|
Carboxyhemoglobin Level
|
Professional
|
$477.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
633627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$453.15 |
| Rate for Payer: Aetna Commercial |
$453.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Medicare Advantage |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.32
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$453.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$238.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12.32
|
| Rate for Payer: Health EOS Commercial |
$434.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$43.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$43.49
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: Preferred Network Access Commercial |
$453.15
|
| Rate for Payer: Quartz Beloit One Network |
$209.88
|
| Rate for Payer: Quartz Commercial |
$271.89
|
| Rate for Payer: Quartz Medicare Advantage |
$12.32
|
| Rate for Payer: The Alliance Commercial |
$48.66
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: WPS Commercial |
$54.21
|
|
|
Carboxyhemoglobin Level
|
Facility
OP
|
$477.00
|
|
|
Service Code
|
CPT 82375
|
| Hospital Charge Code |
633627
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$12.32 |
| Max. Negotiated Rate |
$1,908.00 |
| Rate for Payer: Aetna Commercial |
$429.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$410.22
|
| Rate for Payer: Aetna Managed Medicare |
$12.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$46.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20.45
|
| Rate for Payer: Anthem Medicaid |
$12.73
|
| Rate for Payer: Anthem Medicare Advantage |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$252.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12.32
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cash Price |
$143.10
|
| Rate for Payer: Cigna Commercial |
$438.84
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.73
|
| Rate for Payer: Dean Health Medicaid |
$12.73
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12.32
|
| Rate for Payer: Health EOS Commercial |
$424.53
|
| Rate for Payer: HFN Commercial |
$438.84
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45.83
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12.32
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$12.73
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12.32
|
| Rate for Payer: Managed Health Services Medicaid |
$13.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12.32
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12.32
|
| Rate for Payer: Multiplan Commercial |
$381.60
|
| Rate for Payer: NAPHCARE Commercial |
$18.48
|
| Rate for Payer: Preferred Network Access Commercial |
$438.84
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.73
|
| Rate for Payer: Quartz Beloit One Network |
$233.73
|
| Rate for Payer: Quartz Commercial |
$310.05
|
| Rate for Payer: Quartz Medicare Advantage |
$12.32
|
| Rate for Payer: The Alliance Commercial |
$1,908.00
|
| Rate for Payer: United Healthcare Medicaid |
$12.73
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12.32
|
| Rate for Payer: United Healthcare PPO |
$357.75
|
| Rate for Payer: WEA Trust Commercial |
$262.35
|
| Rate for Payer: Wellcare Medicare |
$12.32
|
| Rate for Payer: WMAP Medicaid |
$12.73
|
| Rate for Payer: WPS Commercial |
$353.31
|
|
|
Carcinoembryonic Antigen
|
Facility
IP
|
$368.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
633697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$180.32 |
| Max. Negotiated Rate |
$338.56 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$220.80
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$220.80
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
Carcinoembryonic Antigen
|
Facility
OP
|
$368.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
633697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$1,472.00 |
| Rate for Payer: Aetna Commercial |
$331.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Aetna Managed Medicare |
$18.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$71.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.47
|
| Rate for Payer: Anthem Medicaid |
$19.59
|
| Rate for Payer: Anthem Medicare Advantage |
$18.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$195.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.96
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$338.56
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19.59
|
| Rate for Payer: Dean Health Medicaid |
$19.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18.96
|
| Rate for Payer: Health EOS Commercial |
$327.52
|
| Rate for Payer: HFN Commercial |
$338.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$70.53
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18.96
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$19.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.96
|
| Rate for Payer: Managed Health Services Medicaid |
$20.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18.96
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: NAPHCARE Commercial |
$28.44
|
| Rate for Payer: Preferred Network Access Commercial |
$338.56
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19.59
|
| Rate for Payer: Quartz Beloit One Network |
$180.32
|
| Rate for Payer: Quartz Commercial |
$239.20
|
| Rate for Payer: Quartz Medicare Advantage |
$18.96
|
| Rate for Payer: The Alliance Commercial |
$1,472.00
|
| Rate for Payer: United Healthcare Medicaid |
$19.59
