|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$14,380.03
|
|
|
Service Code
|
APR-DRG 5122
|
| Min. Negotiated Rate |
$12,773.24 |
| Max. Negotiated Rate |
$14,380.03 |
| Rate for Payer: Anthem Medicaid |
$13,769.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$13,769.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13,769.67
|
| Rate for Payer: Dean Health Medicaid |
$13,769.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12,773.24
|
| Rate for Payer: Managed Health Services Medicaid |
$14,380.03
|
| Rate for Payer: Molina Healthcare Medicaid |
$13,769.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13,769.67
|
| Rate for Payer: United Healthcare Medicaid |
$13,769.67
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$12,538.68
|
|
|
Service Code
|
APR-DRG 5121
|
| Min. Negotiated Rate |
$11,137.64 |
| Max. Negotiated Rate |
$12,538.68 |
| Rate for Payer: Anthem Medicaid |
$12,006.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,006.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,006.48
|
| Rate for Payer: Dean Health Medicaid |
$12,006.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,137.64
|
| Rate for Payer: Managed Health Services Medicaid |
$12,538.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,006.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,006.48
|
| Rate for Payer: United Healthcare Medicaid |
$12,006.48
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$23,762.12
|
|
|
Service Code
|
APR-DRG 5123
|
| Min. Negotiated Rate |
$21,107.00 |
| Max. Negotiated Rate |
$23,762.12 |
| Rate for Payer: Anthem Medicaid |
$22,753.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,753.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,753.54
|
| Rate for Payer: Dean Health Medicaid |
$22,753.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$21,107.00
|
| Rate for Payer: Managed Health Services Medicaid |
$23,762.12
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,753.54
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,753.54
|
| Rate for Payer: United Healthcare Medicaid |
$22,753.54
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$49,743.20
|
|
|
Service Code
|
MSDRG 740
|
| Min. Negotiated Rate |
$14,365.05 |
| Max. Negotiated Rate |
$49,743.20 |
| Rate for Payer: Aetna Managed Medicare |
$14,365.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,484.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,264.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,752.95
|
| Rate for Payer: Anthem Medicare Advantage |
$14,365.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,365.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,365.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,365.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,918.41
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,365.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,240.36
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,365.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,365.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,365.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,365.05
|
| Rate for Payer: NAPHCARE Commercial |
$21,547.58
|
| Rate for Payer: Quartz Medicare Advantage |
$14,365.05
|
| Rate for Payer: The Alliance Commercial |
$49,743.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,365.05
|
| Rate for Payer: United Healthcare PPO |
$28,213.59
|
| Rate for Payer: Wellcare Medicare |
$14,365.05
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$100,321.52
|
|
|
Service Code
|
MSDRG 739
|
| Min. Negotiated Rate |
$27,944.56 |
| Max. Negotiated Rate |
$100,321.52 |
| Rate for Payer: Aetna Managed Medicare |
$27,944.56
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$76,941.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$58,974.69
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,029.80
|
| Rate for Payer: Anthem Medicare Advantage |
$27,944.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,944.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,944.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,944.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62,198.22
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,944.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$73,338.56
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,944.56
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,944.56
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,944.56
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,944.56
|
| Rate for Payer: NAPHCARE Commercial |
$41,916.84
|
| Rate for Payer: Quartz Medicare Advantage |
$27,944.56
|
| Rate for Payer: The Alliance Commercial |
$100,321.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,944.56
|
| Rate for Payer: United Healthcare PPO |
$57,095.01
|
| Rate for Payer: Wellcare Medicare |
$27,944.56
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR NON-OVARIAN AND NON-ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$36,258.56
|
|
|
Service Code
|
MSDRG 741
|
| Min. Negotiated Rate |
$11,428.14 |
| Max. Negotiated Rate |
$36,258.56 |
| Rate for Payer: Aetna Managed Medicare |
$11,428.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$31,116.36
