|
Cervical Collars
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
3040305
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
Cervical collar, soft applied - Treatments Done
|
Facility
|
OP
|
$150.00
|
|
| Hospital Charge Code |
3002555
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$43.68 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Aetna Managed Medicare |
$43.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$101.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$78.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$74.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$87.30
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$117.00
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: NAPHCARE Commercial |
$93.60
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$101.40
|
| Rate for Payer: Quartz Medicare Advantage |
$93.60
|
| Rate for Payer: The Alliance Commercial |
$78.00
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Cervical collar, soft applied - Treatments Done
|
Facility
|
IP
|
$150.00
|
|
| Hospital Charge Code |
3002555
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$76.44 |
| Max. Negotiated Rate |
$143.52 |
| Rate for Payer: Aetna Commercial |
$140.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$134.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$82.68
|
| Rate for Payer: Cash Price |
$45.00
|
| Rate for Payer: Cigna Commercial |
$143.52
|
| Rate for Payer: Health EOS Commercial |
$138.84
|
| Rate for Payer: HFN Commercial |
$143.52
|
| Rate for Payer: Multiplan Commercial |
$124.80
|
| Rate for Payer: Preferred Network Access Commercial |
$143.52
|
| Rate for Payer: Quartz Beloit One Network |
$76.44
|
| Rate for Payer: Quartz Commercial |
$93.60
|
| Rate for Payer: WEA Trust Commercial |
$85.80
|
| Rate for Payer: WPS Commercial |
$115.55
|
|
|
Cervical collar, soft applied - Triage Treatments
|
Facility
|
IP
|
$156.00
|
|
| Hospital Charge Code |
2999899
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$79.50 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$97.34
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
Cervical collar, soft applied - Triage Treatments
|
Facility
|
OP
|
$156.00
|
|
| Hospital Charge Code |
2999899
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$45.43 |
| Max. Negotiated Rate |
$149.26 |
| Rate for Payer: Aetna Commercial |
$146.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$139.53
|
| Rate for Payer: Aetna Managed Medicare |
$45.43
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$81.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$77.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$85.99
|
| Rate for Payer: Cash Price |
$46.80
|
| Rate for Payer: Cigna Commercial |
$149.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$90.79
|
| Rate for Payer: Health EOS Commercial |
$144.39
|
| Rate for Payer: HFN Commercial |
$149.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121.68
|
| Rate for Payer: Multiplan Commercial |
$129.79
|
| Rate for Payer: NAPHCARE Commercial |
$97.34
|
| Rate for Payer: Preferred Network Access Commercial |
$149.26
|
| Rate for Payer: Quartz Beloit One Network |
$79.50
|
| Rate for Payer: Quartz Commercial |
$105.46
|
| Rate for Payer: Quartz Medicare Advantage |
$97.34
|
| Rate for Payer: The Alliance Commercial |
$81.12
|
| Rate for Payer: WEA Trust Commercial |
$89.23
|
| Rate for Payer: WPS Commercial |
$120.17
|
|
|
Cervical Immobilization Device
|
Facility
|
IP
|
$12.00
|
|
| Hospital Charge Code |
3040304
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$6.12 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$7.49
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
Cervical Immobilization Device
|
Facility
|
OP
|
$12.00
|
|
| Hospital Charge Code |
3040304
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$3.49 |
| Max. Negotiated Rate |
$11.48 |
| Rate for Payer: Aetna Commercial |
$11.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10.73
|
| Rate for Payer: Aetna Managed Medicare |
$3.49
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8.11
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6.61
|
| Rate for Payer: Cash Price |
$3.60
|
| Rate for Payer: Cigna Commercial |
$11.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6.98
|
| Rate for Payer: Health EOS Commercial |
$11.11
|
| Rate for Payer: HFN Commercial |
$11.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9.36
|
| Rate for Payer: Multiplan Commercial |
$9.98
|
| Rate for Payer: NAPHCARE Commercial |
$7.49
|
| Rate for Payer: Preferred Network Access Commercial |
$11.48
|
| Rate for Payer: Quartz Beloit One Network |
$6.12
|
| Rate for Payer: Quartz Commercial |
$8.11
|
| Rate for Payer: Quartz Medicare Advantage |
$7.49
|
| Rate for Payer: The Alliance Commercial |
$6.24
|
| Rate for Payer: WEA Trust Commercial |
$6.86
|
| Rate for Payer: WPS Commercial |
$9.24
|
|
|
CERVICAL INFECTION INCISION, SUPERFICIAL & DEEP
|
Facility
|
IP
|
$3,935.00
|
|
| Hospital Charge Code |
2960154
|
|
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
|
|
|
CERVICAL INFECTION INCISION, SUPERFICIAL & DEEP
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960154
|
|
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
|
|
|
Cervical semi-rigid adjustab L0140
|
Facility
|
OP
|
$475.00
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
3530171
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$35.08 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$138.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35.08
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$35.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$35.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$276.45
