Beloit Memorial Hospital

All Charges

Charge

Type

Setting

Price

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITH MCC

Facility

$92,284.40

Service Code	MSDRG 143
Min. Negotiated Rate	$29,198.99
Max. Negotiated Rate	$92,284.40
Rate for Payer: Aetna Managed Medicare	$29,198.99
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$81,747.81
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$62,659.04
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$59,530.18
Rate for Payer: Anthem Medicare Advantage	$29,198.99
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$29,198.99
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$29,198.99
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$29,198.99
Rate for Payer: Dean Health DHI/DHP/ASO	$66,083.95
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$29,198.99
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$67,443.17
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$29,198.99
Rate for Payer: Independent Care Health Plan Medicare	$29,198.99
Rate for Payer: Managed Health Services Medicare Advantage	$29,198.99
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$29,198.99
Rate for Payer: NAPHCARE Commercial	$43,798.48
Rate for Payer: Quartz Medicare Advantage	$29,198.99
Rate for Payer: The Alliance Commercial	$92,284.40
Rate for Payer: United Healthcare Medicare Advantage	$29,198.99
Rate for Payer: United Healthcare PPO	$52,505.37
Rate for Payer: Wellcare Medicare	$29,198.99

OTHER EAR, NOSE, MOUTH AND THROAT O.R. PROCEDURES WITHOUT CC/MCC

Facility

$34,096.40

Service Code	MSDRG 145
Min. Negotiated Rate	$9,714.24
Max. Negotiated Rate	$34,096.40
Rate for Payer: Aetna Managed Medicare	$9,714.24
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$26,233.22
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$20,107.55
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$19,103.49
Rate for Payer: Anthem Medicare Advantage	$9,714.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$9,714.24
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$9,714.24
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$9,714.24
Rate for Payer: Dean Health DHI/DHP/ASO	$21,206.62
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$9,714.24
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$24,763.91
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$9,714.24
Rate for Payer: Independent Care Health Plan Medicare	$9,714.24
Rate for Payer: Managed Health Services Medicare Advantage	$9,714.24
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$9,714.24
Rate for Payer: NAPHCARE Commercial	$14,571.37
Rate for Payer: Quartz Medicare Advantage	$9,714.24
Rate for Payer: The Alliance Commercial	$34,096.40
Rate for Payer: United Healthcare Medicare Advantage	$9,714.24
Rate for Payer: United Healthcare PPO	$19,279.02
Rate for Payer: Wellcare Medicare	$9,714.24

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$4,734.89

Service Code	APR-DRG 1151
Min. Negotiated Rate	$4,205.82
Max. Negotiated Rate	$4,734.89
Rate for Payer: Anthem Medicaid	$4,533.92
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$4,533.92
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$4,533.92
Rate for Payer: Dean Health Medicaid	$4,533.92
Rate for Payer: Independent Care Health Plan Medicaid	$4,205.82
Rate for Payer: Managed Health Services Medicaid	$4,734.89
Rate for Payer: Molina Healthcare Medicaid	$4,533.92
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$4,533.92
Rate for Payer: United Healthcare Medicaid	$4,533.92

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$10,434.29

Service Code	APR-DRG 1153
Min. Negotiated Rate	$9,268.39
Max. Negotiated Rate	$10,434.29
Rate for Payer: Anthem Medicaid	$9,991.41
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9,991.41
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$9,991.41
Rate for Payer: Dean Health Medicaid	$9,991.41
Rate for Payer: Independent Care Health Plan Medicaid	$9,268.39
Rate for Payer: Managed Health Services Medicaid	$10,434.29
Rate for Payer: Molina Healthcare Medicaid	$9,991.41
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$9,991.41
Rate for Payer: United Healthcare Medicaid	$9,991.41

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$7,014.65

Service Code	APR-DRG 1152
Min. Negotiated Rate	$6,230.85
Max. Negotiated Rate	$7,014.65
Rate for Payer: Anthem Medicaid	$6,716.91
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6,716.91
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,716.91
Rate for Payer: Dean Health Medicaid	$6,716.91
Rate for Payer: Independent Care Health Plan Medicaid	$6,230.85
Rate for Payer: Managed Health Services Medicaid	$7,014.65
Rate for Payer: Molina Healthcare Medicaid	$6,716.91
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,716.91
Rate for Payer: United Healthcare Medicaid	$6,716.91