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.96
|
| Rate for Payer: United Healthcare PPO |
$276.00
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: Wellcare Medicare |
$18.96
|
| Rate for Payer: WMAP Medicaid |
$19.59
|
| Rate for Payer: WPS Commercial |
$272.58
|
|
|
Carcinoembryonic Antigen
|
Professional
|
$368.00
|
|
|
Service Code
|
CPT 82378
|
| Hospital Charge Code |
633697
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$18.96 |
| Max. Negotiated Rate |
$349.60 |
| Rate for Payer: Aetna Commercial |
$349.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$316.48
|
| Rate for Payer: Aetna Managed Medicare |
$18.96
|
| Rate for Payer: Anthem Medicare Advantage |
$18.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18.96
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cash Price |
$110.40
|
| Rate for Payer: Cigna Commercial |
$349.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$184.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$18.96
|
| Rate for Payer: Health EOS Commercial |
$334.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$66.93
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$66.93
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18.96
|
| Rate for Payer: Multiplan Commercial |
$294.40
|
| Rate for Payer: Preferred Network Access Commercial |
$349.60
|
| Rate for Payer: Quartz Beloit One Network |
$161.92
|
| Rate for Payer: Quartz Commercial |
$209.76
|
| Rate for Payer: Quartz Medicare Advantage |
$18.96
|
| Rate for Payer: The Alliance Commercial |
$74.89
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18.96
|
| Rate for Payer: WEA Trust Commercial |
$202.40
|
| Rate for Payer: WPS Commercial |
$83.42
|
|
|
Cardiac/Apnea Monitor - Daily Charges
|
Facility
IP
|
$851.00
|
|
| Hospital Charge Code |
3003967
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$416.99 |
| Max. Negotiated Rate |
$782.92 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$510.60
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
Cardiac/Apnea Monitor - Daily Charges
|
Facility
OP
|
$851.00
|
|
| Hospital Charge Code |
3003967
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$238.28 |
| Max. Negotiated Rate |
$3,404.00 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$238.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$553.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$408.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.22
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$638.25
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$553.15
|
| Rate for Payer: Quartz Medicare Advantage |
$510.60
|
| Rate for Payer: The Alliance Commercial |
$3,404.00
|
| Rate for Payer: United Healthcare PPO |
$638.25
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
Cardiac/Apnea Monitor - Nursery Daily Charges
|
Facility
IP
|
$851.00
|
|
| Hospital Charge Code |
3003953
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$416.99 |
| Max. Negotiated Rate |
$782.92 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$510.60
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
Cardiac/Apnea Monitor - Nursery Daily Charges
|
Facility
OP
|
$851.00
|
|
| Hospital Charge Code |
3003953
|
|
Hospital Revenue Code
|
410
|
| Min. Negotiated Rate |
$238.28 |
| Max. Negotiated Rate |
$3,404.00 |
| Rate for Payer: Aetna Commercial |
$765.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$731.86
|
| Rate for Payer: Aetna Managed Medicare |
$238.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$553.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$425.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$408.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$451.03
|
| Rate for Payer: Cash Price |
$255.30
|
| Rate for Payer: Cigna Commercial |
$782.92
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$476.22
|
| Rate for Payer: Health EOS Commercial |
$757.39
|
| Rate for Payer: HFN Commercial |
$782.92
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$638.25
|
| Rate for Payer: Multiplan Commercial |
$680.80
|
| Rate for Payer: NAPHCARE Commercial |
$510.60
|
| Rate for Payer: Preferred Network Access Commercial |
$782.92
|
| Rate for Payer: Quartz Beloit One Network |
$416.99
|
| Rate for Payer: Quartz Commercial |
$553.15
|
| Rate for Payer: Quartz Medicare Advantage |
$510.60
|
| Rate for Payer: The Alliance Commercial |
$3,404.00
|
| Rate for Payer: United Healthcare PPO |
$638.25
|
| Rate for Payer: WEA Trust Commercial |
$468.05
|
| Rate for Payer: WPS Commercial |
$630.34
|
|
|
CARDIAC ARREST, UNEXPLAINED WITH CC
|
Facility
IP
|
$19,691.00
|
|
|
Service Code
|
MS-DRG 297
|
| Min. Negotiated Rate |
$7,083.09 |
| Max. Negotiated Rate |
$19,691.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,083.09
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,315.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,739.13
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,152.94
|
| Rate for Payer: Anthem Medicare Advantage |
$7,083.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,083.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,083.09
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,083.09
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,380.79
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,083.09
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,207.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,083.09
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,083.09
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,083.09