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.50
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$296.40
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$321.10
|
| Rate for Payer: Quartz Medicare Advantage |
$296.40
|
| Rate for Payer: The Alliance Commercial |
$306.01
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.89
|
|
|
Cervical semi-rigid adjustab L0140
|
Facility
|
IP
|
$475.00
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
3530171
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$242.06 |
| Max. Negotiated Rate |
$454.48 |
| Rate for Payer: Aetna Commercial |
$444.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$261.82
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$454.48
|
| Rate for Payer: Health EOS Commercial |
$439.66
|
| Rate for Payer: HFN Commercial |
$454.48
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: Preferred Network Access Commercial |
$454.48
|
| Rate for Payer: Quartz Beloit One Network |
$242.06
|
| Rate for Payer: Quartz Commercial |
$296.40
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$365.89
|
|
|
Cervical semi-rigid adjustab L0140
|
Professional
|
Both
|
$475.00
|
|
|
Service Code
|
HCPCS L0140
|
| Hospital Charge Code |
3530171
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$76.50 |
| Max. Negotiated Rate |
$469.30 |
| Rate for Payer: Aetna Commercial |
$469.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$424.84
|
| Rate for Payer: Aetna Managed Medicare |
$76.50
|
| Rate for Payer: Anthem Medicare Advantage |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$76.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$76.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cash Price |
$142.50
|
| Rate for Payer: Cigna Commercial |
$469.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$247.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$76.50
|
| Rate for Payer: Health EOS Commercial |
$449.54
|
| Rate for Payer: HFN Commercial |
$469.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$220.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$220.60
|
| Rate for Payer: Independent Care Health Plan Medicare |
$76.50
|
| Rate for Payer: Multiplan Commercial |
$395.20
|
| Rate for Payer: NAPHCARE Commercial |
$114.75
|
| Rate for Payer: Preferred Network Access Commercial |
$469.30
|
| Rate for Payer: Quartz Beloit One Network |
$217.36
|
| Rate for Payer: Quartz Commercial |
$281.58
|
| Rate for Payer: Quartz Medicare Advantage |
$76.50
|
| Rate for Payer: The Alliance Commercial |
$210.38
|
| Rate for Payer: United Healthcare Medicare Advantage |
$76.50
|
| Rate for Payer: WEA Trust Commercial |
$271.70
|
| Rate for Payer: WPS Commercial |
$133.88
|
|
|
CERVICAL SPINAL FUSION WITH CC
|
Facility
|
IP
|
$82,048.72
|
|
|
Service Code
|
MSDRG 472
|
| Min. Negotiated Rate |
$23,068.59 |
| Max. Negotiated Rate |
$82,048.72 |
| Rate for Payer: Aetna Managed Medicare |
$23,068.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64,281.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$49,271.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$46,810.94
|
| Rate for Payer: Anthem Medicare Advantage |
$23,068.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$23,068.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$23,068.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$23,068.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$51,964.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$23,068.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$59,935.51
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$23,068.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$23,068.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$23,068.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$23,068.59
|
| Rate for Payer: NAPHCARE Commercial |
$34,602.89
|
| Rate for Payer: Quartz Medicare Advantage |
$23,068.59
|
| Rate for Payer: The Alliance Commercial |
$82,048.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$23,068.59
|
| Rate for Payer: United Healthcare PPO |
$46,660.57
|
| Rate for Payer: Wellcare Medicare |
$23,068.59
|
|
|
CERVICAL SPINAL FUSION WITH MCC
|
Facility
|
IP
|
$136,340.88
|
|
|
Service Code
|
MSDRG 471
|
| Min. Negotiated Rate |
$37,485.92 |
| Max. Negotiated Rate |
$136,340.88 |
| Rate for Payer: Aetna Managed Medicare |
$37,485.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$105,358.37
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$80,756.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$76,723.79
|
| Rate for Payer: Anthem Medicare Advantage |
$37,485.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$37,485.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$37,485.92
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$37,485.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85,170.45
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$37,485.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$99,757.32
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$37,485.92
|
| Rate for Payer: Independent Care Health Plan Medicare |
$37,485.92
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$37,485.92
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$37,485.92
|
| Rate for Payer: NAPHCARE Commercial |
$56,228.87
|
| Rate for Payer: Quartz Medicare Advantage |
$37,485.92
|
| Rate for Payer: The Alliance Commercial |
$136,340.88
|
| Rate for Payer: United Healthcare Medicare Advantage |
$37,485.92
|
| Rate for Payer: United Healthcare PPO |
$77,662.35
|
| Rate for Payer: Wellcare Medicare |
$37,485.92
|
|
|
CERVICAL SPINAL FUSION WITHOUT CC/MCC
|
Facility
|
IP
|
$68,367.52
|
|
|
Service Code
|
MSDRG 473
|
| Min. Negotiated Rate |
$25,535.24 |
