|
CORONARY ARTERY BYPASS GRAFT 3 VESSEL
|
Facility
OP
|
$20,019.00
|
|
| Hospital Charge Code |
2959902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,605.32 |
| Max. Negotiated Rate |
$80,076.00 |
| Rate for Payer: Aetna Commercial |
$18,017.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,216.34
|
| Rate for Payer: Aetna Managed Medicare |
$5,605.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,012.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,009.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,609.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,610.07
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$18,417.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,202.63
|
| Rate for Payer: Health EOS Commercial |
$17,816.91
|
| Rate for Payer: HFN Commercial |
$18,417.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,014.25
|
| Rate for Payer: Multiplan Commercial |
$16,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,011.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,417.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,809.31
|
| Rate for Payer: Quartz Commercial |
$13,012.35
|
| Rate for Payer: Quartz Medicare Advantage |
$12,011.40
|
| Rate for Payer: The Alliance Commercial |
$80,076.00
|
| Rate for Payer: WEA Trust Commercial |
$11,010.45
|
| Rate for Payer: WPS Commercial |
$14,828.07
|
|
|
CORONARY ARTERY BYPASS GRAFT 3 VESSEL
|
Facility
IP
|
$20,019.00
|
|
| Hospital Charge Code |
2959902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,809.31 |
| Max. Negotiated Rate |
$18,417.48 |
| Rate for Payer: Aetna Commercial |
$18,017.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,610.07
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$18,417.48
|
| Rate for Payer: Health EOS Commercial |
$17,816.91
|
| Rate for Payer: HFN Commercial |
$18,417.48
|
| Rate for Payer: Multiplan Commercial |
$16,015.20
|
| Rate for Payer: NAPHCARE Commercial |
$12,011.40
|
| Rate for Payer: Preferred Network Access Commercial |
$18,417.48
|
| Rate for Payer: Quartz Beloit One Network |
$9,809.31
|
| Rate for Payer: Quartz Commercial |
$12,011.40
|
| Rate for Payer: WEA Trust Commercial |
$11,010.45
|
| Rate for Payer: WPS Commercial |
$14,828.07
|
|
|
CORONARY ARTERY BYPASS GRAFT 4 VESSEL
|
Facility
OP
|
$18,589.00
|
|
| Hospital Charge Code |
2959903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,204.92 |
| Max. Negotiated Rate |
$74,356.00 |
| Rate for Payer: Aetna Commercial |
$16,730.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,986.54
|
| Rate for Payer: Aetna Managed Medicare |
$5,204.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,082.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,294.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,922.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,852.17
|
| Rate for Payer: Cash Price |
$5,576.70
|
| Rate for Payer: Cigna Commercial |
$17,101.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,402.40
|
| Rate for Payer: Health EOS Commercial |
$16,544.21
|
| Rate for Payer: HFN Commercial |
$17,101.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,941.75
|
| Rate for Payer: Multiplan Commercial |
$14,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,153.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,101.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,108.61
|
| Rate for Payer: Quartz Commercial |
$12,082.85
|
| Rate for Payer: Quartz Medicare Advantage |
$11,153.40
|
| Rate for Payer: The Alliance Commercial |
$74,356.00
|
| Rate for Payer: WEA Trust Commercial |
$10,223.95
|
| Rate for Payer: WPS Commercial |
$13,768.87
|
|
|
CORONARY ARTERY BYPASS GRAFT 4 VESSEL
|
Facility
IP
|
$18,589.00
|
|
| Hospital Charge Code |
2959903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,108.61 |
| Max. Negotiated Rate |
$17,101.88 |
| Rate for Payer: Aetna Commercial |
$16,730.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,852.17
|
| Rate for Payer: Cash Price |
$5,576.70
|
| Rate for Payer: Cigna Commercial |
$17,101.88
|
| Rate for Payer: Health EOS Commercial |
$16,544.21
|
| Rate for Payer: HFN Commercial |
$17,101.88
|
| Rate for Payer: Multiplan Commercial |
$14,871.20
|
| Rate for Payer: NAPHCARE Commercial |
$11,153.40
|
| Rate for Payer: Preferred Network Access Commercial |
$17,101.88
|
| Rate for Payer: Quartz Beloit One Network |
$9,108.61
|
| Rate for Payer: Quartz Commercial |
$11,153.40
|
| Rate for Payer: WEA Trust Commercial |
$10,223.95
|
| Rate for Payer: WPS Commercial |
$13,768.87
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
IP
|
$207,680.00
|
|
|
Service Code
|
MS-DRG 233
|
| Min. Negotiated Rate |
$74,705.14 |
| Max. Negotiated Rate |
$207,680.00 |
| Rate for Payer: Aetna Managed Medicare |
$74,705.14
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$163,644.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$125,431.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$119,168.40
|
| Rate for Payer: Anthem Medicare Advantage |