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,850.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,659.47
|
| Rate for Payer: Anthem Medicare Advantage |
$11,428.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,428.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,428.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,428.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,154.09
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,428.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,349.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,428.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,428.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,428.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,428.14
|
| Rate for Payer: NAPHCARE Commercial |
$17,142.22
|
| Rate for Payer: Quartz Medicare Advantage |
$11,428.14
|
| Rate for Payer: The Alliance Commercial |
$36,258.56
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,428.14
|
| Rate for Payer: United Healthcare PPO |
$20,513.66
|
| Rate for Payer: Wellcare Medicare |
$11,428.14
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$42,526.30
|
|
|
Service Code
|
APR-DRG 5114
|
| Min. Negotiated Rate |
$37,774.52 |
| Max. Negotiated Rate |
$42,526.30 |
| Rate for Payer: Anthem Medicaid |
$40,721.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$40,721.28
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$40,721.28
|
| Rate for Payer: Dean Health Medicaid |
$40,721.28
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$37,774.52
|
| Rate for Payer: Managed Health Services Medicaid |
$42,526.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$40,721.28
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$40,721.28
|
| Rate for Payer: United Healthcare Medicaid |
$40,721.28
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$12,538.68
|
|
|
Service Code
|
APR-DRG 5111
|
| Min. Negotiated Rate |
$11,137.64 |
| Max. Negotiated Rate |
$12,538.68 |
| Rate for Payer: Anthem Medicaid |
$12,006.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$12,006.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12,006.48
|
| Rate for Payer: Dean Health Medicaid |
$12,006.48
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$11,137.64
|
| Rate for Payer: Managed Health Services Medicaid |
$12,538.68
|
| Rate for Payer: Molina Healthcare Medicaid |
$12,006.48
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12,006.48
|
| Rate for Payer: United Healthcare Medicaid |
$12,006.48
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$15,169.18
|
|
|
Service Code
|
APR-DRG 5112
|
| Min. Negotiated Rate |
$13,474.21 |
| Max. Negotiated Rate |
$15,169.18 |
| Rate for Payer: Anthem Medicaid |
$14,525.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$14,525.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$14,525.32
|
| Rate for Payer: Dean Health Medicaid |
$14,525.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13,474.21
|
| Rate for Payer: Managed Health Services Medicaid |
$15,169.18
|
| Rate for Payer: Molina Healthcare Medicaid |
$14,525.32
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$14,525.32
|
| Rate for Payer: United Healthcare Medicaid |
$14,525.32
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN AND ADNEXAL MALIGNANCY
|
Facility
|
IP
|
$23,236.02
|
|
|
Service Code
|
APR-DRG 5113
|
| Min. Negotiated Rate |
$20,639.68 |
| Max. Negotiated Rate |
$23,236.02 |
| Rate for Payer: Anthem Medicaid |
$22,249.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$22,249.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$22,249.77
|
| Rate for Payer: Dean Health Medicaid |
$22,249.77
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$20,639.68
|
| Rate for Payer: Managed Health Services Medicaid |
$23,236.02
|
| Rate for Payer: Molina Healthcare Medicaid |
$22,249.77
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$22,249.77
|
| Rate for Payer: United Healthcare Medicaid |
$22,249.77
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH CC
|
Facility
|
IP
|
$54,907.84
|
|
|
Service Code
|
MSDRG 737
|
| Min. Negotiated Rate |
$16,287.26 |
| Max. Negotiated Rate |
$54,907.84 |
| Rate for Payer: Aetna Managed Medicare |
$16,287.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44,960.64
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34,461.97
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32,741.12
|
| Rate for Payer: Anthem Medicare Advantage |
$16,287.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,287.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,287.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,287.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36,345.65
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,287.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,028.66
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,287.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,287.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,287.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,287.26
|
| Rate for Payer: NAPHCARE Commercial |
$24,430.89
|
| Rate for Payer: Quartz Medicare Advantage |
$16,287.26
|
| Rate for Payer: The Alliance Commercial |
$54,907.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,287.26
