|
VACURETTE 8MM CURVE 20317/022108-10
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
2965917
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
VACURETTE 8MM STRAIGHT 21655/22208-10
|
Facility
|
IP
|
$89.00
|
|
| Hospital Charge Code |
2965918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$45.35 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$55.54
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
VACURETTE 8MM STRAIGHT 21655/22208-10
|
Facility
|
OP
|
$89.00
|
|
| Hospital Charge Code |
2965918
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.92 |
| Max. Negotiated Rate |
$85.16 |
| Rate for Payer: Aetna Commercial |
$83.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$79.60
|
| Rate for Payer: Aetna Managed Medicare |
$25.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$60.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$46.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$44.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$49.06
|
| Rate for Payer: Cash Price |
$26.70
|
| Rate for Payer: Cigna Commercial |
$85.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51.80
|
| Rate for Payer: Health EOS Commercial |
$82.38
|
| Rate for Payer: HFN Commercial |
$85.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$69.42
|
| Rate for Payer: Multiplan Commercial |
$74.05
|
| Rate for Payer: NAPHCARE Commercial |
$55.54
|
| Rate for Payer: Preferred Network Access Commercial |
$85.16
|
| Rate for Payer: Quartz Beloit One Network |
$45.35
|
| Rate for Payer: Quartz Commercial |
$60.16
|
| Rate for Payer: Quartz Medicare Advantage |
$55.54
|
| Rate for Payer: The Alliance Commercial |
$46.28
|
| Rate for Payer: WEA Trust Commercial |
$50.91
|
| Rate for Payer: WPS Commercial |
$68.56
|
|
|
VACURETTE 9MM CURVE 21552/022109-10
|
Facility
|
IP
|
$86.00
|
|
| Hospital Charge Code |
2965919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$43.83 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$53.66
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
VACURETTE 9MM CURVE 21552/022109-10
|
Facility
|
OP
|
$86.00
|
|
| Hospital Charge Code |
2965919
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$25.04 |
| Max. Negotiated Rate |
$82.28 |
| Rate for Payer: Aetna Commercial |
$80.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$76.92
|
| Rate for Payer: Aetna Managed Medicare |
$25.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$58.14
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$44.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$42.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$47.40
|
| Rate for Payer: Cash Price |
$25.80
|
| Rate for Payer: Cigna Commercial |
$82.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50.05
|
| Rate for Payer: Health EOS Commercial |
$79.60
|
| Rate for Payer: HFN Commercial |
$82.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$67.08
|
| Rate for Payer: Multiplan Commercial |
$71.55
|
| Rate for Payer: NAPHCARE Commercial |
$53.66
|
| Rate for Payer: Preferred Network Access Commercial |
$82.28
|
| Rate for Payer: Quartz Beloit One Network |
$43.83
|
| Rate for Payer: Quartz Commercial |
$58.14
|
| Rate for Payer: Quartz Medicare Advantage |
$53.66
|
| Rate for Payer: The Alliance Commercial |
$44.72
|
| Rate for Payer: WEA Trust Commercial |
$49.19
|
| Rate for Payer: WPS Commercial |
$66.25
|
|
|
VACURETTE 9MM STRAIGHT 022209
|
Facility
|
OP
|
$22.00
|
|
| Hospital Charge Code |
2965920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$6.41 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Aetna Managed Medicare |
$6.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.80
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17.16
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: NAPHCARE Commercial |
$13.73
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$14.87
|
| Rate for Payer: Quartz Medicare Advantage |
$13.73
|
| Rate for Payer: The Alliance Commercial |
$11.44
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
VACURETTE 9MM STRAIGHT 022209
|
Facility
|
IP
|
$22.00
|
|
| Hospital Charge Code |
2965920
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$11.21 |
| Max. Negotiated Rate |
$21.05 |
| Rate for Payer: Aetna Commercial |
$20.59
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$19.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12.13
|
| Rate for Payer: Cash Price |
$6.60
|
| Rate for Payer: Cigna Commercial |
$21.05
|