$74,705.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$74,705.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$74,705.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$74,705.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$132,287.84
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$74,705.14
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$152,092.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$74,705.14
|
| Rate for Payer: Independent Care Health Plan Medicare |
$74,705.14
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$74,705.14
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$74,705.14
|
| Rate for Payer: NAPHCARE Commercial |
$112,057.71
|
| Rate for Payer: Quartz Medicare Advantage |
$74,705.14
|
| Rate for Payer: The Alliance Commercial |
$207,680.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$74,705.14
|
| Rate for Payer: United Healthcare PPO |
$118,405.73
|
| Rate for Payer: Wellcare Medicare |
$74,705.14
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
IP
|
$138,512.00
|
|
|
Service Code
|
MS-DRG 234
|
| Min. Negotiated Rate |
$49,824.31 |
| Max. Negotiated Rate |
$138,512.00 |
| Rate for Payer: Aetna Managed Medicare |
$49,824.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$109,096.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$83,621.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$79,445.60
|
| Rate for Payer: Anthem Medicare Advantage |
$49,824.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$49,824.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$49,824.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$49,824.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88,191.90
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$49,824.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$101,359.10
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49,824.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$49,824.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$49,824.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$49,824.31
|
| Rate for Payer: NAPHCARE Commercial |
$74,736.46
|
| Rate for Payer: Quartz Medicare Advantage |
$49,824.31
|
| Rate for Payer: The Alliance Commercial |
$138,512.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$49,824.31
|
| Rate for Payer: United Healthcare PPO |
$78,909.32
|
| Rate for Payer: Wellcare Medicare |
$49,824.31
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITH MCC
|
Facility
IP
|
$156,662.00
|
|
|
Service Code
|
MS-DRG 235
|
| Min. Negotiated Rate |
$56,353.17 |
| Max. Negotiated Rate |
$156,662.00 |
| Rate for Payer: Aetna Managed Medicare |
$56,353.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$123,362.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$94,556.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$89,834.64
|
| Rate for Payer: Anthem Medicare Advantage |
$56,353.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$56,353.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$56,353.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$56,353.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$99,724.68
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$56,353.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$114,671.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$56,353.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$56,353.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$56,353.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$56,353.17
|
| Rate for Payer: NAPHCARE Commercial |
$84,529.76
|
| Rate for Payer: Quartz Medicare Advantage |
$56,353.17
|
| Rate for Payer: The Alliance Commercial |
$156,662.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$56,353.17
|
| Rate for Payer: United Healthcare PPO |
$89,273.39
|
| Rate for Payer: Wellcare Medicare |
$56,353.17
|
|
|
CORONARY BYPASS WITHOUT CARDIAC CATHETERIZATION WITHOUT MCC
|
Facility
IP
|
$107,760.00
|
|
|
Service Code
|
MS-DRG 236
|
| Min. Negotiated Rate |
$38,762.44 |
| Max. Negotiated Rate |
$107,760.00 |
| Rate for Payer: Aetna Managed Medicare |
$38,762.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$84,759.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$64,967.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$61,723.12
|
| Rate for Payer: Anthem Medicare Advantage |
$38,762.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$38,762.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$38,762.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$38,762.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$68,518.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$38,762.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$78,803.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38,762.44
|
| Rate for Payer: Independent Care Health Plan Medicare |
$38,762.44
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$38,762.44
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$38,762.44
|
| Rate for Payer: NAPHCARE Commercial |
$58,143.66
|
| Rate for Payer: Quartz Medicare Advantage |
$38,762.44
|
