|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$34,864.00
|
|
|
Service Code
|
MS-DRG 741
|
| Min. Negotiated Rate |
$12,540.86 |
| Max. Negotiated Rate |
$34,864.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,540.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,274.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,905.30
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,861.40
|
| Rate for Payer: Anthem Medicare Advantage |
$12,540.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,540.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,540.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,540.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,047.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,540.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,336.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,540.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,540.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,540.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,540.86
|
| Rate for Payer: NAPHCARE Commercial |
$18,811.29
|
| Rate for Payer: Quartz Medicare Advantage |
$12,540.86
|
| Rate for Payer: The Alliance Commercial |
$34,864.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,540.86
|
| Rate for Payer: United Healthcare PPO |
$19,724.67
|
| Rate for Payer: Wellcare Medicare |
$12,540.86
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
IP
|
$52,796.00
|
|
|
Service Code
|
MS-DRG 737
|
| Min. Negotiated Rate |
$18,991.30 |
| Max. Negotiated Rate |
$52,796.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,991.30
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$41,330.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,679.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,097.66
|
| Rate for Payer: Anthem Medicare Advantage |
$18,991.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,991.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,991.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,991.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,411.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,991.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,489.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,991.30
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,991.30
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,991.30
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,991.30
|
| Rate for Payer: NAPHCARE Commercial |
$28,486.95
|
| Rate for Payer: Quartz Medicare Advantage |
$18,991.30
|
| Rate for Payer: The Alliance Commercial |
$52,796.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,991.30
|
| Rate for Payer: United Healthcare PPO |
$29,964.26
|
| Rate for Payer: Wellcare Medicare |
$18,991.30
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
IP
|
$103,665.00
|
|
|
Service Code
|
MS-DRG 736
|
| Min. Negotiated Rate |
$37,289.70 |
| Max. Negotiated Rate |
$103,665.00 |
| Rate for Payer: Aetna Managed Medicare |
$37,289.70
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81,612.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62,555.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$59,431.42
|
| Rate for Payer: Anthem Medicare Advantage |
$37,289.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37,289.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37,289.70
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37,289.70
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$65,974.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37,289.70
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$75,800.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37,289.70
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37,289.70
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37,289.70
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37,289.70
|
| Rate for Payer: NAPHCARE Commercial |
$55,934.55
|
| Rate for Payer: Quartz Medicare Advantage |
$37,289.70
|
| Rate for Payer: The Alliance Commercial |
$103,665.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,289.70
|
| Rate for Payer: United Healthcare PPO |
$59,011.58
|
| Rate for Payer: Wellcare Medicare |
$37,289.70
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
IP
|
$36,600.00
|
|
|
Service Code
|
MS-DRG 738
|
| Min. Negotiated Rate |
$13,165.35 |
| Max. Negotiated Rate |
$36,600.00 |
| Rate for Payer: Aetna Managed Medicare |
$13,165.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,532.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,870.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,778.08
|
| Rate for Payer: Anthem Medicare Advantage |
$13,165.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,165.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,165.35
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,165.35
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,065.57
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,165.35
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,609.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,165.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,165.35
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,165.35
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,165.35
|
| Rate for Payer: NAPHCARE Commercial |
$19,748.02
|
| Rate for Payer: Quartz Medicare Advantage |
$13,165.35
|
| Rate for Payer: The Alliance Commercial |
$36,600.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,165.35
|
| Rate for Payer: United Healthcare PPO |
$20,715.99
|
| Rate for Payer: Wellcare Medicare |
$13,165.35
|
|
|
UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE
|
Facility
OP
|
$14,735.44
|
|
|
Service Code
|
CPT 59870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,726.00 |
| Max. Negotiated Rate |
$14,735.44 |
| Rate for Payer: Aetna Managed Medicare |
$3,090.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,496.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,871.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,726.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,090.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,090.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,090.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,218.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,090.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,495.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,090.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,090.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,090.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,090.12
