|
VAGINAL DELIVERY IN OPERATING ROOM
|
Facility
|
IP
|
$270.00
|
|
| Hospital Charge Code |
2960488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$137.59 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$168.48
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
VAGINAL DELIVERY IN OPERATING ROOM
|
Facility
|
OP
|
$270.00
|
|
| Hospital Charge Code |
2960488
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$78.62 |
| Max. Negotiated Rate |
$258.34 |
| Rate for Payer: Aetna Commercial |
$252.72
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$241.49
|
| Rate for Payer: Aetna Managed Medicare |
$78.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$182.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$140.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$134.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$148.82
|
| Rate for Payer: Cash Price |
$81.00
|
| Rate for Payer: Cigna Commercial |
$258.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$157.14
|
| Rate for Payer: Health EOS Commercial |
$249.91
|
| Rate for Payer: HFN Commercial |
$258.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$210.60
|
| Rate for Payer: Multiplan Commercial |
$224.64
|
| Rate for Payer: NAPHCARE Commercial |
$168.48
|
| Rate for Payer: Preferred Network Access Commercial |
$258.34
|
| Rate for Payer: Quartz Beloit One Network |
$137.59
|
| Rate for Payer: Quartz Commercial |
$182.52
|
| Rate for Payer: Quartz Medicare Advantage |
$168.48
|
| Rate for Payer: The Alliance Commercial |
$140.40
|
| Rate for Payer: WEA Trust Commercial |
$154.44
|
| Rate for Payer: WPS Commercial |
$207.98
|
|
|
VAGINAL DELIVERY PROCEDURES
|
Facility
|
OP
|
$1,429.54
|
|
|
Service Code
|
EAPG 00195
|
| Min. Negotiated Rate |
$1,374.55 |
| Max. Negotiated Rate |
$1,429.54 |
| Rate for Payer: Anthem Medicaid |
$1,374.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$1,374.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,374.55
|
| Rate for Payer: Dean Health Medicaid |
$1,374.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$1,374.55
|
| Rate for Payer: Managed Health Services Medicaid |
$1,429.54
|
| Rate for Payer: Molina Healthcare Medicaid |
$1,374.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$1,374.55
|
| Rate for Payer: United Healthcare Medicaid |
$1,374.55
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$7,891.48
|
|
|
Service Code
|
APR-DRG 5423
|
| Min. Negotiated Rate |
$7,009.70 |
| Max. Negotiated Rate |
$7,891.48 |
| Rate for Payer: Anthem Medicaid |
$7,556.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,556.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,556.53
|
| Rate for Payer: Dean Health Medicaid |
$7,556.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,009.70
|
| Rate for Payer: Managed Health Services Medicaid |
$7,891.48
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,556.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,556.53
|
| Rate for Payer: United Healthcare Medicaid |
$7,556.53
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$4,208.79
|
|
|
Service Code
|
APR-DRG 5422
|
| Min. Negotiated Rate |
$3,738.51 |
| Max. Negotiated Rate |
$4,208.79 |
| Rate for Payer: Anthem Medicaid |
$4,030.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,030.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,030.15
|
| Rate for Payer: Dean Health Medicaid |
$4,030.15
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,738.51
|
| Rate for Payer: Managed Health Services Medicaid |
$4,208.79
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,030.15
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,030.15
|
| Rate for Payer: United Healthcare Medicaid |
$4,030.15
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$21,657.73
|
|
|
Service Code
|
APR-DRG 5424
|
| Min. Negotiated Rate |
$19,237.74 |
| Max. Negotiated Rate |
$21,657.73 |
| Rate for Payer: Anthem Medicaid |
$20,738.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$20,738.47
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$20,738.47
|
| Rate for Payer: Dean Health Medicaid |
$20,738.47
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19,237.74
|
| Rate for Payer: Managed Health Services Medicaid |
$21,657.73
|
| Rate for Payer: Molina Healthcare Medicaid |
$20,738.47
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$20,738.47
|
| Rate for Payer: United Healthcare Medicaid |
$20,738.47
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURE EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$3,419.64
|
|
|
Service Code
|
APR-DRG 5421
|
| Min. Negotiated Rate |
$3,037.54 |
| Max. Negotiated Rate |
$3,419.64 |
| Rate for Payer: Anthem Medicaid |
$3,274.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$3,274.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$3,274.49
|
| Rate for Payer: Dean Health Medicaid |
$3,274.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$3,037.54
|
| Rate for Payer: Managed Health Services Medicaid |
$3,419.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$3,274.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$3,274.49
|
| Rate for Payer: United Healthcare Medicaid |
$3,274.49
|
|
|
VAGINAL DELIVERY WITH O.R. PROCEDURES EXCEPT STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$34,013.20