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIAL OR FACIAL DIAGNOSES

Facility

$19,377.97

Service Code	APR-DRG 1154
Min. Negotiated Rate	$17,212.72
Max. Negotiated Rate	$19,377.97
Rate for Payer: Anthem Medicaid	$18,555.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$18,555.47
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$18,555.47
Rate for Payer: Dean Health Medicaid	$18,555.47
Rate for Payer: Independent Care Health Plan Medicaid	$17,212.72
Rate for Payer: Managed Health Services Medicaid	$19,377.97
Rate for Payer: Molina Healthcare Medicaid	$18,555.47
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$18,555.47
Rate for Payer: United Healthcare Medicaid	$18,555.47

OTHER EAR, NOSE, MOUTH, THROAT AND CRANIOFACIAL DIAGNOSES

Facility

$91.72

Service Code	EAPG 00564
Min. Negotiated Rate	$88.19
Max. Negotiated Rate	$91.72
Rate for Payer: Anthem Medicaid	$88.19
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$88.19
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$88.19
Rate for Payer: Dean Health Medicaid	$88.19
Rate for Payer: Independent Care Health Plan Medicaid	$88.19
Rate for Payer: Managed Health Services Medicaid	$91.72
Rate for Payer: Molina Healthcare Medicaid	$88.19
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$88.19
Rate for Payer: United Healthcare Medicaid	$88.19

OTHER EAR, NOSE, MOUTH, THROAT, CRANIOFACIAL, AND NECK PROCEDURES

Facility

$34,021.04

Service Code	APR-DRG 0984
Min. Negotiated Rate	$30,219.61
Max. Negotiated Rate	$34,021.04
Rate for Payer: Anthem Medicaid	$32,577.02
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$32,577.02
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$32,577.02
Rate for Payer: Dean Health Medicaid	$32,577.02
Rate for Payer: Independent Care Health Plan Medicaid	$30,219.61
Rate for Payer: Managed Health Services Medicaid	$34,021.04
Rate for Payer: Molina Healthcare Medicaid	$32,577.02
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$32,577.02
Rate for Payer: United Healthcare Medicaid	$32,577.02

OTHER EAR, NOSE, MOUTH, THROAT, CRANIOFACIAL, AND NECK PROCEDURES

Facility

$8,329.89

Service Code	APR-DRG 0981
Min. Negotiated Rate	$7,399.13
Max. Negotiated Rate	$8,329.89
Rate for Payer: Anthem Medicaid	$7,976.33
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$7,976.33
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7,976.33
Rate for Payer: Dean Health Medicaid	$7,976.33
Rate for Payer: Independent Care Health Plan Medicaid	$7,399.13
Rate for Payer: Managed Health Services Medicaid	$8,329.89
Rate for Payer: Molina Healthcare Medicaid	$7,976.33
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7,976.33
Rate for Payer: United Healthcare Medicaid	$7,976.33

OTHER EAR, NOSE, MOUTH, THROAT, CRANIOFACIAL, AND NECK PROCEDURES

Facility

$13,853.93

Service Code	APR-DRG 0982
Min. Negotiated Rate	$12,305.92
Max. Negotiated Rate	$13,853.93
Rate for Payer: Anthem Medicaid	$13,265.90
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$13,265.90
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$13,265.90
Rate for Payer: Dean Health Medicaid	$13,265.90
Rate for Payer: Independent Care Health Plan Medicaid	$12,305.92
Rate for Payer: Managed Health Services Medicaid	$13,853.93
Rate for Payer: Molina Healthcare Medicaid	$13,265.90
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$13,265.90
Rate for Payer: United Healthcare Medicaid	$13,265.90

OTHER EAR, NOSE, MOUTH, THROAT, CRANIOFACIAL, AND NECK PROCEDURES

Facility

$21,219.31

Service Code	APR-DRG 0983
Min. Negotiated Rate	$18,848.32
Max. Negotiated Rate	$21,219.31
Rate for Payer: Anthem Medicaid	$20,318.66
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$20,318.66
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$20,318.66
Rate for Payer: Dean Health Medicaid	$20,318.66
Rate for Payer: Independent Care Health Plan Medicaid	$18,848.32
Rate for Payer: Managed Health Services Medicaid	$21,219.31
Rate for Payer: Molina Healthcare Medicaid	$20,318.66
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$20,318.66
Rate for Payer: United Healthcare Medicaid	$20,318.66

