|
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 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
|
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 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, for uterus 250 g or less;
|
Facility
|
OP
|
$21,058.09
|
|
|
Service Code
|
CPT 58260
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,409.60 |
| Max. Negotiated Rate |
$21,058.09 |
| Rate for Payer: Aetna Managed Medicare |
$5,264.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,727.52
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,350.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,781.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,264.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,264.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,264.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,264.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,584.02
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,264.52
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,264.52
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,264.52
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,264.52
|
| Rate for Payer: NAPHCARE Commercial |
$7,896.78
|
| Rate for Payer: Quartz Medicare Advantage |
$5,264.52
|
| Rate for Payer: The Alliance Commercial |
$21,058.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,264.52
|
| Rate for Payer: United Healthcare PPO |
$4,409.60
|
| Rate for Payer: Wellcare Medicare |
$5,264.52
|
|
|
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 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 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
|
|
|
VAGINAL VAULT SUSPENSION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| 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: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| 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: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| 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 |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
VAGOTOMY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
VAGOTOMY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
Valproic Acid, Free
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.50
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$401.86
|
| Rate for Payer: Health EOS Commercial |
$388.75
|
| Rate for Payer: HFN Commercial |
$401.86
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: Preferred Network Access Commercial |
$401.86
|
| Rate for Payer: Quartz Beloit One Network |
$214.03
|
| Rate for Payer: Quartz Commercial |
$262.08
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$323.53
|
|
|
Valproic Acid, Free
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$401.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$388.75
|
| Rate for Payer: HFN Commercial |
$401.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$401.86
|
| Rate for Payer: Quartz Beloit One Network |
$214.03
|
| Rate for Payer: Quartz Commercial |
$283.92
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$56.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: United Healthcare PPO |
$327.60
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: Wellcare Medicare |
$14.08
|
| Rate for Payer: WPS Commercial |
$323.53
|
|
|
Valproic Acid, Free
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$414.96 |
| Rate for Payer: Aetna Commercial |
$414.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$414.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$218.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$397.49
|
| Rate for Payer: HFN Commercial |
$414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$414.96
|
| Rate for Payer: Quartz Beloit One Network |
$192.19
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$55.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$61.96
|
|
|
Valproic Acid Level
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
Valproic Acid Level
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$56.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: United Healthcare PPO |
$217.62
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: Wellcare Medicare |
$14.08
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
Valproic Acid Level
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$275.65 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$275.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$264.05
|
| Rate for Payer: HFN Commercial |
$275.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$275.65
|
| Rate for Payer: Quartz Beloit One Network |
$127.67
|
| Rate for Payer: Quartz Commercial |
$165.39
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$55.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$61.96
|
|
|
VALVE ANTI-REFLUX SALEM SUMP
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2963636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
VALVE ANTI-REFLUX SALEM SUMP
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2963636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
VALVE CO PT BLEEDBACK #1003331
|
Facility
|
IP
|
$1,005.00
|
|
| Hospital Charge Code |
2971810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$512.15 |
| Max. Negotiated Rate |
$961.58 |
| Rate for Payer: Aetna Commercial |
$940.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$898.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.96
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: Health EOS Commercial |
$930.23
|
| Rate for Payer: HFN Commercial |
$961.58
|
| Rate for Payer: Multiplan Commercial |
$836.16
|
| Rate for Payer: Preferred Network Access Commercial |
$961.58
|
| Rate for Payer: Quartz Beloit One Network |
$512.15
|
| Rate for Payer: Quartz Commercial |
$627.12
|
| Rate for Payer: WEA Trust Commercial |
$574.86
|
| Rate for Payer: WPS Commercial |
$774.15
|
|
|
VALVE CO PT BLEEDBACK #1003331
|
Facility
|
OP
|
$1,005.00
|
|
| Hospital Charge Code |
2971810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.66 |
| Max. Negotiated Rate |
$961.58 |
| Rate for Payer: Aetna Commercial |
$940.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$898.87
|
| Rate for Payer: Aetna Managed Medicare |
$292.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$679.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$522.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$501.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.96
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$584.91
|
| Rate for Payer: Health EOS Commercial |
$930.23
|
| Rate for Payer: HFN Commercial |
$961.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$783.90
|
| Rate for Payer: Multiplan Commercial |
$836.16
|
| Rate for Payer: NAPHCARE Commercial |
$627.12
|
| Rate for Payer: Preferred Network Access Commercial |
$961.58
|
| Rate for Payer: Quartz Beloit One Network |
$512.15
|
| Rate for Payer: Quartz Commercial |
$679.38
|
| Rate for Payer: Quartz Medicare Advantage |
$627.12
|
| Rate for Payer: The Alliance Commercial |
$522.60
|
| Rate for Payer: WEA Trust Commercial |
$574.86
|
| Rate for Payer: WPS Commercial |
$774.15
|
|