| Rate for Payer: The Alliance Commercial |
$107,760.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$38,762.44
|
| Rate for Payer: United Healthcare PPO |
$61,349.46
|
| Rate for Payer: Wellcare Medicare |
$38,762.44
|
|
|
CORONARY BYPASS WITH PTCA WITH MCC
|
Facility
IP
|
$216,071.00
|
|
|
Service Code
|
MS-DRG 231
|
| Min. Negotiated Rate |
$77,723.31 |
| Max. Negotiated Rate |
$216,071.00 |
| Rate for Payer: Aetna Managed Medicare |
$77,723.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$170,357.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130,577.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$124,057.36
|
| Rate for Payer: Anthem Medicare Advantage |
$77,723.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$77,723.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$77,723.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$77,723.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$137,715.04
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$77,723.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$158,246.40
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$77,723.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$77,723.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$77,723.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$77,723.31
|
| Rate for Payer: NAPHCARE Commercial |
$116,584.96
|
| Rate for Payer: Quartz Medicare Advantage |
$77,723.31
|
| Rate for Payer: The Alliance Commercial |
$216,071.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$77,723.31
|
| Rate for Payer: United Healthcare PPO |
$123,196.85
|
| Rate for Payer: Wellcare Medicare |
$77,723.31
|
|
|
CORONARY BYPASS WITH PTCA WITHOUT MCC
|
Facility
IP
|
$158,470.00
|
|
|
Service Code
|
MS-DRG 232
|
| Min. Negotiated Rate |
$57,003.48 |
| Max. Negotiated Rate |
$158,470.00 |
| Rate for Payer: Aetna Managed Medicare |
$57,003.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$124,831.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$95,681.95
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$90,904.10
|
| Rate for Payer: Anthem Medicare Advantage |
$57,003.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$57,003.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$57,003.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$57,003.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$100,911.88
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$57,003.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$115,997.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$57,003.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$57,003.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$57,003.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$57,003.48
|
| Rate for Payer: NAPHCARE Commercial |
$85,505.22
|
| Rate for Payer: Quartz Medicare Advantage |
$57,003.48
|
| Rate for Payer: The Alliance Commercial |
$158,470.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$57,003.48
|
| Rate for Payer: United Healthcare PPO |
$90,305.70
|
| Rate for Payer: Wellcare Medicare |
$57,003.48
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITH MCC
|
Facility
IP
|
$110,386.00
|
|
|
Service Code
|
MS-DRG 323
|
| Min. Negotiated Rate |
$39,707.31 |
| Max. Negotiated Rate |
$110,386.00 |
| Rate for Payer: Aetna Managed Medicare |
$39,707.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$86,857.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66,575.34
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63,250.92
|
| Rate for Payer: Anthem Medicare Advantage |
$39,707.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39,707.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39,707.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39,707.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70,214.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39,707.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$80,730.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39,707.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$39,707.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$39,707.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39,707.31
|
| Rate for Payer: NAPHCARE Commercial |
$59,560.96
|
| Rate for Payer: Quartz Medicare Advantage |
$39,707.31
|
| Rate for Payer: The Alliance Commercial |
$110,386.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$39,707.31
|
| Rate for Payer: United Healthcare PPO |
$62,849.34
|
| Rate for Payer: Wellcare Medicare |
$39,707.31
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITH INTRALUMINAL DEVICE WITHOUT MCC
|
Facility
IP
|
$79,244.00
|
|
|
Service Code
|
MS-DRG 324
|
| Min. Negotiated Rate |
$28,504.86 |
| Max. Negotiated Rate |
$79,244.00 |
| Rate for Payer: Aetna Managed Medicare |
$28,504.86
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$62,310.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$47,760.57
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$45,375.66
|
| Rate for Payer: Anthem Medicare Advantage |
