|
Cervical Immobilization Device
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
3040304
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.36 |
| Max. Negotiated Rate |
$48.00 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Aetna Managed Medicare |
$3.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.72
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.00
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.80
|
| Rate for Payer: Quartz Medicare Advantage |
$7.20
|
| Rate for Payer: The Alliance Commercial |
$48.00
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
Cervical Immobilization Device
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
3040304
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$5.88 |
| Max. Negotiated Rate |
$11.04 |
| Rate for Payer: Aetna Commercial |
$10.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.36
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.04
|
| Rate for Payer: Health EOS Commercial |
$10.68
|
| Rate for Payer: HFN Commercial |
$11.04
|
| Rate for Payer: Multiplan Commercial |
$9.60
|
| Rate for Payer: NAPHCARE Commercial |
$7.20
|
| Rate for Payer: Preferred Network Access Commercial |
$11.04
|
| Rate for Payer: Quartz Beloit One Network |
$5.88
|
| Rate for Payer: Quartz Commercial |
$7.20
|
| Rate for Payer: WEA Trust Commercial |
$6.60
|
| Rate for Payer: WPS Commercial |
$8.89
|
|
|
CERVICAL INFECTION INCISION, SUPERFICIAL & DEEP
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960154
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,101.80 |
| Max. Negotiated Rate |
$15,740.00 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Aetna Managed Medicare |
$1,101.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,888.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,202.03
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,951.25
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,361.00
|
| Rate for Payer: The Alliance Commercial |
$15,740.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
CERVICAL INFECTION INCISION, SUPERFICIAL & DEEP
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960154
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,928.15 |
| Max. Negotiated Rate |
$3,620.20 |
| Rate for Payer: Aetna Commercial |
$3,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,384.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,085.55
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,620.20
|
| Rate for Payer: Health EOS Commercial |
$3,502.15
|
| Rate for Payer: HFN Commercial |
$3,620.20
|
| Rate for Payer: Multiplan Commercial |
$3,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,620.20
|
| Rate for Payer: Quartz Beloit One Network |
$1,928.15
|
| Rate for Payer: Quartz Commercial |
$2,361.00
|
| Rate for Payer: WEA Trust Commercial |
$2,164.25
|
| Rate for Payer: WPS Commercial |
$2,914.65
|
|
|
Cervical semi-rigid adjustab L0140
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
3530171
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$33.73 |
| Max. Negotiated Rate |
$1,900.00 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Aetna Managed Medicare |
$133.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.73
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$33.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.75
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$437.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$265.81
|
| Rate for Payer: Health EOS Commercial |
$422.75
|
| Rate for Payer: HFN Commercial |
$437.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$356.25
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: NAPHCARE Commercial |
$285.00
|
| Rate for Payer: Preferred Network Access Commercial |
$437.00
|
| Rate for Payer: Quartz Beloit One Network |
$232.75
|
| Rate for Payer: Quartz Commercial |
$308.75
|
| Rate for Payer: Quartz Medicare Advantage |
$285.00
|
| Rate for Payer: The Alliance Commercial |
$1,900.00
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
Cervical semi-rigid adjustab L0140
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
3530171
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$209.00 |
| Max. Negotiated Rate |
$451.25 |
| Rate for Payer: Aetna Commercial |
$451.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$451.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$237.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$285.00
|
| Rate for Payer: Health EOS Commercial |
$432.25
|
| Rate for Payer: HFN Commercial |
$451.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$212.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$212.12
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: Preferred Network Access Commercial |
$451.25
|
| Rate for Payer: Quartz Beloit One Network |
$209.00
|
| Rate for Payer: Quartz Commercial |
$270.75
|
| Rate for Payer: The Alliance Commercial |
$237.50
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
Cervical semi-rigid adjustab L0140
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
3530171
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$232.75 |
| Max. Negotiated Rate |
$437.00 |
| Rate for Payer: Aetna Commercial |
$427.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$408.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$251.75
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$437.00
|
| Rate for Payer: Health EOS Commercial |
$422.75
|
| Rate for Payer: HFN Commercial |
$437.00
|
| Rate for Payer: Multiplan Commercial |
$380.00
|
| Rate for Payer: NAPHCARE Commercial |
$285.00
|
| Rate for Payer: Preferred Network Access Commercial |
$437.00
|
| Rate for Payer: Quartz Beloit One Network |
$232.75
|
| Rate for Payer: Quartz Commercial |
$285.00
|
| Rate for Payer: WEA Trust Commercial |