OTHER ENDOCRINE DISORDERS

Facility

$7,628.43

Service Code	APR-DRG 4242
Min. Negotiated Rate	$6,776.05
Max. Negotiated Rate	$7,628.43
Rate for Payer: Anthem Medicaid	$7,304.64
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$7,304.64
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$7,304.64
Rate for Payer: Dean Health Medicaid	$7,304.64
Rate for Payer: Independent Care Health Plan Medicaid	$6,776.05
Rate for Payer: Managed Health Services Medicaid	$7,628.43
Rate for Payer: Molina Healthcare Medicaid	$7,304.64
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$7,304.64
Rate for Payer: United Healthcare Medicaid	$7,304.64

OTHER ENDOCRINE DISORDERS

Facility

$5,260.99

Service Code	APR-DRG 4241
Min. Negotiated Rate	$4,673.14
Max. Negotiated Rate	$5,260.99
Rate for Payer: Anthem Medicaid	$5,037.68
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$5,037.68
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,037.68
Rate for Payer: Dean Health Medicaid	$5,037.68
Rate for Payer: Independent Care Health Plan Medicaid	$4,673.14
Rate for Payer: Managed Health Services Medicaid	$5,260.99
Rate for Payer: Molina Healthcare Medicaid	$5,037.68
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,037.68
Rate for Payer: United Healthcare Medicaid	$5,037.68

OTHER ENDOCRINE DISORDERS

Facility

$11,486.49

Service Code	APR-DRG 4243
Min. Negotiated Rate	$10,203.01
Max. Negotiated Rate	$11,486.49
Rate for Payer: Anthem Medicaid	$10,998.94
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$10,998.94
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$10,998.94
Rate for Payer: Dean Health Medicaid	$10,998.94
Rate for Payer: Independent Care Health Plan Medicaid	$10,203.01
Rate for Payer: Managed Health Services Medicaid	$11,486.49
Rate for Payer: Molina Healthcare Medicaid	$10,998.94
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$10,998.94
Rate for Payer: United Healthcare Medicaid	$10,998.94

OTHER ENDOCRINE DISORDERS

Facility

$18,588.82

Service Code	APR-DRG 4244
Min. Negotiated Rate	$16,511.75
Max. Negotiated Rate	$18,588.82
Rate for Payer: Anthem Medicaid	$17,799.82
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$17,799.82
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$17,799.82
Rate for Payer: Dean Health Medicaid	$17,799.82
Rate for Payer: Independent Care Health Plan Medicaid	$16,511.75
Rate for Payer: Managed Health Services Medicaid	$18,588.82
Rate for Payer: Molina Healthcare Medicaid	$17,799.82
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$17,799.82
Rate for Payer: United Healthcare Medicaid	$17,799.82

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH CC

Facility

$62,898.16

Service Code	MSDRG 629
Min. Negotiated Rate	$17,192.47
Max. Negotiated Rate	$62,898.16
Rate for Payer: Aetna Managed Medicare	$17,192.47
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$47,539.67
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$36,438.77
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$34,619.21
Rate for Payer: Anthem Medicare Advantage	$17,192.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$17,192.47
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$17,192.47
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$17,192.47
Rate for Payer: Dean Health DHI/DHP/ASO	$38,430.50
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$17,192.47
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$45,889.58
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$17,192.47
Rate for Payer: Independent Care Health Plan Medicare	$17,192.47
Rate for Payer: Managed Health Services Medicare Advantage	$17,192.47
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$17,192.47
Rate for Payer: NAPHCARE Commercial	$25,788.70
Rate for Payer: Quartz Medicare Advantage	$17,192.47
Rate for Payer: The Alliance Commercial	$62,898.16
Rate for Payer: United Healthcare Medicare Advantage	$17,192.47
Rate for Payer: United Healthcare PPO	$35,725.63
Rate for Payer: Wellcare Medicare	$17,192.47