|
| Rate for Payer: NAPHCARE Commercial |
$4,635.18
|
| Rate for Payer: Quartz Medicare Advantage |
$3,090.12
|
| Rate for Payer: The Alliance Commercial |
$14,735.44
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,090.12
|
| Rate for Payer: United Healthcare PPO |
$3,583.00
|
| Rate for Payer: Wellcare Medicare |
$3,090.12
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 2.5CM AD750SC-KE25
|
Facility
IP
|
$2,512.00
|
|
| Hospital Charge Code |
5459712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,230.88 |
| Max. Negotiated Rate |
$2,311.04 |
| Rate for Payer: Aetna Commercial |
$2,260.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,331.36
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cigna Commercial |
$2,311.04
|
| Rate for Payer: Health EOS Commercial |
$2,235.68
|
| Rate for Payer: HFN Commercial |
$2,311.04
|
| Rate for Payer: Multiplan Commercial |
$2,009.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,507.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,311.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.88
|
| Rate for Payer: Quartz Commercial |
$1,507.20
|
| Rate for Payer: WEA Trust Commercial |
$1,381.60
|
| Rate for Payer: WPS Commercial |
$1,860.64
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 2.5CM AD750SC-KE25
|
Facility
OP
|
$2,512.00
|
|
| Hospital Charge Code |
5459712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$703.36 |
| Max. Negotiated Rate |
$10,048.00 |
| Rate for Payer: Aetna Commercial |
$2,260.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,160.32
|
| Rate for Payer: Aetna Managed Medicare |
$703.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,632.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,256.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,205.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,331.36
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cigna Commercial |
$2,311.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,405.72
|
| Rate for Payer: Health EOS Commercial |
$2,235.68
|
| Rate for Payer: HFN Commercial |
$2,311.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,884.00
|
| Rate for Payer: Multiplan Commercial |
$2,009.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,507.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,311.04
|
| Rate for Payer: Quartz Beloit One Network |
$1,230.88
|
| Rate for Payer: Quartz Commercial |
$1,632.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,507.20
|
| Rate for Payer: The Alliance Commercial |
$10,048.00
|
| Rate for Payer: WEA Trust Commercial |
$1,381.60
|
| Rate for Payer: WPS Commercial |
$1,860.64
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.0CM AD750SC-KE30
|
Facility
IP
|
$2,608.00
|
|
| Hospital Charge Code |
5459713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,277.92 |
| Max. Negotiated Rate |
$2,399.36 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,564.80
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.0CM AD750SC-KE30
|
Facility
OP
|
$2,608.00
|
|
| Hospital Charge Code |
5459713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.24 |
| Max. Negotiated Rate |
$10,432.00 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,242.88
|
| Rate for Payer: Aetna Managed Medicare |
$730.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,695.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,304.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,459.44
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,956.00
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,695.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,564.80
|
| Rate for Payer: The Alliance Commercial |
$10,432.00
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.5CM AD750SC-KE35
|
Facility
IP
|
$2,608.00
|
|
| Hospital Charge Code |
5459563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,277.92 |
| Max. Negotiated Rate |
$2,399.36 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,564.80
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.5CM AD750SC-KE35
|
Facility
OP
|
$2,608.00
|
|
| Hospital Charge Code |
5459563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.24 |
| Max. Negotiated Rate |
$10,432.00 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,242.88
|
| Rate for Payer: Aetna Managed Medicare |
$730.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,695.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,304.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,459.44
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,956.00
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,695.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,564.80
|
| Rate for Payer: The Alliance Commercial |
$10,432.00
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 4.0CM AD750SC-KE40
|
Facility
IP
|
$2,608.00
|
|
| Hospital Charge Code |
5459714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,277.92 |
| Max. Negotiated Rate |
$2,399.36 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,564.80
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 4.0CM AD750SC-KE40
|
Facility
OP
|
$2,608.00
|
|
| Hospital Charge Code |
5459714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$730.24 |
| Max. Negotiated Rate |
$10,432.00 |
| Rate for Payer: Aetna Commercial |
$2,347.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,242.88
|
| Rate for Payer: Aetna Managed Medicare |
$730.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,695.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,304.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,251.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,382.24
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,399.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,459.44
|
| Rate for Payer: Health EOS Commercial |
$2,321.12
|
| Rate for Payer: HFN Commercial |
$2,399.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,956.00
|
| Rate for Payer: Multiplan Commercial |
$2,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,564.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,399.36
|
| Rate for Payer: Quartz Beloit One Network |
$1,277.92
|
