,639.00 |
| Max. Negotiated Rate |
$38,030.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,679.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,324.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$13,679.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,679.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,679.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,679.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,083.17
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,679.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,658.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,679.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,679.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,679.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,679.83
|
| Rate for Payer: NAPHCARE Commercial |
$20,519.74
|
| Rate for Payer: Quartz Medicare Advantage |
$13,679.83
|
| Rate for Payer: The Alliance Commercial |
$38,030.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,679.83
|
| Rate for Payer: United Healthcare PPO |
$21,532.73
|
| Rate for Payer: Wellcare Medicare |
$13,679.83
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$22,522.00
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$7,639.00 |
| Max. Negotiated Rate |
$22,522.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,101.57
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,324.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,101.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,101.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,101.57
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,101.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,737.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,101.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,818.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,101.57
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,101.57
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,101.57
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,101.57
|
| Rate for Payer: NAPHCARE Commercial |
$12,152.36
|
| Rate for Payer: Quartz Medicare Advantage |
$8,101.57
|
| Rate for Payer: The Alliance Commercial |
$22,522.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,101.57
|
| Rate for Payer: United Healthcare PPO |
$12,314.83
|
| Rate for Payer: Wellcare Medicare |
$8,101.57
|
|
|
VAGINAL HYSTERECTOMY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
VAGINAL HYSTERECTOMY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
VAGINAL SPECULA MEDIUM #59001
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
2969788
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$35.40
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
VAGINAL SPECULA MEDIUM #59001
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
2969788
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$16.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.02
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$38.35
|
| Rate for Payer: Quartz Medicare Advantage |
$35.40
|
| Rate for Payer: The Alliance Commercial |
$236.00
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
VAGINAL SPECULA SMALL
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
2969787
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$16.52 |
| Max. Negotiated Rate |
$236.00 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Aetna Managed Medicare |
$16.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$38.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33.02
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.25
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$38.35
|
| Rate for Payer: Quartz Medicare Advantage |
$35.40
|
| Rate for Payer: The Alliance Commercial |
$236.00
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
VAGINAL SPECULA SMALL
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
2969787
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$28.91 |
| Max. Negotiated Rate |
$54.28 |
| Rate for Payer: Aetna Commercial |
$53.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$50.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$31.27
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$54.28
|
| Rate for Payer: Health EOS Commercial |
$52.51
|
| Rate for Payer: HFN Commercial |
$54.28
|
| Rate for Payer: Multiplan Commercial |
$47.20
|
| Rate for Payer: NAPHCARE Commercial |
$35.40
|
| Rate for Payer: Preferred Network Access Commercial |
$54.28
|
| Rate for Payer: Quartz Beloit One Network |
$28.91
|
| Rate for Payer: Quartz Commercial |
$35.40
|
| Rate for Payer: WEA Trust Commercial |
$32.45
|
| Rate for Payer: WPS Commercial |
$43.70
|
|
|
VAGINAL VAULT SUSPENSION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
VAGINAL VAULT SUSPENSION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
VAGOTOMY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,185.40 |
| Max. Negotiated Rate |
$4,103.20 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,676.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
VAGOTOMY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,248.80 |
| Max. Negotiated Rate |
$17,840.00 |
| Rate for Payer: Aetna Commercial |
$4,014.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,835.60
|
| Rate for Payer: Aetna Managed Medicare |
$1,248.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,899.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,140.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,363.80
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,103.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,495.82
|
| Rate for Payer: Health EOS Commercial |
$3,969.40
|
| Rate for Payer: HFN Commercial |
$4,103.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,345.00
|
| Rate for Payer: Multiplan Commercial |
$3,568.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,103.20
|
| Rate for Payer: Quartz Beloit One Network |
$2,185.40
|
| Rate for Payer: Quartz Commercial |
$2,899.00
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.00
|
| Rate for Payer: The Alliance Commercial |
$17,840.00
|
| Rate for Payer: WEA Trust Commercial |
$2,453.00
|
| Rate for Payer: WPS Commercial |
$3,303.52
|
|
|
Valproic Acid, Free
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$378.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.60
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$386.40
|
| Rate for Payer: Health EOS Commercial |
$373.80
|
| Rate for Payer: HFN Commercial |
$386.40
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: NAPHCARE Commercial |
$252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$386.40
|
| Rate for Payer: Quartz Beloit One Network |
$205.80
|
| Rate for Payer: Quartz Commercial |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Valproic Acid, Free
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Health EOS Commercial |
$382.20
|
| Rate for Payer: HFN Commercial |
$399.00
|
| Rate for Payer: Aetna Commercial |
$399.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$399.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$399.00
|
| Rate for Payer: Quartz Beloit One Network |
$184.80
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: The Alliance Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Valproic Acid, Free
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$378.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Aetna Managed Medicare |
$13.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.48
|
| Rate for Payer: Anthem Medicaid |
$13.99
|
| Rate for Payer: Anthem Medicare Advantage |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.54
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$386.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.03
|
| Rate for Payer: Dean Health Medicaid |
$13.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.54
|
| Rate for Payer: Health EOS Commercial |
$373.80
|
| Rate for Payer: HFN Commercial |
$386.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.54
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: NAPHCARE Commercial |
$20.31
|
| Rate for Payer: Preferred Network Access Commercial |
$386.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.99
|
| Rate for Payer: Quartz Beloit One Network |
$205.80
|
| Rate for Payer: Quartz Commercial |
$273.00
|
| Rate for Payer: Quartz Medicare Advantage |
$13.54
|
| Rate for Payer: The Alliance Commercial |
$54.16
|
| Rate for Payer: United Healthcare Medicaid |
$13.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare PPO |
$315.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: Wellcare Medicare |
$13.54
|
| Rate for Payer: WMAP Medicaid |
$13.99
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Valproic Acid Level
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$265.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.40
|
| Rate for Payer: Health EOS Commercial |
$253.89
|
| Rate for Payer: HFN Commercial |
$265.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.80
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: Preferred Network Access Commercial |
$265.05
|
| Rate for Payer: Quartz Beloit One Network |
$122.76
|
| Rate for Payer: Quartz Commercial |
$159.03
|
| Rate for Payer: The Alliance Commercial |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Valproic Acid Level
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.48
|
| Rate for Payer: Anthem Medicaid |
$13.99
|
| Rate for Payer: Anthem Medicare Advantage |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.54
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Dean Health Medicaid |
$13.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.54
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.54
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.31
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.99
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$13.54
|
| Rate for Payer: The Alliance Commercial |
$54.16
|
| Rate for Payer: United Healthcare Medicaid |
$13.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare PPO |
$209.25
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: Wellcare Medicare |
$13.54
|
| Rate for Payer: WMAP Medicaid |
$13.99
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Valproic Acid Level
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
VALVE ANTI-REFLUX SALEM SUMP
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2963636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