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITH MCC

Facility

$111,332.00

Service Code	MSDRG 628
Min. Negotiated Rate	$29,047.34
Max. Negotiated Rate	$111,332.00
Rate for Payer: Aetna Managed Medicare	$29,047.34
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$81,315.79
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$62,327.90
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$59,215.57
Rate for Payer: Anthem Medicare Advantage	$29,047.34
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$29,047.34
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$29,047.34
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$29,047.34
Rate for Payer: Dean Health DHI/DHP/ASO	$65,734.71
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$29,047.34
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$81,414.06
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$29,047.34
Rate for Payer: Independent Care Health Plan Medicare	$29,047.34
Rate for Payer: Managed Health Services Medicare Advantage	$29,047.34
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$29,047.34
Rate for Payer: NAPHCARE Commercial	$43,571.00
Rate for Payer: Quartz Medicare Advantage	$29,047.34
Rate for Payer: The Alliance Commercial	$111,332.00
Rate for Payer: United Healthcare Medicare Advantage	$29,047.34
Rate for Payer: United Healthcare PPO	$63,381.88
Rate for Payer: Wellcare Medicare	$29,047.34

OTHER ENDOCRINE, NUTRITIONAL AND METABOLIC O.R. PROCEDURES WITHOUT CC/MCC

Facility

$38,939.68

Service Code	MSDRG 630
Min. Negotiated Rate	$11,683.91
Max. Negotiated Rate	$38,939.68
Rate for Payer: Aetna Managed Medicare	$11,683.91
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$31,845.12
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$24,409.03
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$23,190.17
Rate for Payer: Anthem Medicare Advantage	$11,683.91
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$11,683.91
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$11,683.91
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$11,683.91
Rate for Payer: Dean Health DHI/DHP/ASO	$25,743.22
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$11,683.91
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$28,316.96
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$11,683.91
Rate for Payer: Independent Care Health Plan Medicare	$11,683.91
Rate for Payer: Managed Health Services Medicare Advantage	$11,683.91
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$11,683.91
Rate for Payer: NAPHCARE Commercial	$17,525.87
Rate for Payer: Quartz Medicare Advantage	$11,683.91
Rate for Payer: The Alliance Commercial	$38,939.68
Rate for Payer: United Healthcare Medicare Advantage	$11,683.91
Rate for Payer: United Healthcare PPO	$22,045.12
Rate for Payer: Wellcare Medicare	$11,683.91

OTHER ENDOCRINE SYSTEM DIAGNOSES

Facility

$90.41

Service Code	EAPG 00692
Min. Negotiated Rate	$86.93
Max. Negotiated Rate	$90.41
Rate for Payer: Anthem Medicaid	$86.93
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$86.93
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$86.93
Rate for Payer: Dean Health Medicaid	$86.93
Rate for Payer: Independent Care Health Plan Medicaid	$86.93
Rate for Payer: Managed Health Services Medicaid	$90.41
Rate for Payer: Molina Healthcare Medicaid	$86.93
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$86.93
Rate for Payer: United Healthcare Medicaid	$86.93

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITH MCC

Facility

$120,937.44

Service Code	MSDRG 319
Min. Negotiated Rate	$34,684.55
Max. Negotiated Rate	$120,937.44
Rate for Payer: Aetna Managed Medicare	$34,684.55
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$97,376.91
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$74,638.61
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$70,911.55
Rate for Payer: Anthem Medicare Advantage	$34,684.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$34,684.55
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$34,684.55
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$34,684.55
Rate for Payer: Dean Health DHI/DHP/ASO	$78,718.33
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$34,684.55
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$88,459.33
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$34,684.55
Rate for Payer: Independent Care Health Plan Medicare	$34,684.55
Rate for Payer: Managed Health Services Medicare Advantage	$34,684.55
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$34,684.55
Rate for Payer: NAPHCARE Commercial	$52,026.83
Rate for Payer: Quartz Medicare Advantage	$34,684.55
Rate for Payer: The Alliance Commercial	$120,937.44
Rate for Payer: United Healthcare Medicare Advantage	$34,684.55
Rate for Payer: United Healthcare PPO	$68,866.72
Rate for Payer: Wellcare Medicare	$34,684.55