|
|
|
Service Code
|
MSDRG 768
|
| Min. Negotiated Rate |
$7,800.00 |
| Max. Negotiated Rate |
$34,013.20 |
| Rate for Payer: Aetna Managed Medicare |
$8,713.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$8,713.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,713.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,713.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,713.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18,901.29
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,713.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,800.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,713.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,713.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,713.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,713.31
|
| Rate for Payer: NAPHCARE Commercial |
$13,069.96
|
| Rate for Payer: Quartz Medicare Advantage |
$8,713.31
|
| Rate for Payer: The Alliance Commercial |
$34,013.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,713.31
|
| Rate for Payer: United Healthcare PPO |
$10,596.56
|
| Rate for Payer: Wellcare Medicare |
$8,713.31
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH CC
|
Facility
|
IP
|
$20,978.88
|
|
|
Service Code
|
MSDRG 806
|
| Min. Negotiated Rate |
$6,281.06 |
| Max. Negotiated Rate |
$20,978.88 |
| Rate for Payer: Aetna Managed Medicare |
$6,281.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$6,281.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$6,281.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$6,281.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$6,281.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,299.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$6,281.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,143.08
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$6,281.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$6,281.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$6,281.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$6,281.06
|
| Rate for Payer: NAPHCARE Commercial |
$9,421.59
|
| Rate for Payer: Quartz Medicare Advantage |
$6,281.06
|
| Rate for Payer: The Alliance Commercial |
$20,978.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$6,281.06
|
| Rate for Payer: United Healthcare PPO |
$11,789.08
|
| Rate for Payer: Wellcare Medicare |
$6,281.06
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITH MCC
|
Facility
|
IP
|
$28,208.96
|
|
|
Service Code
|
MSDRG 805
|
| Min. Negotiated Rate |
$7,944.56 |
| Max. Negotiated Rate |
$28,208.96 |
| Rate for Payer: Aetna Managed Medicare |
$8,771.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$8,771.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,771.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,771.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,771.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$19,035.34
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,771.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,446.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,771.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,771.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,771.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,771.51
|
| Rate for Payer: NAPHCARE Commercial |
$13,157.26
|
| Rate for Payer: Quartz Medicare Advantage |
$8,771.51
|
| Rate for Payer: The Alliance Commercial |
$28,208.96
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,771.51
|
| Rate for Payer: United Healthcare PPO |
$15,917.70
|
| Rate for Payer: Wellcare Medicare |
$8,771.51
|
|
|
VAGINAL DELIVERY WITHOUT STERILIZATION OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$18,424.64
|
|
|
Service Code
|
MSDRG 807
|
| Min. Negotiated Rate |
$5,669.94 |
| Max. Negotiated Rate |
$18,424.64 |
| Rate for Payer: Aetna Managed Medicare |
$5,669.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$5,669.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,669.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,669.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,669.94
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,891.80
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,669.94
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,269.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,669.94
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,669.94
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,669.94
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,669.94
|
| Rate for Payer: NAPHCARE Commercial |
$8,504.92
|
| Rate for Payer: Quartz Medicare Advantage |
$5,669.94
|
| Rate for Payer: The Alliance Commercial |
$18,424.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,669.94
|
| Rate for Payer: United Healthcare PPO |
$10,330.25
|
| Rate for Payer: Wellcare Medicare |
$5,669.94
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$4,997.94
|
|
|
Service Code
|
APR-DRG 5411
|
| Min. Negotiated Rate |
$4,439.48 |
| Max. Negotiated Rate |
$4,997.94 |
| Rate for Payer: Anthem Medicaid |
$4,785.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,785.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,785.80
|