| Max. Negotiated Rate |
$68,367.52 |
| Rate for Payer: Aetna Managed Medicare |
$25,535.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$53,267.21
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$40,828.89
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$38,790.11
|
| Rate for Payer: Anthem Medicare Advantage |
$25,535.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,535.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,535.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,535.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$43,060.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,535.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49,900.97
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,535.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,535.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,535.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,535.24
|
| Rate for Payer: NAPHCARE Commercial |
$38,302.87
|
| Rate for Payer: Quartz Medicare Advantage |
$25,535.24
|
| Rate for Payer: The Alliance Commercial |
$68,367.52
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,535.24
|
| Rate for Payer: United Healthcare PPO |
$38,848.54
|
| Rate for Payer: Wellcare Medicare |
$25,535.24
|
|
|
CERVICLE COLLAR PEDIATRIC
|
Facility
|
IP
|
$314.00
|
|
| Hospital Charge Code |
2963973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$160.01 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$195.94
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
CERVICLE COLLAR PEDIATRIC
|
Facility
|
OP
|
$314.00
|
|
| Hospital Charge Code |
2963973
|
|
Hospital Revenue Code
|
271
|
| Min. Negotiated Rate |
$91.44 |
| Max. Negotiated Rate |
$300.44 |
| Rate for Payer: Aetna Commercial |
$293.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$280.84
|
| Rate for Payer: Aetna Managed Medicare |
$91.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$212.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$163.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$156.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$173.08
|
| Rate for Payer: Cash Price |
$94.20
|
| Rate for Payer: Cigna Commercial |
$300.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$182.75
|
| Rate for Payer: Health EOS Commercial |
$290.64
|
| Rate for Payer: HFN Commercial |
$300.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.92
|
| Rate for Payer: Multiplan Commercial |
$261.25
|
| Rate for Payer: NAPHCARE Commercial |
$195.94
|
| Rate for Payer: Preferred Network Access Commercial |
$300.44
|
| Rate for Payer: Quartz Beloit One Network |
$160.01
|
| Rate for Payer: Quartz Commercial |
$212.26
|
| Rate for Payer: Quartz Medicare Advantage |
$195.94
|
| Rate for Payer: The Alliance Commercial |
$163.28
|
| Rate for Payer: WEA Trust Commercial |
$179.61
|
| Rate for Payer: WPS Commercial |
$241.87
|
|
|
CESAREAN SECTION, PRIMARY
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959970
|
|
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
|
|
|
CESAREAN SECTION, PRIMARY
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959970
|
|
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
|
|
|
CESAREAN SECTION, REPEAT
|
Facility
|
OP
|
$4,238.00
|
|
| Hospital Charge Code |
2959971
|
|
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
|
|
|
CESAREAN SECTION, REPEAT
|
Facility
|
IP
|
$4,238.00
|
|
| Hospital Charge Code |
2959971
|
|
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
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$6,488.55
|
|
|
Service Code
|
APR-DRG 5402
|
| Min. Negotiated Rate |
$5,763.53 |
| Max. Negotiated Rate |
$6,488.55 |
| Rate for Payer: Anthem Medicaid |
$6,213.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,213.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,213.14
|
| Rate for Payer: Dean Health Medicaid |
$6,213.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,763.53
|
| Rate for Payer: Managed Health Services Medicaid |
$6,488.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,213.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,213.14
|
| Rate for Payer: United Healthcare Medicaid |
$6,213.14
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$5,085.62
|
|
|
Service Code
|
APR-DRG 5401
|
| Min. Negotiated Rate |
$4,517.36 |
| Max. Negotiated Rate |
$5,085.62 |
| Rate for Payer: Anthem Medicaid |
$4,869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,869.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,869.76
|
| Rate for Payer: Dean Health Medicaid |
$4,869.76
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,517.36
|
| Rate for Payer: Managed Health Services Medicaid |
$5,085.62
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,869.76
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,869.76
|
| Rate for Payer: United Healthcare Medicaid |
$4,869.76
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$9,820.51
|
|
|
Service Code
|
APR-DRG 5403
|
| Min. Negotiated Rate |
$8,723.19 |
| Max. Negotiated Rate |
$9,820.51 |
| Rate for Payer: Anthem Medicaid |
$9,403.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$9,403.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$9,403.68
|
| Rate for Payer: Dean Health Medicaid |
$9,403.68
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$8,723.19
|
| Rate for Payer: Managed Health Services Medicaid |
$9,820.51
|
| Rate for Payer: Molina Healthcare Medicaid |
$9,403.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$9,403.68
|
| Rate for Payer: United Healthcare Medicaid |
$9,403.68
|
|
|
CESAREAN SECTION WITHOUT STERILIZATION
|
Facility
|
IP
|
$21,657.73
|
|
|
Service Code
|
APR-DRG 5404
|
| 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
|
|