OTHER ENDOVASCULAR CARDIAC VALVE PROCEDURES WITHOUT MCC

Facility

$61,881.04

Service Code	MSDRG 320
Min. Negotiated Rate	$18,927.04
Max. Negotiated Rate	$61,881.04
Rate for Payer: Aetna Managed Medicare	$18,927.04
Rate for Payer: Anthem Blue Access PPO/Blue Traditional	$52,481.72
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus	$40,226.81
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI	$38,218.10
Rate for Payer: Anthem Medicare Advantage	$18,927.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO	$18,927.04
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO	$18,927.04
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial	$18,927.04
Rate for Payer: Dean Health DHI/DHP/ASO	$42,425.60
Rate for Payer: Dean Health Medicare Advantage/Medicare Select	$18,927.04
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO	$45,143.28
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO	$18,927.04
Rate for Payer: Independent Care Health Plan Medicare	$18,927.04
Rate for Payer: Managed Health Services Medicare Advantage	$18,927.04
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace	$18,927.04
Rate for Payer: NAPHCARE Commercial	$28,390.56
Rate for Payer: Quartz Medicare Advantage	$18,927.04
Rate for Payer: The Alliance Commercial	$61,881.04
Rate for Payer: United Healthcare Medicare Advantage	$18,927.04
Rate for Payer: United Healthcare PPO	$35,144.63
Rate for Payer: Wellcare Medicare	$18,927.04

OTHER ESOPHAGEAL DISORDERS

Facility

$5,611.72

Service Code	APR-DRG 2431
Min. Negotiated Rate	$4,984.68
Max. Negotiated Rate	$5,611.72
Rate for Payer: Anthem Medicaid	$5,373.53
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$5,373.53
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$5,373.53
Rate for Payer: Dean Health Medicaid	$5,373.53
Rate for Payer: Independent Care Health Plan Medicaid	$4,984.68
Rate for Payer: Managed Health Services Medicaid	$5,611.72
Rate for Payer: Molina Healthcare Medicaid	$5,373.53
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$5,373.53
Rate for Payer: United Healthcare Medicaid	$5,373.53

OTHER ESOPHAGEAL DISORDERS

Facility

$7,277.70

Service Code	APR-DRG 2432
Min. Negotiated Rate	$6,464.50
Max. Negotiated Rate	$7,277.70
Rate for Payer: Anthem Medicaid	$6,968.80
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$6,968.80
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$6,968.80
Rate for Payer: Dean Health Medicaid	$6,968.80
Rate for Payer: Independent Care Health Plan Medicaid	$6,464.50
Rate for Payer: Managed Health Services Medicaid	$7,277.70
Rate for Payer: Molina Healthcare Medicaid	$6,968.80
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$6,968.80
Rate for Payer: United Healthcare Medicaid	$6,968.80

OTHER ESOPHAGEAL DISORDERS

Facility

$18,939.55

Service Code	APR-DRG 2434
Min. Negotiated Rate	$16,823.29
Max. Negotiated Rate	$18,939.55
Rate for Payer: Anthem Medicaid	$18,135.66
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$18,135.66
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$18,135.66
Rate for Payer: Dean Health Medicaid	$18,135.66
Rate for Payer: Independent Care Health Plan Medicaid	$16,823.29
Rate for Payer: Managed Health Services Medicaid	$18,939.55
Rate for Payer: Molina Healthcare Medicaid	$18,135.66
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$18,135.66
Rate for Payer: United Healthcare Medicaid	$18,135.66

OTHER ESOPHAGEAL DISORDERS

Facility

$10,258.92

Service Code	APR-DRG 2433
Min. Negotiated Rate	$9,112.62
Max. Negotiated Rate	$10,258.92
Rate for Payer: Anthem Medicaid	$9,823.48
Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO	$9,823.48
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid	$9,823.48
Rate for Payer: Dean Health Medicaid	$9,823.48
Rate for Payer: Independent Care Health Plan Medicaid	$9,112.62
Rate for Payer: Managed Health Services Medicaid	$10,258.92
Rate for Payer: Molina Healthcare Medicaid	$9,823.48
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP	$9,823.48
Rate for Payer: United Healthcare Medicaid	$9,823.48

Know your out-of-pocket cost for care.

All Charges