| Rate for Payer: Quartz Commercial |
$1,695.20
|
| Rate for Payer: Quartz Medicare Advantage |
$1,564.80
|
| Rate for Payer: The Alliance Commercial |
$10,432.00
|
| Rate for Payer: WEA Trust Commercial |
$1,434.40
|
| Rate for Payer: WPS Commercial |
$1,931.75
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 30MM CUP 110030
|
Facility
IP
|
$2,396.00
|
|
| Hospital Charge Code |
5603652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 30MM CUP 110030
|
Facility
OP
|
$2,396.00
|
|
| Hospital Charge Code |
5603652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.88 |
| Max. Negotiated Rate |
$9,584.00 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Aetna Managed Medicare |
$670.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.80
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,797.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.60
|
| Rate for Payer: The Alliance Commercial |
$9,584.00
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 35MM CUP 110035
|
Facility
OP
|
$2,396.00
|
|
| Hospital Charge Code |
5603653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.88 |
| Max. Negotiated Rate |
$9,584.00 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Aetna Managed Medicare |
$670.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.80
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,797.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.60
|
| Rate for Payer: The Alliance Commercial |
$9,584.00
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 35MM CUP 110035
|
Facility
IP
|
$2,396.00
|
|
| Hospital Charge Code |
5603653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 40MM CUP 110040
|
Facility
IP
|
$2,396.00
|
|
| Hospital Charge Code |
5603654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,174.04 |
| Max. Negotiated Rate |
$2,204.32 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,437.60
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 40MM CUP 110040
|
Facility
OP
|
$2,396.00
|
|
| Hospital Charge Code |
5603654
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$670.88 |
| Max. Negotiated Rate |
$9,584.00 |
| Rate for Payer: Aetna Commercial |
$2,156.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,060.56
|
| Rate for Payer: Aetna Managed Medicare |
$670.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,557.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,198.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,150.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,269.88
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,204.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,340.80
|
| Rate for Payer: Health EOS Commercial |
$2,132.44
|
| Rate for Payer: HFN Commercial |
$2,204.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,797.00
|
| Rate for Payer: Multiplan Commercial |
$1,916.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,437.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,204.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,174.04
|
| Rate for Payer: Quartz Commercial |
$1,557.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,437.60
|
| Rate for Payer: The Alliance Commercial |
$9,584.00
|
| Rate for Payer: WEA Trust Commercial |
$1,317.80
|
| Rate for Payer: WPS Commercial |
$1,774.72
|
|
|
UVULECTOMY
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960484
|
|
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
|
|
|
UVULECTOMY
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960484
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| 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
|
|
|
UVULOPALATOPHARYNOGOPLASTY/UVULECTOMY/UVULOPLASTY
|
Facility
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2960467
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$492.94 |
| Max. Negotiated Rate |
$925.52 |
| Rate for Payer: Aetna Commercial |
$905.40
|
| 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
|
|
|
UVULOPALATOPHARYNOGOPLASTY/UVULECTOMY/UVULOPLASTY
|
Facility
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2960467
|
|
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
|
|
|
Vaccine/Toxoid Injection
|
Facility
OP
|
$118.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3040438
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$56.64 |
| Max. Negotiated Rate |
$259.02 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$101.48
|
| Rate for Payer: Aetna Managed Medicare |
$69.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56.64
|
| Rate for Payer: Anthem Medicare Advantage |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$69.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$69.63
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$69.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$66.03
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$69.63
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$259.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$69.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$69.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$69.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$69.63
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$104.44
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$76.70
|
| Rate for Payer: Quartz Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare Medicare Advantage |
$69.63
|
| Rate for Payer: United Healthcare PPO |
$88.50
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: Wellcare Medicare |
$69.63
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
|
Vaccine/Toxoid Injection
|
Facility
IP
|
$118.00
|
|
|
Service Code
|
CPT 90471
|
| Hospital Charge Code |
3040438
|
|
Hospital Revenue Code
|
771
|
| Min. Negotiated Rate |
$57.82 |
| Max. Negotiated Rate |
$108.56 |
| Rate for Payer: Aetna Commercial |
$106.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$62.54
|
| Rate for Payer: Cash Price |
$35.40
|
| Rate for Payer: Cigna Commercial |
$108.56
|
| Rate for Payer: Health EOS Commercial |
$105.02
|
| Rate for Payer: HFN Commercial |
$108.56
|
| Rate for Payer: Multiplan Commercial |
$94.40
|
| Rate for Payer: NAPHCARE Commercial |
$70.80
|
| Rate for Payer: Preferred Network Access Commercial |
$108.56
|
| Rate for Payer: Quartz Beloit One Network |
$57.82
|
| Rate for Payer: Quartz Commercial |
$70.80
|
| Rate for Payer: WEA Trust Commercial |
$64.90
|
| Rate for Payer: WPS Commercial |
$87.40
|
|