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,083.09
|
| Rate for Payer: NAPHCARE Commercial |
$10,624.64
|
| Rate for Payer: Quartz Medicare Advantage |
$7,083.09
|
| Rate for Payer: The Alliance Commercial |
$19,691.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,083.09
|
| Rate for Payer: United Healthcare PPO |
$11,060.88
|
| Rate for Payer: Wellcare Medicare |
$7,083.09
|
|
|
CARDIAC ARREST, UNEXPLAINED WITH MCC
|
Facility
IP
|
$42,943.00
|
|
|
Service Code
|
MS-DRG 296
|
| Min. Negotiated Rate |
$15,447.14 |
| Max. Negotiated Rate |
$42,943.00 |
| Rate for Payer: Aetna Managed Medicare |
$15,447.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,568.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,729.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,444.80
|
| Rate for Payer: Anthem Medicare Advantage |
$15,447.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$15,447.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$15,447.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$15,447.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,135.97
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$15,447.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,262.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$15,447.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$15,447.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$15,447.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$15,447.14
|
| Rate for Payer: NAPHCARE Commercial |
$23,170.71
|
| Rate for Payer: Quartz Medicare Advantage |
$15,447.14
|
| Rate for Payer: The Alliance Commercial |
$42,943.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$15,447.14
|
| Rate for Payer: United Healthcare PPO |
$24,338.18
|
| Rate for Payer: Wellcare Medicare |
$15,447.14
|
|
|
CARDIAC ARREST, UNEXPLAINED WITHOUT CC/MCC
|
Facility
IP
|
$12,010.00
|
|
|
Service Code
|
MS-DRG 298
|
| Min. Negotiated Rate |
$4,320.25 |
| Max. Negotiated Rate |
$12,010.00 |
| Rate for Payer: Aetna Managed Medicare |
$4,320.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,231.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,075.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,722.32
|
| Rate for Payer: Anthem Medicare Advantage |
$4,320.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,320.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,320.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,320.25
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,462.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,320.25
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,558.55
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,320.25
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,320.25
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,320.25
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,320.25
|
| Rate for Payer: NAPHCARE Commercial |
$6,480.38
|
| Rate for Payer: Quartz Medicare Advantage |
$4,320.25
|
| Rate for Payer: The Alliance Commercial |
$12,010.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,320.25
|
| Rate for Payer: United Healthcare PPO |
$6,662.94
|
| Rate for Payer: Wellcare Medicare |
$4,320.25
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH CC
|
Facility
IP
|
$20,119.00
|
|
|
Service Code
|
MS-DRG 309
|
| Min. Negotiated Rate |
$7,237.06 |
| Max. Negotiated Rate |
$20,119.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,237.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,525.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,899.94
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,305.72
|
| Rate for Payer: Anthem Medicare Advantage |
$7,237.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,237.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,237.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,237.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,550.39
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,237.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,521.65
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,237.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,237.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,237.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,237.06
|
| Rate for Payer: NAPHCARE Commercial |
$10,855.59
|
| Rate for Payer: Quartz Medicare Advantage |
$7,237.06
|
| Rate for Payer: The Alliance Commercial |
$20,119.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,237.06
|
| Rate for Payer: United Healthcare PPO |
$11,305.29
|
| Rate for Payer: Wellcare Medicare |
$7,237.06
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITH MCC
|
Facility
IP
|
$32,282.00
|
|
|
Service Code
|
MS-DRG 308
|
| Min. Negotiated Rate |
$11,612.26 |
| Max. Negotiated Rate |
$32,282.00 |
| Rate for Payer: Aetna Managed Medicare |
$11,612.26
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,176.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,297.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,333.60
|
| Rate for Payer: Anthem Medicare Advantage |
$11,612.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11,612.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11,612.26
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11,612.26
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,351.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11,612.26
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$23,442.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11,612.26