| Rate for Payer: Health EOS Commercial |
$20.36
|
| Rate for Payer: HFN Commercial |
$21.05
|
| Rate for Payer: Multiplan Commercial |
$18.30
|
| Rate for Payer: Preferred Network Access Commercial |
$21.05
|
| Rate for Payer: Quartz Beloit One Network |
$11.21
|
| Rate for Payer: Quartz Commercial |
$13.73
|
| Rate for Payer: WEA Trust Commercial |
$12.58
|
| Rate for Payer: WPS Commercial |
$16.95
|
|
|
VACUTAINER STERILE 2/PKG
|
Facility
|
IP
|
$93.00
|
|
| Hospital Charge Code |
2963467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$47.39 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$58.03
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
VACUTAINER STERILE 2/PKG
|
Facility
|
OP
|
$93.00
|
|
| Hospital Charge Code |
2963467
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$27.08 |
| Max. Negotiated Rate |
$88.98 |
| Rate for Payer: Aetna Commercial |
$87.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$83.18
|
| Rate for Payer: Aetna Managed Medicare |
$27.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62.87
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$48.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$51.26
|
| Rate for Payer: Cash Price |
$27.90
|
| Rate for Payer: Cigna Commercial |
$88.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$54.13
|
| Rate for Payer: Health EOS Commercial |
$86.08
|
| Rate for Payer: HFN Commercial |
$88.98
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$72.54
|
| Rate for Payer: Multiplan Commercial |
$77.38
|
| Rate for Payer: NAPHCARE Commercial |
$58.03
|
| Rate for Payer: Preferred Network Access Commercial |
$88.98
|
| Rate for Payer: Quartz Beloit One Network |
$47.39
|
| Rate for Payer: Quartz Commercial |
$62.87
|
| Rate for Payer: Quartz Medicare Advantage |
$58.03
|
| Rate for Payer: The Alliance Commercial |
$48.36
|
| Rate for Payer: WEA Trust Commercial |
$53.20
|
| Rate for Payer: WPS Commercial |
$71.64
|
|
|
VACUUM CUP KIWI OMNICUP VAC-6000M
|
Facility
|
OP
|
$502.00
|
|
| Hospital Charge Code |
2963166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$146.18 |
| Max. Negotiated Rate |
$480.31 |
| Rate for Payer: Aetna Commercial |
$469.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.99
|
| Rate for Payer: Aetna Managed Medicare |
$146.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$339.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$261.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$250.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.70
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$480.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$292.16
|
| Rate for Payer: Health EOS Commercial |
$464.65
|
| Rate for Payer: HFN Commercial |
$480.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$391.56
|
| Rate for Payer: Multiplan Commercial |
$417.66
|
| Rate for Payer: NAPHCARE Commercial |
$313.25
|
| Rate for Payer: Preferred Network Access Commercial |
$480.31
|
| Rate for Payer: Quartz Beloit One Network |
$255.82
|
| Rate for Payer: Quartz Commercial |
$339.35
|
| Rate for Payer: Quartz Medicare Advantage |
$313.25
|
| Rate for Payer: The Alliance Commercial |
$261.04
|
| Rate for Payer: WEA Trust Commercial |
$287.14
|
| Rate for Payer: WPS Commercial |
$386.69
|
|
|
VACUUM CUP KIWI OMNICUP VAC-6000M
|
Facility
|
IP
|
$502.00
|
|
| Hospital Charge Code |
2963166
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$255.82 |
| Max. Negotiated Rate |
$480.31 |
| Rate for Payer: Aetna Commercial |
$469.87
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$448.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$276.70
|
| Rate for Payer: Cash Price |
$150.60
|
| Rate for Payer: Cigna Commercial |
$480.31
|
| Rate for Payer: Health EOS Commercial |
$464.65
|
| Rate for Payer: HFN Commercial |
$480.31
|
| Rate for Payer: Multiplan Commercial |
$417.66
|
| Rate for Payer: Preferred Network Access Commercial |
$480.31
|
| Rate for Payer: Quartz Beloit One Network |
$255.82
|
| Rate for Payer: Quartz Commercial |
$313.25
|
| Rate for Payer: WEA Trust Commercial |
$287.14
|
| Rate for Payer: WPS Commercial |
$386.69
|
|
|
Vacuum Extraction-Kiwi - Individual Charges
|
Facility
|
IP
|
$1,161.00
|
|
| Hospital Charge Code |
3003918
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$591.65 |
| Max. Negotiated Rate |
$1,110.84 |
| Rate for Payer: Aetna Commercial |
$1,086.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.94