| Rate for Payer: Dean Health Medicaid |
$4,785.80
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,439.48
|
| Rate for Payer: Managed Health Services Medicaid |
$4,997.94
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,785.80
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,785.80
|
| Rate for Payer: United Healthcare Medicaid |
$4,785.80
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$8,242.21
|
|
|
Service Code
|
APR-DRG 5413
|
| Min. Negotiated Rate |
$7,321.25 |
| Max. Negotiated Rate |
$8,242.21 |
| Rate for Payer: Anthem Medicaid |
$7,892.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$7,892.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$7,892.37
|
| Rate for Payer: Dean Health Medicaid |
$7,892.37
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$7,321.25
|
| Rate for Payer: Managed Health Services Medicaid |
$8,242.21
|
| Rate for Payer: Molina Healthcare Medicaid |
$7,892.37
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$7,892.37
|
| Rate for Payer: United Healthcare Medicaid |
$7,892.37
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$5,611.72
|
|
|
Service Code
|
APR-DRG 5412
|
| Min. Negotiated Rate |
$4,984.68 |
| Max. Negotiated Rate |
$5,611.72 |
| Rate for Payer: Anthem Medicaid |
$5,373.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$5,373.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$5,373.53
|
| Rate for Payer: Dean Health Medicaid |
$5,373.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,984.68
|
| Rate for Payer: Managed Health Services Medicaid |
$5,611.72
|
| Rate for Payer: Molina Healthcare Medicaid |
$5,373.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$5,373.53
|
| Rate for Payer: United Healthcare Medicaid |
$5,373.53
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C
|
Facility
|
IP
|
$16,922.84
|
|
|
Service Code
|
APR-DRG 5414
|
| Min. Negotiated Rate |
$15,031.92 |
| Max. Negotiated Rate |
$16,922.84 |
| Rate for Payer: Anthem Medicaid |
$16,204.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$16,204.55
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$16,204.55
|
| Rate for Payer: Dean Health Medicaid |
$16,204.55
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$15,031.92
|
| Rate for Payer: Managed Health Services Medicaid |
$16,922.84
|
| Rate for Payer: Molina Healthcare Medicaid |
$16,204.55
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$16,204.55
|
| Rate for Payer: United Healthcare Medicaid |
$16,204.55
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH CC
|
Facility
|
IP
|
$27,868.88
|
|
|
Service Code
|
MSDRG 797
|
| Min. Negotiated Rate |
$7,944.56 |
| Max. Negotiated Rate |
$27,868.88 |
| Rate for Payer: Aetna Managed Medicare |
$8,168.05
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$8,168.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,168.05
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,168.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,168.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,645.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,168.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,196.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,168.05
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,168.05
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,168.05
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,168.05
|
| Rate for Payer: NAPHCARE Commercial |
$12,252.07
|
| Rate for Payer: Quartz Medicare Advantage |
$8,168.05
|
| Rate for Payer: The Alliance Commercial |
$27,868.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,168.05
|
| Rate for Payer: United Healthcare PPO |
$15,723.51
|
| Rate for Payer: Wellcare Medicare |
$8,168.05
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITH MCC
|
Facility
|
IP
|
$39,551.20
|
|
|
Service Code
|
MSDRG 796
|
| Min. Negotiated Rate |
$7,944.56 |
| Max. Negotiated Rate |
$39,551.20 |
| Rate for Payer: Aetna Managed Medicare |
$9,443.89
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$9,443.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,443.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,443.89
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,443.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,583.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,443.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,765.15
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,443.89
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,443.89
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,443.89
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,443.89
|
| Rate for Payer: NAPHCARE Commercial |
$14,165.83
|
| Rate for Payer: Quartz Medicare Advantage |
$9,443.89
|
| Rate for Payer: The Alliance Commercial |
$39,551.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,443.89
|
| Rate for Payer: United Healthcare PPO |
$22,394.04
|
| Rate for Payer: Wellcare Medicare |
$9,443.89
|
|
|
VAGINAL DELIVERY WITH STERILIZATION AND/OR D&C WITHOUT CC/MCC
|
Facility
|
IP
|
$23,422.88
|
|
|
Service Code
|
MSDRG 798
|
| Min. Negotiated Rate |
$7,836.43 |
| Max. Negotiated Rate |
$23,422.88 |
| Rate for Payer: Aetna Managed Medicare |