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11,612.26
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$11,612.26
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11,612.26
|
| Rate for Payer: NAPHCARE Commercial |
$17,418.39
|
| Rate for Payer: Quartz Medicare Advantage |
$11,612.26
|
| Rate for Payer: The Alliance Commercial |
$32,282.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11,612.26
|
| Rate for Payer: United Healthcare PPO |
$18,250.60
|
| Rate for Payer: Wellcare Medicare |
$11,612.26
|
|
|
CARDIAC ARRHYTHMIA AND CONDUCTION DISORDERS WITHOUT CC/MCC
|
Facility
IP
|
$15,022.00
|
|
|
Service Code
|
MS-DRG 310
|
| Min. Negotiated Rate |
$5,403.77 |
| Max. Negotiated Rate |
$15,022.00 |
| Rate for Payer: Aetna Managed Medicare |
$5,403.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,539.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,844.55
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,402.90
|
| Rate for Payer: Anthem Medicare Advantage |
$5,403.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,403.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,403.77
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,403.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,327.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,403.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,783.50
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,403.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,403.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,403.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,403.77
|
| Rate for Payer: NAPHCARE Commercial |
$8,105.66
|
| Rate for Payer: Quartz Medicare Advantage |
$5,403.77
|
| Rate for Payer: The Alliance Commercial |
$15,022.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,403.77
|
| Rate for Payer: United Healthcare PPO |
$8,395.09
|
| Rate for Payer: Wellcare Medicare |
$5,403.77
|
|
|
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITH MCC
|
Facility
IP
|
$41,178.00
|
|
|
Service Code
|
MS-DRG 306
|
| Min. Negotiated Rate |
$14,812.14 |
| Max. Negotiated Rate |
$41,178.00 |
| Rate for Payer: Aetna Managed Medicare |
$14,812.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,309.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,764.74
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,528.12
|
| Rate for Payer: Anthem Medicare Advantage |
$14,812.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14,812.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14,812.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14,812.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,118.37
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14,812.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,967.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14,812.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14,812.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14,812.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14,812.14
|
| Rate for Payer: NAPHCARE Commercial |
$22,218.21
|
| Rate for Payer: Quartz Medicare Advantage |
$14,812.14
|
| Rate for Payer: The Alliance Commercial |
$41,178.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14,812.14
|
| Rate for Payer: United Healthcare PPO |
$23,330.16
|
| Rate for Payer: Wellcare Medicare |
$14,812.14
|
|
|
CARDIAC CONGENITAL AND VALVULAR DISORDERS WITHOUT MCC
|
Facility
IP
|
$25,380.00
|
|
|
Service Code
|
MS-DRG 307
|
| Min. Negotiated Rate |
$9,129.63 |
| Max. Negotiated Rate |
$25,380.00 |
| Rate for Payer: Aetna Managed Medicare |
$9,129.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,721.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,116.14
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,361.32
|
| Rate for Payer: Anthem Medicare Advantage |
$9,129.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$9,129.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$9,129.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$9,129.63
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$15,942.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$9,129.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,380.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$9,129.63
|
| Rate for Payer: Independent Care Health Plan Medicare |
$9,129.63
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$9,129.63
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$9,129.63
|
| Rate for Payer: NAPHCARE Commercial |
$13,694.44
|
| Rate for Payer: Quartz Medicare Advantage |
$9,129.63
|
| Rate for Payer: The Alliance Commercial |
$25,380.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$9,129.63
|
| Rate for Payer: United Healthcare PPO |
$14,309.61
|
| Rate for Payer: Wellcare Medicare |
$9,129.63
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH CARDIAC CATHETERIZATION AND MCC
|
Facility
IP
|
$187,374.00
|
|
|
Service Code
|
MS-DRG 275
|
| Min. Negotiated Rate |
$67,400.68 |
| Max. Negotiated Rate |
$187,374.00 |
| Rate for Payer: Aetna Managed Medicare |
$67,400.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$147,699.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$113,210.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$107,557.12
|
| Rate for Payer: Anthem Medicare Advantage |
$67,400.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$67,400.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$67,400.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$67,400.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$119,398.26