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna Commercial |
$1,110.84
|
| Rate for Payer: Health EOS Commercial |
$1,074.62
|
| Rate for Payer: HFN Commercial |
$1,110.84
|
| Rate for Payer: Multiplan Commercial |
$965.95
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.84
|
| Rate for Payer: Quartz Beloit One Network |
$591.65
|
| Rate for Payer: Quartz Commercial |
$724.46
|
| Rate for Payer: WEA Trust Commercial |
$664.09
|
| Rate for Payer: WPS Commercial |
$894.32
|
|
|
Vacuum Extraction-Kiwi - Individual Charges
|
Facility
|
OP
|
$1,161.00
|
|
| Hospital Charge Code |
3003918
|
|
Hospital Revenue Code
|
720
|
| Min. Negotiated Rate |
$338.08 |
| Max. Negotiated Rate |
$1,110.84 |
| Rate for Payer: Aetna Commercial |
$1,086.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,038.40
|
| Rate for Payer: Aetna Managed Medicare |
$338.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$784.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$603.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$579.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$639.94
|
| Rate for Payer: Cash Price |
$348.30
|
| Rate for Payer: Cigna Commercial |
$1,110.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$675.70
|
| Rate for Payer: Health EOS Commercial |
$1,074.62
|
| Rate for Payer: HFN Commercial |
$1,110.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$905.58
|
| Rate for Payer: Multiplan Commercial |
$965.95
|
| Rate for Payer: NAPHCARE Commercial |
$724.46
|
| Rate for Payer: Preferred Network Access Commercial |
$1,110.84
|
| Rate for Payer: Quartz Beloit One Network |
$591.65
|
| Rate for Payer: Quartz Commercial |
$784.84
|
| Rate for Payer: Quartz Medicare Advantage |
$724.46
|
| Rate for Payer: The Alliance Commercial |
$603.72
|
| Rate for Payer: United Healthcare PPO |
$905.58
|
| Rate for Payer: WEA Trust Commercial |
$664.09
|
| Rate for Payer: WPS Commercial |
$894.32
|
|
|
VACUUM LINE CELL SAVER ELITE SMARTSUCTION FILTERED NON-STERILE HAR-A-1000
|
Facility
|
IP
|
$246.00
|
|
| Hospital Charge Code |
5804220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$125.36 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.60
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$235.37
|
| Rate for Payer: Health EOS Commercial |
$227.70
|
| Rate for Payer: HFN Commercial |
$235.37
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: Preferred Network Access Commercial |
$235.37
|
| Rate for Payer: Quartz Beloit One Network |
$125.36
|
| Rate for Payer: Quartz Commercial |
$153.50
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: WPS Commercial |
$189.49
|
|
|
VACUUM LINE CELL SAVER ELITE SMARTSUCTION FILTERED NON-STERILE HAR-A-1000
|
Facility
|
OP
|
$246.00
|
|
| Hospital Charge Code |
5804220
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$71.64 |
| Max. Negotiated Rate |
$235.37 |
| Rate for Payer: Aetna Commercial |
$230.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$220.02
|
| Rate for Payer: Aetna Managed Medicare |
$71.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$122.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$135.60
|
| Rate for Payer: Cash Price |
$73.80
|
| Rate for Payer: Cigna Commercial |
$235.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$143.17
|
| Rate for Payer: Health EOS Commercial |
$227.70
|
| Rate for Payer: HFN Commercial |
$235.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$191.88
|
| Rate for Payer: Multiplan Commercial |
$204.67
|
| Rate for Payer: NAPHCARE Commercial |
$153.50
|
| Rate for Payer: Preferred Network Access Commercial |
$235.37
|
| Rate for Payer: Quartz Beloit One Network |
$125.36
|
| Rate for Payer: Quartz Commercial |
$166.30
|
| Rate for Payer: Quartz Medicare Advantage |
$153.50
|
| Rate for Payer: The Alliance Commercial |
$127.92
|
| Rate for Payer: WEA Trust Commercial |
$140.71
|
| Rate for Payer: WPS Commercial |
$189.49
|
|
|
VAGAL NERVE STIMULATOR, INSERTION
|
Facility
|
OP
|
$4,048.00
|
|
| Hospital Charge Code |
2960486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,178.78 |
| Max. Negotiated Rate |
$3,873.13 |
| Rate for Payer: Aetna Commercial |
$3,788.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,620.53
|
| Rate for Payer: Aetna Managed Medicare |
$1,178.78
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,736.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,104.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,020.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,231.26