$261.25
|
| Rate for Payer: WPS Commercial |
$351.83
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$78,893.00
|
|
|
Service Code
|
MSDRG 472
|
| Min. Negotiated Rate |
$28,378.63 |
| Max. Negotiated Rate |
$78,893.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,378.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62,100.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47,599.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45,222.88
|
| Rate for Payer: Anthem Medicare Advantage |
$28,378.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,378.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,378.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,378.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50,201.54
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,378.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57,630.30
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,378.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,378.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,378.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,378.63
|
| Rate for Payer: NAPHCARE Commercial |
$42,567.94
|
| Rate for Payer: Quartz Medicare Advantage |
$28,378.63
|
| Rate for Payer: The Alliance Commercial |
$78,893.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,378.63
|
| Rate for Payer: United Healthcare PPO |
$44,865.93
|
| Rate for Payer: Wellcare Medicare |
$28,378.63
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$131,097.00
|
|
|
Service Code
|
MSDRG 471
|
| Min. Negotiated Rate |
$47,157.12 |
| Max. Negotiated Rate |
$131,097.00 |
| Rate for Payer: Aetna Managed Medicare |
$47,157.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$103,221.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$79,118.52
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$75,167.76
|
| Rate for Payer: Anthem Medicare Advantage |
$47,157.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$47,157.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$47,157.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$47,157.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$83,443.10
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$47,157.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$95,920.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47,157.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$47,157.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$47,157.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$47,157.12
|
| Rate for Payer: NAPHCARE Commercial |
$70,735.68
|
| Rate for Payer: Quartz Medicare Advantage |
$47,157.12
|
| Rate for Payer: The Alliance Commercial |
$131,097.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$47,157.12
|
| Rate for Payer: United Healthcare PPO |
$74,675.34
|
| Rate for Payer: Wellcare Medicare |
$47,157.12
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$65,738.00
|
|
|
Service Code
|
MSDRG 473
|
| Min. Negotiated Rate |
$23,646.71 |
| Max. Negotiated Rate |
$65,738.00 |
| Rate for Payer: Aetna Managed Medicare |
$23,646.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$51,610.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$39,559.26
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$37,583.88
|
| Rate for Payer: Anthem Medicare Advantage |
$23,646.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,646.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,646.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,646.71
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$41,721.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,646.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47,981.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,646.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,646.71
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,646.71
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,646.71
|
| Rate for Payer: NAPHCARE Commercial |
$35,470.06
|
| Rate for Payer: Quartz Medicare Advantage |
$23,646.71
|
| Rate for Payer: The Alliance Commercial |
$65,738.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,646.71
|
| Rate for Payer: United Healthcare PPO |
$37,354.37
|
| Rate for Payer: Wellcare Medicare |
$23,646.71
|
|
|
CERVICLE COLLAR PEDIATRIC
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
2963973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$153.86 |
| Max. Negotiated Rate |
$288.88 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$188.40
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
CERVICLE COLLAR PEDIATRIC
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
2963973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$87.92 |
| Max. Negotiated Rate |
$1,256.00 |
| Rate for Payer: Aetna Commercial |
$282.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$270.04
|
| Rate for Payer: Aetna Managed Medicare |
$87.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$204.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$157.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$150.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$166.42
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$288.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$175.71
|
| Rate for Payer: Health EOS Commercial |
$279.46
|
| Rate for Payer: HFN Commercial |
$288.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.50
|
| Rate for Payer: Multiplan Commercial |
$251.20
|
| Rate for Payer: NAPHCARE Commercial |
$188.40
|
| Rate for Payer: Preferred Network Access Commercial |
$288.88
|
| Rate for Payer: Quartz Beloit One Network |
$153.86
|
| Rate for Payer: Quartz Commercial |
$204.10
|
| Rate for Payer: Quartz Medicare Advantage |
$188.40
|
| Rate for Payer: The Alliance Commercial |