$28,504.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$28,504.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$28,504.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$28,504.86
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$50,371.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$28,504.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$57,887.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$28,504.86
|
| Rate for Payer: Independent Care Health Plan Medicare |
$28,504.86
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$28,504.86
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$28,504.86
|
| Rate for Payer: NAPHCARE Commercial |
$42,757.29
|
| Rate for Payer: Quartz Medicare Advantage |
$28,504.86
|
| Rate for Payer: The Alliance Commercial |
$79,244.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$28,504.86
|
| Rate for Payer: United Healthcare PPO |
$45,066.32
|
| Rate for Payer: Wellcare Medicare |
$28,504.86
|
|
|
CORONARY INTRAVASCULAR LITHOTRIPSY WITHOUT INTRALUMINAL DEVICE
|
Facility
IP
|
$70,622.00
|
|
|
Service Code
|
MS-DRG 325
|
| Min. Negotiated Rate |
$25,403.48 |
| Max. Negotiated Rate |
$70,622.00 |
| Rate for Payer: Aetna Managed Medicare |
$25,403.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$55,387.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$42,453.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$40,333.92
|
| Rate for Payer: Anthem Medicare Advantage |
$25,403.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$25,403.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$25,403.48
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$25,403.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$44,774.35
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$25,403.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51,563.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$25,403.48
|
| Rate for Payer: Independent Care Health Plan Medicare |
$25,403.48
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$25,403.48
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$25,403.48
|
| Rate for Payer: NAPHCARE Commercial |
$38,105.22
|
| Rate for Payer: Quartz Medicare Advantage |
$25,403.48
|
| Rate for Payer: The Alliance Commercial |
$70,622.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$25,403.48
|
| Rate for Payer: United Healthcare PPO |
$40,143.12
|
| Rate for Payer: Wellcare Medicare |
$25,403.48
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DISTAL METATARSAL OSTEOTOMY, ANY METHOD
|
Facility
OP
|
$12,336.12
|
|
|
Service Code
|
CPT 28296
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH DOUBLE OSTEOTOMY, ANY METHOD
|
Facility
OP
|
$27,974.00
|
|
|
Service Code
|
CPT 28299
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,125.32 |
| Max. Negotiated Rate |
$27,974.00 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,974.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,272.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,008.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,339.76
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$6,125.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$13,676.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH FIRST METATARSAL AND MEDIAL CUNEIFORM JOINT ARTHRODESIS, ANY METHOD
|
Facility
OP
|
$27,265.32
|
|
|
Service Code
|
CPT 28297
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,546.14 |
| Max. Negotiated Rate |
$27,265.32 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$27,265.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH PROXIMAL PHALANX OSTEOTOMY, ANY METHOD
|
Facility
OP
|
$26,304.57
|
|
|
Service Code
|
CPT 28298
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$6,125.32 |
| Max. Negotiated Rate |
$26,304.57 |
| Rate for Payer: Aetna Managed Medicare |
$7,071.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$17,483.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16,081.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15,278.00
|
| Rate for Payer: Anthem Medicare Advantage |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,071.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,071.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,071.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,071.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,304.57
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,071.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,071.12
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,071.12
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,071.12
|
| Rate for Payer: NAPHCARE Commercial |
$10,606.68
|
| Rate for Payer: Quartz Medicare Advantage |
$7,071.12
|
| Rate for Payer: The Alliance Commercial |
$6,125.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,071.12
|
| Rate for Payer: United Healthcare PPO |
$8,452.00
|
| Rate for Payer: Wellcare Medicare |
$7,071.12
|
|
|
CORRECTION, HALLUX VALGUS WITH BUNIONECTOMY, WITH SESAMOIDECTOMY WHEN PERFORMED; WITH RESECTION OF PROXIMAL PHALANX BASE, WHEN PERFORMED, ANY METHOD
|
Facility
OP
