|
CORNEAL TRANSPLANT
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2959952
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
Corneal Ultrasound
|
Professional
|
Both
|
$58.00
|
|
|
Service Code
|
CPT 76514
|
| Hospital Charge Code |
1188930
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$11.40 |
| Max. Negotiated Rate |
$57.30 |
| Rate for Payer: Aetna Commercial |
$57.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51.88
|
| Rate for Payer: Aetna Managed Medicare |
$11.40
|
| Rate for Payer: Anthem Medicare Advantage |
$11.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cash Price |
$17.40
|
| Rate for Payer: Cigna Commercial |
$57.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$30.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11.40
|
| Rate for Payer: Health EOS Commercial |
$54.89
|
| Rate for Payer: HFN Commercial |
$57.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$40.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$11.40
|
| Rate for Payer: Multiplan Commercial |
$48.26
|
| Rate for Payer: NAPHCARE Commercial |
$17.10
|
| Rate for Payer: Preferred Network Access Commercial |
$57.30
|
| Rate for Payer: Quartz Beloit One Network |
$26.54
|
| Rate for Payer: Quartz Commercial |
$34.38
|
| Rate for Payer: Quartz Medicare Advantage |
$11.40
|
| Rate for Payer: The Alliance Commercial |
$43.31
|
| Rate for Payer: United Healthcare Medicare Advantage |
$11.40
|
| Rate for Payer: WEA Trust Commercial |
$33.18
|
| Rate for Payer: WPS Commercial |
$56.99
|
|
|
CORNER DRILL BIT TIBIAL 33600048
|
Facility
|
OP
|
$2,871.00
|
|
| Hospital Charge Code |
5831730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.04 |
| Max. Negotiated Rate |
$2,746.97 |
| Rate for Payer: Aetna Commercial |
$2,687.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,567.82
|
| Rate for Payer: Aetna Managed Medicare |
$836.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,940.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,492.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,433.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,582.50
|
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: Cigna Commercial |
$2,746.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,670.92
|
| Rate for Payer: Health EOS Commercial |
$2,657.40
|
| Rate for Payer: HFN Commercial |
$2,746.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,239.38
|
| Rate for Payer: Multiplan Commercial |
$2,388.67
|
| Rate for Payer: NAPHCARE Commercial |
$1,791.50
|
| Rate for Payer: Preferred Network Access Commercial |
$2,746.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,463.06
|
| Rate for Payer: Quartz Commercial |
$1,940.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,791.50
|
| Rate for Payer: The Alliance Commercial |
$1,492.92
|
| Rate for Payer: WEA Trust Commercial |
$1,642.21
|
| Rate for Payer: WPS Commercial |
$2,211.53
|
|
|
CORNER DRILL BIT TIBIAL 33600048
|
Facility
|
IP
|
$2,871.00
|
|
| Hospital Charge Code |
5831730
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,463.06 |
| Max. Negotiated Rate |
$2,746.97 |
| Rate for Payer: Aetna Commercial |
$2,687.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,567.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,582.50
|
| Rate for Payer: Cash Price |
$861.30
|
| Rate for Payer: Cigna Commercial |
$2,746.97
|
| Rate for Payer: Health EOS Commercial |
$2,657.40
|
| Rate for Payer: HFN Commercial |
$2,746.97
|
| Rate for Payer: Multiplan Commercial |
$2,388.67
|
| Rate for Payer: Preferred Network Access Commercial |
$2,746.97
|
| Rate for Payer: Quartz Beloit One Network |
$1,463.06
|
| Rate for Payer: Quartz Commercial |
$1,791.50
|
| Rate for Payer: WEA Trust Commercial |
$1,642.21
|
| Rate for Payer: WPS Commercial |
$2,211.53
|
|
|
Coronaries/BPG Only
|
Facility
|
OP
|
$16,928.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
3052495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,411.77 |
| Max. Negotiated Rate |
$18,182.32 |
| Rate for Payer: Aetna Commercial |
$15,844.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,140.40
|
| Rate for Payer: Aetna Managed Medicare |
$3,411.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,530.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,753.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,330.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,411.77
|
| Rate for Payer: Cash Price |
$5,078.40
|
| Rate for Payer: Cash Price |
$5,078.40
|
| Rate for Payer: Cash Price |
$5,078.40
|
| Rate for Payer: Cigna Commercial |
$16,196.71
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,411.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,411.77
|
| Rate for Payer: Health EOS Commercial |
$15,668.56
|
| Rate for Payer: HFN Commercial |
$16,196.71
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,691.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,411.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,411.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,411.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,411.77
|