|
| Rate for Payer: United Healthcare PPO |
$31,162.83
|
| Rate for Payer: Wellcare Medicare |
$16,287.26
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITH MCC
|
Facility
|
IP
|
$107,811.60
|
|
|
Service Code
|
MSDRG 736
|
| Min. Negotiated Rate |
$27,881.01 |
| Max. Negotiated Rate |
$107,811.60 |
| Rate for Payer: Aetna Managed Medicare |
$27,881.01
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$77,992.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$59,780.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$56,795.66
|
| Rate for Payer: Anthem Medicare Advantage |
$27,881.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$27,881.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$27,881.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$27,881.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$63,048.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$27,881.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78,832.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$27,881.01
|
| Rate for Payer: Independent Care Health Plan Medicare |
$27,881.01
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$27,881.01
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$27,881.01
|
| Rate for Payer: NAPHCARE Commercial |
$41,821.51
|
| Rate for Payer: Quartz Medicare Advantage |
$27,881.01
|
| Rate for Payer: The Alliance Commercial |
$107,811.60
|
| Rate for Payer: United Healthcare Medicare Advantage |
$27,881.01
|
| Rate for Payer: United Healthcare PPO |
$61,372.04
|
| Rate for Payer: Wellcare Medicare |
$27,881.01
|
|
|
UTERINE AND ADNEXA PROCEDURES FOR OVARIAN OR ADNEXAL MALIGNANCY WITHOUT CC/MCC
|
Facility
|
IP
|
$38,064.00
|
|
|
Service Code
|
MSDRG 738
|
| Min. Negotiated Rate |
$11,752.84 |
| Max. Negotiated Rate |
$38,064.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,752.84
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,041.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,559.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,333.17
|
| Rate for Payer: Anthem Medicare Advantage |
$11,752.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,752.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,752.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,752.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,901.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,752.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,674.09
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,752.84
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,752.84
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,752.84
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,752.84
|
| Rate for Payer: NAPHCARE Commercial |
$17,629.26
|
| Rate for Payer: Quartz Medicare Advantage |
$11,752.84
|
| Rate for Payer: The Alliance Commercial |
$38,064.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,752.84
|
| Rate for Payer: United Healthcare PPO |
$21,544.63
|
| Rate for Payer: Wellcare Medicare |
$11,752.84
|
|
|
UTERINE EVACUATION AND CURETTAGE FOR HYDATIDIFORM MOLE
|
Facility
|
OP
|
$13,626.87
|
|
|
Service Code
|
CPT 59870
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$13,626.87 |
| Rate for Payer: Aetna Managed Medicare |
$3,406.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,406.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,406.72
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,406.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,406.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,672.99
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,406.72
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,406.72
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,406.72
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,406.72
|
| Rate for Payer: NAPHCARE Commercial |
$5,110.08
|
| Rate for Payer: Quartz Medicare Advantage |
$3,406.72
|
| Rate for Payer: The Alliance Commercial |
$13,626.87
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,406.72
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$3,406.72
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 2.5CM AD750SC-KE25
|
Facility
|
OP
|
$2,512.00
|
|
| Hospital Charge Code |
5459712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$731.49 |
| Max. Negotiated Rate |
$2,403.48 |
| Rate for Payer: Aetna Commercial |
$2,351.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.73
|
| Rate for Payer: Aetna Managed Medicare |
$731.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,698.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,306.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,253.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.61
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cigna Commercial |
$2,403.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,461.98
|
| Rate for Payer: Health EOS Commercial |
$2,325.11
|
| Rate for Payer: HFN Commercial |
$2,403.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,959.36
|
| Rate for Payer: Multiplan Commercial |
$2,089.98
|
| Rate for Payer: NAPHCARE Commercial |
$1,567.49
|
| Rate for Payer: Preferred Network Access Commercial |
$2,403.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,280.12
|
| Rate for Payer: Quartz Commercial |