$7,836.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,696.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,364.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,944.56
|
| Rate for Payer: Anthem Medicare Advantage |
$7,836.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,836.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,836.43
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,836.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,881.69
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,836.43
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,451.14
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,836.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,836.43
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,836.43
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,836.43
|
| Rate for Payer: NAPHCARE Commercial |
$11,754.65
|
| Rate for Payer: Quartz Medicare Advantage |
$7,836.43
|
| Rate for Payer: The Alliance Commercial |
$23,422.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,836.43
|
| Rate for Payer: United Healthcare PPO |
$12,807.42
|
| Rate for Payer: Wellcare Medicare |
$7,836.43
|
|
|
VAGINAL HYSTERECTOMY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2960487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,159.68 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,644.51
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
VAGINAL HYSTERECTOMY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2960487
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,234.11 |
| Max. Negotiated Rate |
$4,054.92 |
| Rate for Payer: Aetna Commercial |
$3,966.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,790.47
|
| Rate for Payer: Aetna Managed Medicare |
$1,234.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,864.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,203.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,115.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,335.99
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$4,054.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,466.52
|
| Rate for Payer: Health EOS Commercial |
$3,922.69
|
| Rate for Payer: HFN Commercial |
$4,054.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,305.64
|
| Rate for Payer: Multiplan Commercial |
$3,526.02
|
| Rate for Payer: NAPHCARE Commercial |
$2,644.51
|
| Rate for Payer: Preferred Network Access Commercial |
$4,054.92
|
| Rate for Payer: Quartz Beloit One Network |
$2,159.68
|
| Rate for Payer: Quartz Commercial |
$2,864.89
|
| Rate for Payer: Quartz Medicare Advantage |
$2,644.51
|
| Rate for Payer: The Alliance Commercial |
$2,203.76
|
| Rate for Payer: WEA Trust Commercial |
$2,424.14
|
| Rate for Payer: WPS Commercial |
$3,264.53
|
|
|
VAGINAL SPECULA MEDIUM #59001
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
2969788
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$36.82
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
VAGINAL SPECULA MEDIUM #59001
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
2969788
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Aetna Managed Medicare |
$17.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.34
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.02
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$36.82
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$39.88
|
| Rate for Payer: Quartz Medicare Advantage |
$36.82
|
| Rate for Payer: The Alliance Commercial |
$30.68
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
VAGINAL SPECULA SMALL
|
Facility
|
OP
|
$59.00
|
|
| Hospital Charge Code |
2969787
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$17.18 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Aetna Managed Medicare |
$17.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$29.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$34.34
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$46.02
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: NAPHCARE Commercial |
$36.82
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$39.88
|
| Rate for Payer: Quartz Medicare Advantage |
$36.82
|
| Rate for Payer: The Alliance Commercial |
$30.68
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
VAGINAL SPECULA SMALL
|
Facility
|
IP
|
$59.00
|
|
| Hospital Charge Code |
2969787
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$30.07 |
| Max. Negotiated Rate |
$56.45 |
| Rate for Payer: Aetna Commercial |
$55.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$52.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32.52
|
| Rate for Payer: Cash Price |
$17.70
|
| Rate for Payer: Cigna Commercial |
$56.45
|
| Rate for Payer: Health EOS Commercial |
$54.61
|
| Rate for Payer: HFN Commercial |
$56.45
|
| Rate for Payer: Multiplan Commercial |
$49.09
|
| Rate for Payer: Preferred Network Access Commercial |
$56.45
|
| Rate for Payer: Quartz Beloit One Network |
$30.07
|
| Rate for Payer: Quartz Commercial |
$36.82
|
| Rate for Payer: WEA Trust Commercial |
$33.75
|
| Rate for Payer: WPS Commercial |
$45.45
|
|
|
VAGINAL VAULT SUSPENSION
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,005.28 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,455.44
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