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$67,400.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$137,198.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$67,400.68
|
| Rate for Payer: Independent Care Health Plan Medicare |
$67,400.68
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$67,400.68
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$67,400.68
|
| Rate for Payer: NAPHCARE Commercial |
$101,101.02
|
| Rate for Payer: Quartz Medicare Advantage |
$67,400.68
|
| Rate for Payer: The Alliance Commercial |
$187,374.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$67,400.68
|
| Rate for Payer: United Healthcare PPO |
$106,810.48
|
| Rate for Payer: Wellcare Medicare |
$67,400.68
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITH MCC
|
Facility
IP
|
$165,425.00
|
|
|
Service Code
|
MS-DRG 276
|
| Min. Negotiated Rate |
$59,505.24 |
| Max. Negotiated Rate |
$165,425.00 |
| Rate for Payer: Aetna Managed Medicare |
$59,505.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130,285.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$99,863.01
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$94,876.38
|
| Rate for Payer: Anthem Medicare Advantage |
$59,505.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59,505.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59,505.24
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$59,505.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105,321.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$59,505.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$121,098.90
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59,505.24
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59,505.24
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$59,505.24
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$59,505.24
|
| Rate for Payer: NAPHCARE Commercial |
$89,257.86
|
| Rate for Payer: Quartz Medicare Advantage |
$59,505.24
|
| Rate for Payer: The Alliance Commercial |
$165,425.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59,505.24
|
| Rate for Payer: United Healthcare PPO |
$94,277.05
|
| Rate for Payer: Wellcare Medicare |
$59,505.24
|
|
|
CARDIAC DEFIBRILLATOR IMPLANT WITHOUT MCC
|
Facility
IP
|
$127,465.00
|
|
|
Service Code
|
MS-DRG 277
|
| Min. Negotiated Rate |
$45,850.76 |
| Max. Negotiated Rate |
$127,465.00 |
| Rate for Payer: Aetna Managed Medicare |
$45,850.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$100,284.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$76,867.18
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$73,028.84
|
| Rate for Payer: Anthem Medicare Advantage |
$45,850.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$45,850.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$45,850.76
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$45,850.76
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$81,068.70
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$45,850.76
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$93,256.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$45,850.76
|
| Rate for Payer: Independent Care Health Plan Medicare |
$45,850.76
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$45,850.76
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$45,850.76
|
| Rate for Payer: NAPHCARE Commercial |
$68,776.14
|
| Rate for Payer: Quartz Medicare Advantage |
$45,850.76
|
| Rate for Payer: The Alliance Commercial |
$127,465.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$45,850.76
|
| Rate for Payer: United Healthcare PPO |
$72,601.61
|
| Rate for Payer: Wellcare Medicare |
$45,850.76
|
|
|
CARDIAC DRUG STRESS TEST 93024
|
Professional
|
$437.00
|
|
|
Service Code
|
CPT 93024
|
| Hospital Charge Code |
3015356
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$103.36 |
| Max. Negotiated Rate |
$422.12 |
| Rate for Payer: Aetna Commercial |
$415.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.82
|
| Rate for Payer: Aetna Managed Medicare |
$105.53
|
| Rate for Payer: Anthem Medicare Advantage |
$105.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$105.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$105.53
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cash Price |
$131.10
|
| Rate for Payer: Cigna Commercial |
$415.15
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$218.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$105.53
|
| Rate for Payer: Health EOS Commercial |
$397.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$370.23
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$370.23
|
| Rate for Payer: Independent Care Health Plan Medicare |
$105.53
|
| Rate for Payer: Multiplan Commercial |
$349.60
|
| Rate for Payer: Preferred Network Access Commercial |
$415.15
|
| Rate for Payer: Quartz Beloit One Network |
$192.28
|
| Rate for Payer: Quartz Commercial |
$249.09
|
| Rate for Payer: Quartz Medicare Advantage |
$105.53
|
| Rate for Payer: The Alliance Commercial |
$401.01
|
| Rate for Payer: United Healthcare Medicaid |
$103.36
|
| Rate for Payer: United Healthcare Medicare Advantage |
$105.53
|
| Rate for Payer: WEA Trust Commercial |
$240.35
|
| Rate for Payer: WPS Commercial |
$422.12
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITH MCC
|
Facility
IP
|
$72,331.00
|
|
|
Service Code
|
MS-DRG 258
|
| Min. Negotiated Rate |
$26,018.41 |
| Max. Negotiated Rate |
$72,331.00 |
| Rate for Payer: Aetna Managed Medicare |