$1,698.11
|
| Rate for Payer: Quartz Medicare Advantage |
$1,567.49
|
| Rate for Payer: The Alliance Commercial |
$1,306.24
|
| Rate for Payer: WEA Trust Commercial |
$1,436.86
|
| Rate for Payer: WPS Commercial |
$1,934.99
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 2.5CM AD750SC-KE25
|
Facility
|
IP
|
$2,512.00
|
|
| Hospital Charge Code |
5459712
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,280.12 |
| Max. Negotiated Rate |
$2,403.48 |
| Rate for Payer: Aetna Commercial |
$2,351.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,246.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,384.61
|
| Rate for Payer: Cash Price |
$753.60
|
| Rate for Payer: Cigna Commercial |
$2,403.48
|
| Rate for Payer: Health EOS Commercial |
$2,325.11
|
| Rate for Payer: HFN Commercial |
$2,403.48
|
| Rate for Payer: Multiplan Commercial |
$2,089.98
|
| Rate for Payer: Preferred Network Access Commercial |
$2,403.48
|
| Rate for Payer: Quartz Beloit One Network |
$1,280.12
|
| Rate for Payer: Quartz Commercial |
$1,567.49
|
| Rate for Payer: WEA Trust Commercial |
$1,436.86
|
| Rate for Payer: WPS Commercial |
$1,934.99
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.0CM AD750SC-KE30
|
Facility
|
OP
|
$2,608.00
|
|
| Hospital Charge Code |
5459713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$759.45 |
| Max. Negotiated Rate |
$2,495.33 |
| Rate for Payer: Aetna Commercial |
$2,441.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,332.60
|
| Rate for Payer: Aetna Managed Medicare |
$759.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,763.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,356.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,301.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,437.53
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,495.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,517.86
|
| Rate for Payer: Health EOS Commercial |
$2,413.96
|
| Rate for Payer: HFN Commercial |
$2,495.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,034.24
|
| Rate for Payer: Multiplan Commercial |
$2,169.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,627.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,495.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,329.04
|
| Rate for Payer: Quartz Commercial |
$1,763.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,627.39
|
| Rate for Payer: The Alliance Commercial |
$1,356.16
|
| Rate for Payer: WEA Trust Commercial |
$1,491.78
|
| Rate for Payer: WPS Commercial |
$2,008.94
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.0CM AD750SC-KE30
|
Facility
|
IP
|
$2,608.00
|
|
| Hospital Charge Code |
5459713
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,329.04 |
| Max. Negotiated Rate |
$2,495.33 |
| Rate for Payer: Aetna Commercial |
$2,441.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,332.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,437.53
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,495.33
|
| Rate for Payer: Health EOS Commercial |
$2,413.96
|
| Rate for Payer: HFN Commercial |
$2,495.33
|
| Rate for Payer: Multiplan Commercial |
$2,169.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,495.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,329.04
|
| Rate for Payer: Quartz Commercial |
$1,627.39
|
| Rate for Payer: WEA Trust Commercial |
$1,491.78
|
| Rate for Payer: WPS Commercial |
$2,008.94
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.5CM AD750SC-KE35
|
Facility
|
IP
|
$2,608.00
|
|
| Hospital Charge Code |
5459563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,329.04 |
| Max. Negotiated Rate |
$2,495.33 |
| Rate for Payer: Aetna Commercial |
$2,441.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,332.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,437.53
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,495.33
|
| Rate for Payer: Health EOS Commercial |
$2,413.96
|
| Rate for Payer: HFN Commercial |
$2,495.33
|
| Rate for Payer: Multiplan Commercial |
$2,169.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,495.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,329.04
|
| Rate for Payer: Quartz Commercial |
$1,627.39
|
| Rate for Payer: WEA Trust Commercial |
$1,491.78
|
| Rate for Payer: WPS Commercial |
$2,008.94
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 3.5CM AD750SC-KE35
|
Facility
|
OP
|
$2,608.00
|
|
| Hospital Charge Code |
5459563
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$759.45 |
| Max. Negotiated Rate |
$2,495.33 |
| Rate for Payer: Aetna Commercial |
$2,441.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,332.60
|
| Rate for Payer: Aetna Managed Medicare |
$759.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,763.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,356.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,301.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,437.53
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,495.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,517.86
|
| Rate for Payer: Health EOS Commercial |
$2,413.96
|
| Rate for Payer: HFN Commercial |
$2,495.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,034.24
|
| Rate for Payer: Multiplan Commercial |