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$3,873.13
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,355.94
|
| Rate for Payer: Health EOS Commercial |
$3,746.83
|
| Rate for Payer: HFN Commercial |
$3,873.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,157.44
|
| Rate for Payer: Multiplan Commercial |
$3,367.94
|
| Rate for Payer: NAPHCARE Commercial |
$2,525.95
|
| Rate for Payer: Preferred Network Access Commercial |
$3,873.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,062.86
|
| Rate for Payer: Quartz Commercial |
$2,736.45
|
| Rate for Payer: Quartz Medicare Advantage |
$2,525.95
|
| Rate for Payer: The Alliance Commercial |
$2,104.96
|
| Rate for Payer: WEA Trust Commercial |
$2,315.46
|
| Rate for Payer: WPS Commercial |
$3,118.17
|
|
|
VAGAL NERVE STIMULATOR, INSERTION
|
Facility
|
IP
|
$4,048.00
|
|
| Hospital Charge Code |
2960486
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,062.86 |
| Max. Negotiated Rate |
$3,873.13 |
| Rate for Payer: Aetna Commercial |
$3,788.93
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,620.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,231.26
|
| Rate for Payer: Cash Price |
$1,214.40
|
| Rate for Payer: Cigna Commercial |
$3,873.13
|
| Rate for Payer: Health EOS Commercial |
$3,746.83
|
| Rate for Payer: HFN Commercial |
$3,873.13
|
| Rate for Payer: Multiplan Commercial |
$3,367.94
|
| Rate for Payer: Preferred Network Access Commercial |
$3,873.13
|
| Rate for Payer: Quartz Beloit One Network |
$2,062.86
|
| Rate for Payer: Quartz Commercial |
$2,525.95
|
| Rate for Payer: WEA Trust Commercial |
$2,315.46
|
| Rate for Payer: WPS Commercial |
$3,118.17
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITH CC/MCC
|
Facility
|
IP
|
$46,676.24
|
|
|
Service Code
|
MSDRG 746
|
| Min. Negotiated Rate |
$13,809.83 |
| Max. Negotiated Rate |
$46,676.24 |
| Rate for Payer: Aetna Managed Medicare |
$13,809.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,902.13
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$29,051.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,600.99
|
| Rate for Payer: Anthem Medicare Advantage |
$13,809.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13,809.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13,809.83
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13,809.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,639.63
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13,809.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,991.31
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13,809.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13,809.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13,809.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13,809.83
|
| Rate for Payer: NAPHCARE Commercial |
$20,714.74
|
| Rate for Payer: Quartz Medicare Advantage |
$13,809.83
|
| Rate for Payer: The Alliance Commercial |
$46,676.24
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13,809.83
|
| Rate for Payer: United Healthcare PPO |
$26,462.66
|
| Rate for Payer: Wellcare Medicare |
$13,809.83
|
|
|
VAGINA, CERVIX AND VULVA PROCEDURES WITHOUT CC/MCC
|
Facility
|
IP
|
$24,863.28
|
|
|
Service Code
|
MSDRG 747
|
| Min. Negotiated Rate |
$7,090.52 |
| Max. Negotiated Rate |
$24,863.28 |
| Rate for Payer: Aetna Managed Medicare |
$7,090.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,317.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,040.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,338.92
|
| Rate for Payer: Anthem Medicare Advantage |
$7,090.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,090.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,090.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,090.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,807.42
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,090.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,992.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,090.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,090.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,090.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,090.52
|
| Rate for Payer: NAPHCARE Commercial |
$10,635.78
|
| Rate for Payer: Quartz Medicare Advantage |
$7,090.52
|
| Rate for Payer: The Alliance Commercial |
$24,863.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,090.52
|
| Rate for Payer: United Healthcare PPO |
$14,007.32
|
