Wellmark/Healthnetwork: disclosed hospital rates

iDirect answer

Based on the published hospital price files, Wellmark/Healthnetwork appears in disclosed negotiated rates across 1 hospital and 39 services. This is public hospital price transparency data, not a guaranteed estimate of your bill.

Actual patient responsibility may vary based on your insurance plan, deductible, coinsurance, network status, diagnosis, setting, bundled services, clinical circumstances, and hospital billing practices.

39 prices shown.

Service	Hospital	Code	List price	Cash price	Negotiated range	Allowed (median)
ANCHOR SUTURE SUTURETAK TIGERWIRE FIBERWIRE 3MM Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	51462 LOCAL	$1,344	$941	$497 – $2,656	—
APPENDECTOMY WITHOUT COMPLEX PRINCIPAL DIAGNOSIS Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	234-2 APR-DRG	$113,849	$79,695	$900 – $108,157	—
CARDIAC STRUCTURAL AND VALVULAR DISORDERS Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	200-3 APR-DRG	$80,980	$56,686	$900 – $76,931	—
CARDIAC VALVE PROCEDURES WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	163-4 APR-DRG	$908,823	$636,176	$900 – $863,381	—
CATH BALLN DILATATION BIB 8FR 30MM 110CM Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	59256 LOCAL	$4,499	$3,149	$900 – $4,274	—
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	011-3 APR-DRG	$1,868,916	$1,308,241	$900 – $1,775,470	—
CHIMERIC ANTIGEN RECEPTOR (CAR) T-CELL AND OTHER IMMUNOTHERAPIES Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	011-4 APR-DRG	$2,836,904	$1,985,833	$900 – $2,695,059	—
CLEFT LIP AND PALATE REPAIR Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	095-1 APR-DRG	$63,535	$44,475	$900 – $60,359	—
DEPRESSION EXCEPT MAJOR DEPRESSIVE DISORDER Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	754-1 APR-DRG	$42,384	$29,669	$900 – $40,265	—
DIPHENHYDRAMINE-LIDOCAINE-MAALOX SUSPENSION (CMH) Outpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	99999-2250-14 NDC	$2.05	$1.43	$0.35 – $8,500	—
DIVERTICULITIS AND DIVERTICULOSIS Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	244-2 APR-DRG	$63,999	$44,799	$900 – $60,799	—
DORSAL AND LUMBAR FUSION PROCEDURE EXCEPT FOR CURVATURE OF BACK Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	304-3 APR-DRG	$818,360	$572,852	$900 – $777,442	—
FILGRASTIM-AAFI 300 MCG/ML INJECTION SOLUTION Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	0069-0293-10 NDC	$4.00	$2.80	$1.48 – $3,678	—
FRACTURE OF FEMUR Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	340-2 APR-DRG	$29,602	$20,721	$900 – $28,122	—
INBORN ERRORS OF METABOLISM Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	423-1 APR-DRG	$33,102	$23,172	$900 – $31,447	—
LEVONORGESTREL 14 MCG/24 HR (UP TO 3 YRS) 13.5 MG INTRAUTERINE DEVICE Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	50419-422-01 NDC	$3,304	$2,313	$900 – $3,678	—
MAJOR BLADDER PROCEDURES Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	441-4 APR-DRG	$617,896	$432,527	$900 – $587,001	—
MAJOR CRANIAL OR FACIAL BONE PROCEDURES Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	089-2 APR-DRG	$272,892	$191,024	$900 – $259,248	—
MAJOR PANCREAS LIVER AND SHUNT PROCEDURES Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	260-3 APR-DRG	$423,381	$296,366	$900 – $402,212	—
MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	951-1 APR-DRG	$81,086	$56,760	$900 – $77,032	—
MODERATELY EXTENSIVE O.R. PROCEDURE UNRELATED TO PRINCIPAL DIAGNOSIS Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	951-3 APR-DRG	$340,678	$238,474	$900 – $323,644	—
NAILIM 10MM X 360MM FEMORAL RT Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	51829 LOCAL	$1,723	$1,206	$638 – $2,656	—
NEONATE BIRTH WEIGHT 750-999 GRAMS WITHOUT MAJOR PROCEDURE Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	593-4 APR-DRG	$1,784,667	$1,249,267	$900 – $1,695,434	—
NEONATE WITH ECMO Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	583-1 APR-DRG	$1,687,788	$1,181,452	$900 – $1,603,399	—
NON-HYPOVOLEMIC SODIUM DISORDERS Inpatient	Ann & Robert H. Lurie Children's Hospital of Chicago	426-4 APR-DRG	$143,605	$100,524	$900 – $136,425	—