| Rate for Payer: Multiplan Commercial |
$14,084.10
|
| Rate for Payer: NAPHCARE Commercial |
$5,117.66
|
| Rate for Payer: Preferred Network Access Commercial |
$16,196.71
|
| Rate for Payer: Quartz Beloit One Network |
$8,626.51
|
| Rate for Payer: Quartz Commercial |
$11,443.33
|
| Rate for Payer: Quartz Medicare Advantage |
$3,411.77
|
| Rate for Payer: The Alliance Commercial |
$13,647.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,411.77
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$9,682.82
|
| Rate for Payer: Wellcare Medicare |
$3,411.77
|
| Rate for Payer: WPS Commercial |
$13,039.64
|
|
|
Coronaries/BPG Only
|
Facility
|
IP
|
$16,928.00
|
|
|
Service Code
|
CPT 93455
|
| Hospital Charge Code |
3052495
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$8,626.51 |
| Max. Negotiated Rate |
$16,196.71 |
| Rate for Payer: Aetna Commercial |
$15,844.61
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,140.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,330.71
|
| Rate for Payer: Cash Price |
$5,078.40
|
| Rate for Payer: Cigna Commercial |
$16,196.71
|
| Rate for Payer: Health EOS Commercial |
$15,668.56
|
| Rate for Payer: HFN Commercial |
$16,196.71
|
| Rate for Payer: Multiplan Commercial |
$14,084.10
|
| Rate for Payer: Preferred Network Access Commercial |
$16,196.71
|
| Rate for Payer: Quartz Beloit One Network |
$8,626.51
|
| Rate for Payer: Quartz Commercial |
$10,563.07
|
| Rate for Payer: WEA Trust Commercial |
$9,682.82
|
| Rate for Payer: WPS Commercial |
$13,039.64
|
|
|
Coronaries Only
|
Facility
|
OP
|
$14,095.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
3052494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,411.77 |
| Max. Negotiated Rate |
$18,182.32 |
| Rate for Payer: Aetna Commercial |
$13,192.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,606.57
|
| Rate for Payer: Aetna Managed Medicare |
$3,411.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,182.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$15,530.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,753.44
|
| Rate for Payer: Anthem Medicare Advantage |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,769.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$3,411.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$3,411.77
|
| Rate for Payer: Cash Price |
$4,228.50
|
| Rate for Payer: Cash Price |
$4,228.50
|
| Rate for Payer: Cash Price |
$4,228.50
|
| Rate for Payer: Cigna Commercial |
$13,486.10
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$3,411.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$3,411.77
|
| Rate for Payer: Health EOS Commercial |
$13,046.33
|
| Rate for Payer: HFN Commercial |
$13,486.10
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,691.79
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$3,411.77
|
| Rate for Payer: Independent Care Health Plan Medicare |
$3,411.77
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$3,411.77
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$3,411.77
|
| Rate for Payer: Multiplan Commercial |
$11,727.04
|
| Rate for Payer: NAPHCARE Commercial |
$5,117.66
|
| Rate for Payer: Preferred Network Access Commercial |
$13,486.10
|
| Rate for Payer: Quartz Beloit One Network |
$7,182.81
|
| Rate for Payer: Quartz Commercial |
$9,528.22
|
| Rate for Payer: Quartz Medicare Advantage |
$3,411.77
|
| Rate for Payer: The Alliance Commercial |
$13,647.09
|
| Rate for Payer: United Healthcare Medicare Advantage |
$3,411.77
|
| Rate for Payer: United Healthcare PPO |
$4,267.12
|
| Rate for Payer: WEA Trust Commercial |
$8,062.34
|
| Rate for Payer: Wellcare Medicare |
$3,411.77
|
| Rate for Payer: WPS Commercial |
$10,857.38
|
|
|
Coronaries Only
|
Facility
|
IP
|
$14,095.00
|
|
|
Service Code
|
CPT 93454
|
| Hospital Charge Code |
3052494
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$7,182.81 |
| Max. Negotiated Rate |
$13,486.10 |
| Rate for Payer: Aetna Commercial |
$13,192.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,606.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,769.16
|
| Rate for Payer: Cash Price |
$4,228.50
|
| Rate for Payer: Cigna Commercial |
$13,486.10
|
| Rate for Payer: Health EOS Commercial |
$13,046.33
|
| Rate for Payer: HFN Commercial |
$13,486.10
|
| Rate for Payer: Multiplan Commercial |
$11,727.04
|
| Rate for Payer: Preferred Network Access Commercial |
$13,486.10
|
| Rate for Payer: Quartz Beloit One Network |
$7,182.81
|
| Rate for Payer: Quartz Commercial |
$8,795.28
|
| Rate for Payer: WEA Trust Commercial |
$8,062.34
|
| Rate for Payer: WPS Commercial |
$10,857.38
|
|
|
CORONARY ARTERY BYPASS GRAFT 1 VESSEL
|
Facility
|
OP
|
$20,019.00
|
|
| Hospital Charge Code |
2959900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,829.53 |
| Max. Negotiated Rate |
$19,154.18 |
| Rate for Payer: Aetna Commercial |
$18,737.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,904.99
|
| Rate for Payer: Aetna Managed Medicare |
$5,829.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,532.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,409.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,993.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,034.47