| Rate for Payer: Wellcare Medicare |
$7,090.52
|
|
|
VAGINAL CONDYLOMA, CAUTERY OF
|
Facility
|
OP
|
$1,006.00
|
|
| Hospital Charge Code |
2959949
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$292.95 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Aetna Managed Medicare |
$292.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$680.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$523.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$502.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$585.49
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$784.68
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: NAPHCARE Commercial |
$627.74
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$680.06
|
| Rate for Payer: Quartz Medicare Advantage |
$627.74
|
| Rate for Payer: The Alliance Commercial |
$523.12
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
VAGINAL CONDYLOMA, CAUTERY OF
|
Facility
|
IP
|
$1,006.00
|
|
| Hospital Charge Code |
2959949
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$512.66 |
| Max. Negotiated Rate |
$962.54 |
| Rate for Payer: Aetna Commercial |
$941.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$899.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$554.51
|
| Rate for Payer: Cash Price |
$301.80
|
| Rate for Payer: Cigna Commercial |
$962.54
|
| Rate for Payer: Health EOS Commercial |
$931.15
|
| Rate for Payer: HFN Commercial |
$962.54
|
| Rate for Payer: Multiplan Commercial |
$836.99
|
| Rate for Payer: Preferred Network Access Commercial |
$962.54
|
| Rate for Payer: Quartz Beloit One Network |
$512.66
|
| Rate for Payer: Quartz Commercial |
$627.74
|
| Rate for Payer: WEA Trust Commercial |
$575.43
|
| Rate for Payer: WPS Commercial |
$774.92
|
|
|
VAGINAL DELIVERY
|
Facility
|
IP
|
$10,521.97
|
|
|
Service Code
|
APR-DRG 5604
|
| Min. Negotiated Rate |
$9,346.27 |
| Max. Negotiated Rate |
$10,521.97 |
| Rate for Payer: Anthem Medicaid |
$10,075.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,075.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,075.37
|
| Rate for Payer: Dean Health Medicaid |
$10,075.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,346.27
|
| Rate for Payer: Managed Health Services Medicaid |
$10,521.97
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,075.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,075.37
|
| Rate for Payer: United Healthcare Medicaid |
$10,075.37
|
|
|
VAGINAL DELIVERY
|
Facility
|
IP
|
$5,260.99
|
|
|
Service Code
|
APR-DRG 5603
|
| Min. Negotiated Rate |
$4,673.14 |
| Max. Negotiated Rate |
$5,260.99 |
| Rate for Payer: Anthem Medicaid |
$5,037.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,037.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,037.68
|
| Rate for Payer: Dean Health Medicaid |
$5,037.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,673.14
|
| Rate for Payer: Managed Health Services Medicaid |
$5,260.99
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,037.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,037.68
|
| Rate for Payer: United Healthcare Medicaid |
$5,037.68
|
|
|
VAGINAL DELIVERY
|
Facility
|
IP
|
$3,507.32
|
|
|
Service Code
|
APR-DRG 5602
|
| Min. Negotiated Rate |
$3,115.42 |
| Max. Negotiated Rate |
$3,507.32 |
| Rate for Payer: Anthem Medicaid |
$3,358.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,358.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,358.46
|
| Rate for Payer: Dean Health Medicaid |
$3,358.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,115.42
|
| Rate for Payer: Managed Health Services Medicaid |
$3,507.32
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,358.46
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,358.46
|
| Rate for Payer: United Healthcare Medicaid |
$3,358.46
|
|
|
VAGINAL DELIVERY
|
Facility
|
IP
|
$2,981.23
|
|
|
Service Code
|
APR-DRG 5601
|
| Min. Negotiated Rate |
$2,648.11 |
| Max. Negotiated Rate |
$2,981.23 |
| Rate for Payer: Anthem Medicaid |
$2,854.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$2,854.69
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,854.69
|
| Rate for Payer: Dean Health Medicaid |
$2,854.69
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$2,648.11
|
| Rate for Payer: Managed Health Services Medicaid |
$2,981.23
|
| Rate for Payer: Molina Healthcare Medicaid |
$2,854.69
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$2,854.69
|
| Rate for Payer: United Healthcare Medicaid |
$2,854.69
|
|