|
$50,159.28
|
|
|
Service Code
|
CPT 28292
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$50,159.28 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,757.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$50,159.28
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
CORRECTION, HAMMERTOE (EG, INTERPHALANGEAL FUSION, PARTIAL OR TOTAL PHALANGECTOMY)
|
Facility
OP
|
$12,336.12
|
|
|
Service Code
|
CPT 28285
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$3,199.31 |
| Max. Negotiated Rate |
$12,336.12 |
| Rate for Payer: Aetna Managed Medicare |
$3,199.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,907.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,043.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,639.00
|
| Rate for Payer: Anthem Medicare Advantage |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,199.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,199.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,199.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,546.14
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,199.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,901.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,199.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,199.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,199.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,199.31
|
| Rate for Payer: NAPHCARE Commercial |
$4,798.96
|
| Rate for Payer: Quartz Medicare Advantage |
$3,199.31
|
| Rate for Payer: The Alliance Commercial |
$12,336.12
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,199.31
|
| Rate for Payer: United Healthcare PPO |
$4,103.00
|
| Rate for Payer: Wellcare Medicare |
$3,199.31
|
|
|
CORRECTION OF BUNION 28292
|
Professional
|
$2,739.00
|
|
|
Service Code
|
CPT 28292
|
| Hospital Charge Code |
3014234
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$460.34 |
| Max. Negotiated Rate |
$2,602.05 |
| Rate for Payer: Aetna Commercial |
$2,602.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,355.54
|
| Rate for Payer: Aetna Managed Medicare |
$460.34
|
| Rate for Payer: Anthem Medicare Advantage |
$460.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$460.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$460.34
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cash Price |
$821.70
|
| Rate for Payer: Cigna Commercial |
$2,602.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,369.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$460.34
|
| Rate for Payer: Health EOS Commercial |
$2,492.49
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,624.54
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,624.54
|
| Rate for Payer: Independent Care Health Plan Medicare |
$460.34
|
| Rate for Payer: Multiplan Commercial |
$2,191.20
|
| Rate for Payer: Preferred Network Access Commercial |
$2,602.05
|
| Rate for Payer: Quartz Beloit One Network |
$1,205.16
|
| Rate for Payer: Quartz Commercial |
$1,561.23
|
| Rate for Payer: Quartz Medicare Advantage |
$460.34
|
| Rate for Payer: The Alliance Commercial |
$1,956.44
|
| Rate for Payer: United Healthcare Medicaid |
$486.72
|
| Rate for Payer: United Healthcare Medicare Advantage |
$460.34
|
| Rate for Payer: WEA Trust Commercial |
$1,506.45
|
| Rate for Payer: WPS Commercial |
$2,071.53
|
|
|
Correction of Bunion 2829250
|
Professional
|
$5,480.00
|
|
|
Service Code
|
CPT 28292 50
|
| Hospital Charge Code |
5170621
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$486.72 |
| Max. Negotiated Rate |
$5,206.00 |
| Rate for Payer: Aetna Commercial |
$5,206.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,712.80
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cash Price |
$1,644.00
|
| Rate for Payer: Cigna Commercial |
$5,206.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,740.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,288.00
|
| Rate for Payer: Health EOS Commercial |
$4,986.80
|
| Rate for Payer: Multiplan Commercial |
$4,384.00
|
| Rate for Payer: Preferred Network Access Commercial |
$5,206.00
|
| Rate for Payer: Quartz Beloit One Network |
$2,411.20
|
| Rate for Payer: Quartz Commercial |
$3,123.60
|
| Rate for Payer: The Alliance Commercial |
$2,740.00
|
| Rate for Payer: United Healthcare Medicaid |
$486.72
|
| Rate for Payer: WEA Trust Commercial |
$3,014.00
|
| Rate for Payer: WPS Commercial |
$4,059.04
|
|
|
CORRECTION OF BUNION 28293
|
Professional
|
$4,712.00
|
|
| Hospital Charge Code |
3014235
|
| Min. Negotiated Rate |
$2,073.28 |
| Max. Negotiated Rate |
$4,476.40 |
| Rate for Payer: Aetna Commercial |
$4,476.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,052.32
|
| Rate for Payer: Cash Price |
$1,413.60
|
| Rate for Payer: Cigna Commercial |
$4,476.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,356.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,827.20
|
| Rate for Payer: Health EOS Commercial |
$4,287.92
|
| Rate for Payer: Multiplan Commercial |
$3,769.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,476.40
|