$2,169.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,627.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,495.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,329.04
|
| Rate for Payer: Quartz Commercial |
$1,763.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,627.39
|
| Rate for Payer: The Alliance Commercial |
$1,356.16
|
| Rate for Payer: WEA Trust Commercial |
$1,491.78
|
| Rate for Payer: WPS Commercial |
$2,008.94
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 4.0CM AD750SC-KE40
|
Facility
|
IP
|
$2,608.00
|
|
| Hospital Charge Code |
5459714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,329.04 |
| Max. Negotiated Rate |
$2,495.33 |
| Rate for Payer: Aetna Commercial |
$2,441.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,332.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,437.53
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,495.33
|
| Rate for Payer: Health EOS Commercial |
$2,413.96
|
| Rate for Payer: HFN Commercial |
$2,495.33
|
| Rate for Payer: Multiplan Commercial |
$2,169.86
|
| Rate for Payer: Preferred Network Access Commercial |
$2,495.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,329.04
|
| Rate for Payer: Quartz Commercial |
$1,627.39
|
| Rate for Payer: WEA Trust Commercial |
$1,491.78
|
| Rate for Payer: WPS Commercial |
$2,008.94
|
|
|
UTERINE MANIPULATOR ADVINCULA DELINEATOR 4.0CM AD750SC-KE40
|
Facility
|
OP
|
$2,608.00
|
|
| Hospital Charge Code |
5459714
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$759.45 |
| Max. Negotiated Rate |
$2,495.33 |
| Rate for Payer: Aetna Commercial |
$2,441.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,332.60
|
| Rate for Payer: Aetna Managed Medicare |
$759.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,763.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,356.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,301.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,437.53
|
| Rate for Payer: Cash Price |
$782.40
|
| Rate for Payer: Cigna Commercial |
$2,495.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,517.86
|
| Rate for Payer: Health EOS Commercial |
$2,413.96
|
| Rate for Payer: HFN Commercial |
$2,495.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,034.24
|
| Rate for Payer: Multiplan Commercial |
$2,169.86
|
| Rate for Payer: NAPHCARE Commercial |
$1,627.39
|
| Rate for Payer: Preferred Network Access Commercial |
$2,495.33
|
| Rate for Payer: Quartz Beloit One Network |
$1,329.04
|
| Rate for Payer: Quartz Commercial |
$1,763.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,627.39
|
| Rate for Payer: The Alliance Commercial |
$1,356.16
|
| Rate for Payer: WEA Trust Commercial |
$1,491.78
|
| Rate for Payer: WPS Commercial |
$2,008.94
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 30MM CUP 110030
|
Facility
|
IP
|
$2,396.00
|
|
| Hospital Charge Code |
5603652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,221.00 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,495.10
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 30MM CUP 110030
|
Facility
|
OP
|
$2,396.00
|
|
| Hospital Charge Code |
5603652
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$697.72 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Aetna Managed Medicare |
$697.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,619.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,245.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,196.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,394.47
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,868.88
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,495.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,619.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,495.10
|
| Rate for Payer: The Alliance Commercial |
$1,245.92
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
|
UTERINE MANIPULATOR FORNISEE DEVICE 35MM CUP 110035
|
Facility
|
OP
|
$2,396.00
|
|
| Hospital Charge Code |
5603653
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$697.72 |
| Max. Negotiated Rate |
$2,292.49 |
| Rate for Payer: Aetna Commercial |
$2,242.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,142.98
|
| Rate for Payer: Aetna Managed Medicare |
$697.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,619.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,245.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,196.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,320.68
|
| Rate for Payer: Cash Price |
$718.80
|
| Rate for Payer: Cigna Commercial |
$2,292.49
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,394.47
|
| Rate for Payer: Health EOS Commercial |
$2,217.74
|
| Rate for Payer: HFN Commercial |
$2,292.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,868.88
|
| Rate for Payer: Multiplan Commercial |
$1,993.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,495.10
|
| Rate for Payer: Preferred Network Access Commercial |
$2,292.49
|
| Rate for Payer: Quartz Beloit One Network |
$1,221.00
|
| Rate for Payer: Quartz Commercial |
$1,619.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,495.10
|
| Rate for Payer: The Alliance Commercial |
$1,245.92
|
| Rate for Payer: WEA Trust Commercial |
$1,370.51
|
| Rate for Payer: WPS Commercial |
$1,845.64
|
|