$1,256.00
|
| Rate for Payer: WEA Trust Commercial |
$172.70
|
| Rate for Payer: WPS Commercial |
$232.58
|
|
|
CESAREAN SECTION, PRIMARY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
CESAREAN SECTION, PRIMARY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959970
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
CESAREAN SECTION, REPEAT
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959971
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,076.62 |
| Max. Negotiated Rate |
$3,898.96 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,542.80
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
CESAREAN SECTION, REPEAT
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959971
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,186.64 |
| Max. Negotiated Rate |
$16,952.00 |
| Rate for Payer: Aetna Commercial |
$3,814.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,644.68
|
| Rate for Payer: Aetna Managed Medicare |
$1,186.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,754.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,119.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,034.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,246.14
|
| Rate for Payer: Cash Price |
$1,271.40
|
| Rate for Payer: Cigna Commercial |
$3,898.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,371.58
|
| Rate for Payer: Health EOS Commercial |
$3,771.82
|
| Rate for Payer: HFN Commercial |
$3,898.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,178.50
|
| Rate for Payer: Multiplan Commercial |
$3,390.40
|
| Rate for Payer: NAPHCARE Commercial |
$2,542.80
|
| Rate for Payer: Preferred Network Access Commercial |
$3,898.96
|
| Rate for Payer: Quartz Beloit One Network |
$2,076.62
|
| Rate for Payer: Quartz Commercial |
$2,754.70
|
| Rate for Payer: Quartz Medicare Advantage |
$2,542.80
|
| Rate for Payer: The Alliance Commercial |
$16,952.00
|
| Rate for Payer: WEA Trust Commercial |
$2,330.90
|
| Rate for Payer: WPS Commercial |
$3,139.09
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH CC
|
Facility
|
IP
|
$28,265.00
|
|
|
Service Code
|
MSDRG 787
|
| Min. Negotiated Rate |
$10,167.25 |
| Max. Negotiated Rate |
$28,265.00 |
| Rate for Payer: Aetna Managed Medicare |
$10,167.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,167.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,167.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,167.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,807.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,167.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$20,496.45
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,167.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,167.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,167.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,167.25
|
| Rate for Payer: NAPHCARE Commercial |
$15,250.88
|
| Rate for Payer: Quartz Medicare Advantage |
$10,167.25
|
| Rate for Payer: The Alliance Commercial |
$28,265.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,167.25
|
| Rate for Payer: United Healthcare PPO |
$15,956.75
|
| Rate for Payer: Wellcare Medicare |
$10,167.25
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITH MCC
|
Facility
|
IP
|
$46,833.00
|
|
|
Service Code
|
MSDRG 786
|
| Min. Negotiated Rate |
$13,096.00 |
| Max. Negotiated Rate |
$46,833.00 |
| Rate for Payer: Aetna Managed Medicare |
$16,846.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$16,846.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$16,846.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$16,846.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$16,846.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,679.96
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$16,846.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,115.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$16,846.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$16,846.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$16,846.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$16,846.25
|
| Rate for Payer: NAPHCARE Commercial |
$25,269.38
|
| Rate for Payer: Quartz Medicare Advantage |
$16,846.25
|
| Rate for Payer: The Alliance Commercial |
$46,833.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$16,846.25
|
| Rate for Payer: United Healthcare PPO |
$26,559.16
|
| Rate for Payer: Wellcare Medicare |
$16,846.25
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$23,051.00
|
|
|
Service Code
|
MSDRG 788
|
| Min. Negotiated Rate |
$8,291.87 |
| Max. Negotiated Rate |
$23,051.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,291.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,291.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,291.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,291.87
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,291.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,585.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,291.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,672.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,291.87
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,291.87
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,291.87
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,291.87
|
| Rate for Payer: NAPHCARE Commercial |
$12,437.80
|
| Rate for Payer: Quartz Medicare Advantage |
$8,291.87
|
| Rate for Payer: The Alliance Commercial |
$23,051.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,291.87
|
| Rate for Payer: United Healthcare PPO |
$12,979.76
|
| Rate for Payer: Wellcare Medicare |
$8,291.87
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH CC
|
Facility
|
IP
|
$27,547.00
|
|
|
Service Code
|
MSDRG 784
|
| Min. Negotiated Rate |