| Rate for Payer: Quartz Beloit One Network |
$2,073.28
|
| Rate for Payer: Quartz Commercial |
$2,685.84
|
| Rate for Payer: The Alliance Commercial |
$2,356.00
|
| Rate for Payer: WEA Trust Commercial |
$2,591.60
|
| Rate for Payer: WPS Commercial |
$3,490.18
|
|
|
CORRECTION OF BUNION 28296
|
Professional
|
$3,143.00
|
|
|
Service Code
|
CPT 28296
|
| Hospital Charge Code |
3014236
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$488.76 |
| Max. Negotiated Rate |
$2,985.85 |
| Rate for Payer: Aetna Commercial |
$2,985.85
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,702.98
|
| Rate for Payer: Aetna Managed Medicare |
$488.76
|
| Rate for Payer: Anthem Medicare Advantage |
$488.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$488.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$488.76
|
| Rate for Payer: Cash Price |
$942.90
|
| Rate for Payer: Cash Price |
$942.90
|
| Rate for Payer: Cigna Commercial |
$2,985.85
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,571.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$488.76
|
| Rate for Payer: Health EOS Commercial |
$2,860.13
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,732.35
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,732.35
|
| Rate for Payer: Independent Care Health Plan Medicare |
$488.76
|
| Rate for Payer: Multiplan Commercial |
$2,514.40
|
| Rate for Payer: Preferred Network Access Commercial |
$2,985.85
|
| Rate for Payer: Quartz Beloit One Network |
$1,382.92
|
| Rate for Payer: Quartz Commercial |
$1,791.51
|
| Rate for Payer: Quartz Medicare Advantage |
$488.76
|
| Rate for Payer: The Alliance Commercial |
$2,077.23
|
| Rate for Payer: United Healthcare Medicaid |
$606.50
|
| Rate for Payer: United Healthcare Medicare Advantage |
$488.76
|
| Rate for Payer: WEA Trust Commercial |
$1,728.65
|
| Rate for Payer: WPS Commercial |
$2,199.42
|
|
|
CORRECTION OF BUNION 28297
|
Professional
|
$4,115.00
|
|
|
Service Code
|
CPT 28297
|
| Hospital Charge Code |
3014237
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$570.64 |
| Max. Negotiated Rate |
$3,909.25 |
| Rate for Payer: Aetna Commercial |
$3,909.25
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,538.90
|
| Rate for Payer: Aetna Managed Medicare |
$570.64
|
| Rate for Payer: Anthem Medicare Advantage |
$570.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$570.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$570.64
|
| Rate for Payer: Cash Price |
$1,234.50
|
| Rate for Payer: Cash Price |
$1,234.50
|
| Rate for Payer: Cigna Commercial |
$3,909.25
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$2,057.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$570.64
|
| Rate for Payer: Health EOS Commercial |
$3,744.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,024.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,024.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$570.64
|
| Rate for Payer: Multiplan Commercial |
$3,292.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,909.25
|
| Rate for Payer: Quartz Beloit One Network |
$1,810.60
|
| Rate for Payer: Quartz Commercial |
$2,345.55
|
| Rate for Payer: Quartz Medicare Advantage |
$570.64
|
| Rate for Payer: The Alliance Commercial |
$2,425.22
|
| Rate for Payer: United Healthcare Medicaid |
$679.61
|
| Rate for Payer: United Healthcare Medicare Advantage |
$570.64
|
| Rate for Payer: WEA Trust Commercial |
$2,263.25
|
| Rate for Payer: WPS Commercial |
$2,567.88
|
|
|
CORRECTION OF BUNION 28298
|
Professional
|
$3,464.00
|
|
|
Service Code
|
CPT 28298
|
| Hospital Charge Code |
3014238
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$452.00 |
| Max. Negotiated Rate |
$3,290.80 |
| Rate for Payer: Aetna Commercial |
$3,290.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,979.04
|
| Rate for Payer: Aetna Managed Medicare |
$478.56
|
| Rate for Payer: Anthem Medicare Advantage |
$478.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$478.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$478.56
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cash Price |
$1,039.20
|
| Rate for Payer: Cigna Commercial |
$3,290.80
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$1,732.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$478.56
|
| Rate for Payer: Health EOS Commercial |
$3,152.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,682.12
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$1,682.12
|
| Rate for Payer: Independent Care Health Plan Medicare |
$478.56
|
| Rate for Payer: Multiplan Commercial |
$2,771.20
|
| Rate for Payer: Preferred Network Access Commercial |
$3,290.80
|
| Rate for Payer: Quartz Beloit One Network |
$1,524.16
|
| Rate for Payer: Quartz Commercial |
$1,974.48
|
| Rate for Payer: Quartz Medicare Advantage |
$478.56
|
| Rate for Payer: The Alliance Commercial |
$2,033.88
|
| Rate for Payer: United Healthcare Medicaid |
$452.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$478.56
|
| Rate for Payer: WEA Trust Commercial |
$1,905.20
|
| Rate for Payer: WPS Commercial |
$2,153.52
|
|