$26,018.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$56,855.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$43,579.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$41,403.38
|
| Rate for Payer: Anthem Medicare Advantage |
$26,018.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$26,018.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$26,018.41
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$26,018.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$45,961.55
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$26,018.41
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52,817.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$26,018.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$26,018.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$26,018.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$26,018.41
|
| Rate for Payer: NAPHCARE Commercial |
$39,027.62
|
| Rate for Payer: Quartz Medicare Advantage |
$26,018.41
|
| Rate for Payer: The Alliance Commercial |
$72,331.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$26,018.41
|
| Rate for Payer: United Healthcare PPO |
$41,119.26
|
| Rate for Payer: Wellcare Medicare |
$26,018.41
|
|
|
CARDIAC PACEMAKER DEVICE REPLACEMENT WITHOUT MCC
|
Facility
IP
|
$49,946.00
|
|
|
Service Code
|
MS-DRG 259
|
| Min. Negotiated Rate |
$17,966.11 |
| Max. Negotiated Rate |
$49,946.00 |
| Rate for Payer: Aetna Managed Medicare |
$17,966.11
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,232.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,071.47
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,569.86
|
| Rate for Payer: Anthem Medicare Advantage |
$17,966.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,966.11
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,966.11
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,966.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,715.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,966.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,398.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,966.11
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,966.11
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,966.11
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,966.11
|
| Rate for Payer: NAPHCARE Commercial |
$26,949.16
|
| Rate for Payer: Quartz Medicare Advantage |
$17,966.11
|
| Rate for Payer: The Alliance Commercial |
$49,946.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,966.11
|
| Rate for Payer: United Healthcare PPO |
$28,336.85
|
| Rate for Payer: Wellcare Medicare |
$17,966.11
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH CC
|
Facility
IP
|
$50,350.00
|
|
|
Service Code
|
MS-DRG 261
|
| Min. Negotiated Rate |
$18,111.48 |
| Max. Negotiated Rate |
$50,350.00 |
| Rate for Payer: Aetna Managed Medicare |
$18,111.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,442.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,232.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,722.64
|
| Rate for Payer: Anthem Medicare Advantage |
$18,111.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$18,111.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$18,111.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$18,111.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,884.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$18,111.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$36,695.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$18,111.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$18,111.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$18,111.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$18,111.48
|
| Rate for Payer: NAPHCARE Commercial |
$27,167.22
|
| Rate for Payer: Quartz Medicare Advantage |
$18,111.48
|
| Rate for Payer: The Alliance Commercial |
$50,350.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$18,111.48
|
| Rate for Payer: United Healthcare PPO |
$28,567.61
|
| Rate for Payer: Wellcare Medicare |
$18,111.48
|
|
|
CARDIAC PACEMAKER REVISION EXCEPT DEVICE REPLACEMENT WITH MCC
|
Facility
IP
|
$88,458.00
|
|
|
Service Code
|
MS-DRG 260
|
| Min. Negotiated Rate |
$31,819.51 |
| Max. Negotiated Rate |
$88,458.00 |
| Rate for Payer: Aetna Managed Medicare |
$31,819.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$69,653.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$53,388.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$50,722.96
|
| Rate for Payer: Anthem Medicare Advantage |
$31,819.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$31,819.51
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$31,819.51
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$31,819.51
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$56,307.13
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$31,819.51
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,646.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$31,819.51
|
| Rate for Payer: Independent Care Health Plan Medicare |
$31,819.51
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$31,819.51
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$31,819.51
|
| Rate for Payer: NAPHCARE Commercial |
$47,729.26
|
| Rate for Payer: Quartz Medicare Advantage |
$31,819.51
|
| Rate for Payer: The Alliance Commercial |
$88,458.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$31,819.51
|
| Rate for Payer: United Healthcare PPO |
$50,328.05
|
| Rate for Payer: Wellcare Medicare |
$31,819.51
|
|