$9,909.04 |
| Max. Negotiated Rate |
$27,547.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,909.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$9,909.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,909.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,909.04
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,909.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$17,299.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,909.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$19,969.95
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,909.04
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,909.04
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,909.04
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,909.04
|
| Rate for Payer: NAPHCARE Commercial |
$14,863.56
|
| Rate for Payer: Quartz Medicare Advantage |
$9,909.04
|
| Rate for Payer: The Alliance Commercial |
$27,547.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,909.04
|
| Rate for Payer: United Healthcare PPO |
$15,546.86
|
| Rate for Payer: Wellcare Medicare |
$9,909.04
|
|
|
CESAREAN SECTION WITH STERILIZATION WITH MCC
|
Facility
|
IP
|
$47,425.00
|
|
|
Service Code
|
MSDRG 783
|
| Min. Negotiated Rate |
$13,096.00 |
| Max. Negotiated Rate |
$47,425.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,059.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17,059.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,059.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,059.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,059.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,019.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,059.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,550.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,059.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,059.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,059.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,059.51
|
| Rate for Payer: NAPHCARE Commercial |
$25,589.26
|
| Rate for Payer: Quartz Medicare Advantage |
$17,059.51
|
| Rate for Payer: The Alliance Commercial |
$47,425.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,059.51
|
| Rate for Payer: United Healthcare PPO |
$26,897.70
|
| Rate for Payer: Wellcare Medicare |
$17,059.51
|
|
|
CESAREAN SECTION WITH STERILIZATION WITHOUT CC/MCC
|
Facility
|
IP
|
$23,352.00
|
|
|
Service Code
|
MSDRG 785
|
| Min. Negotiated Rate |
$8,399.95 |
| Max. Negotiated Rate |
$23,352.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,399.95
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,152.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$8,399.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,399.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,399.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,399.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,755.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,399.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,892.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,399.95
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,399.95
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,399.95
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,399.95
|
| Rate for Payer: NAPHCARE Commercial |
$12,599.92
|
| Rate for Payer: Quartz Medicare Advantage |
$8,399.95
|
| Rate for Payer: The Alliance Commercial |
$23,352.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,399.95
|
| Rate for Payer: United Healthcare PPO |
$13,151.30
|
| Rate for Payer: Wellcare Medicare |
$8,399.95
|
|
|
CF DNA Amplification 83900
|
Facility
|
IP
|
$8.00
|
|
| Hospital Charge Code |
2790818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.92 |
| Max. Negotiated Rate |
$7.36 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$4.80
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF DNA Amplification 83900
|
Facility
|
OP
|
$8.00
|
|
| Hospital Charge Code |
2790818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$2.24 |
| Max. Negotiated Rate |
$32.00 |
| Rate for Payer: Aetna Commercial |
$7.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Aetna Managed Medicare |
$2.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4.24
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.48
|
| Rate for Payer: Health EOS Commercial |
$7.12
|
| Rate for Payer: HFN Commercial |
$7.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6.00
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: NAPHCARE Commercial |
$4.80
|
| Rate for Payer: Preferred Network Access Commercial |
$7.36
|
| Rate for Payer: Quartz Beloit One Network |
$3.92
|
| Rate for Payer: Quartz Commercial |
$5.20
|
| Rate for Payer: Quartz Medicare Advantage |
$4.80
|
| Rate for Payer: The Alliance Commercial |
$32.00
|
| Rate for Payer: United Healthcare PPO |
$6.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
|
CF DNA Amplification 83900
|
Professional
|
Both
|
$8.00
|
|
| Hospital Charge Code |
2790818
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$3.52 |
| Max. Negotiated Rate |
$7.60 |
| Rate for Payer: Aetna Commercial |
$7.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6.88
|
| Rate for Payer: Cash Price |
$2.40
|
| Rate for Payer: Cigna Commercial |
$7.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4.80
|
| Rate for Payer: Health EOS Commercial |
$7.28
|
| Rate for Payer: HFN Commercial |
$7.60
|
| Rate for Payer: Multiplan Commercial |
$6.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7.60
|
| Rate for Payer: Quartz Beloit One Network |
$3.52
|
| Rate for Payer: Quartz Commercial |
$4.56
|
| Rate for Payer: The Alliance Commercial |
$4.00
|
| Rate for Payer: WEA Trust Commercial |
$4.40
|
| Rate for Payer: WPS Commercial |
$5.93
|
|