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$19,154.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,651.06
|
| Rate for Payer: Health EOS Commercial |
$18,529.59
|
| Rate for Payer: HFN Commercial |
$19,154.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,614.82
|
| Rate for Payer: Multiplan Commercial |
$16,655.81
|
| Rate for Payer: NAPHCARE Commercial |
$12,491.86
|
| Rate for Payer: Preferred Network Access Commercial |
$19,154.18
|
| Rate for Payer: Quartz Beloit One Network |
$10,201.68
|
| Rate for Payer: Quartz Commercial |
$13,532.84
|
| Rate for Payer: Quartz Medicare Advantage |
$12,491.86
|
| Rate for Payer: The Alliance Commercial |
$10,409.88
|
| Rate for Payer: WEA Trust Commercial |
$11,450.87
|
| Rate for Payer: WPS Commercial |
$15,420.64
|
|
|
CORONARY ARTERY BYPASS GRAFT 1 VESSEL
|
Facility
|
IP
|
$20,019.00
|
|
| Hospital Charge Code |
2959900
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,201.68 |
| Max. Negotiated Rate |
$19,154.18 |
| Rate for Payer: Aetna Commercial |
$18,737.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,904.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,034.47
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$19,154.18
|
| Rate for Payer: Health EOS Commercial |
$18,529.59
|
| Rate for Payer: HFN Commercial |
$19,154.18
|
| Rate for Payer: Multiplan Commercial |
$16,655.81
|
| Rate for Payer: Preferred Network Access Commercial |
$19,154.18
|
| Rate for Payer: Quartz Beloit One Network |
$10,201.68
|
| Rate for Payer: Quartz Commercial |
$12,491.86
|
| Rate for Payer: WEA Trust Commercial |
$11,450.87
|
| Rate for Payer: WPS Commercial |
$15,420.64
|
|
|
CORONARY ARTERY BYPASS GRAFT 2 VESSEL
|
Facility
|
IP
|
$20,019.00
|
|
| Hospital Charge Code |
2959901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,201.68 |
| Max. Negotiated Rate |
$19,154.18 |
| Rate for Payer: Aetna Commercial |
$18,737.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,904.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,034.47
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$19,154.18
|
| Rate for Payer: Health EOS Commercial |
$18,529.59
|
| Rate for Payer: HFN Commercial |
$19,154.18
|
| Rate for Payer: Multiplan Commercial |
$16,655.81
|
| Rate for Payer: Preferred Network Access Commercial |
$19,154.18
|
| Rate for Payer: Quartz Beloit One Network |
$10,201.68
|
| Rate for Payer: Quartz Commercial |
$12,491.86
|
| Rate for Payer: WEA Trust Commercial |
$11,450.87
|
| Rate for Payer: WPS Commercial |
$15,420.64
|
|
|
CORONARY ARTERY BYPASS GRAFT 2 VESSEL
|
Facility
|
OP
|
$20,019.00
|
|
| Hospital Charge Code |
2959901
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,829.53 |
| Max. Negotiated Rate |
$19,154.18 |
| Rate for Payer: Aetna Commercial |
$18,737.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,904.99
|
| Rate for Payer: Aetna Managed Medicare |
$5,829.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,532.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,409.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,993.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,034.47
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$19,154.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,651.06
|
| Rate for Payer: Health EOS Commercial |
$18,529.59
|
| Rate for Payer: HFN Commercial |
$19,154.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,614.82
|
| Rate for Payer: Multiplan Commercial |
$16,655.81
|
| Rate for Payer: NAPHCARE Commercial |
$12,491.86
|
| Rate for Payer: Preferred Network Access Commercial |
$19,154.18
|
| Rate for Payer: Quartz Beloit One Network |
$10,201.68
|
| Rate for Payer: Quartz Commercial |
$13,532.84
|
| Rate for Payer: Quartz Medicare Advantage |
$12,491.86
|
| Rate for Payer: The Alliance Commercial |
$10,409.88
|
| Rate for Payer: WEA Trust Commercial |
$11,450.87
|
| Rate for Payer: WPS Commercial |
$15,420.64
|
|
|
CORONARY ARTERY BYPASS GRAFT 3 VESSEL
|
Facility
|
OP
|
$20,019.00
|
|
| Hospital Charge Code |
2959902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,829.53 |
| Max. Negotiated Rate |
$19,154.18 |
| Rate for Payer: Aetna Commercial |
$18,737.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,904.99
|
| Rate for Payer: Aetna Managed Medicare |
$5,829.53
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,532.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,409.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,993.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,034.47
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$19,154.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,651.06
|
| Rate for Payer: Health EOS Commercial |
$18,529.59
|
| Rate for Payer: HFN Commercial |
$19,154.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,614.82
|
| Rate for Payer: Multiplan Commercial |
$16,655.81
|
| Rate for Payer: NAPHCARE Commercial |
$12,491.86
|
| Rate for Payer: Preferred Network Access Commercial |
$19,154.18
|
| Rate for Payer: Quartz Beloit One Network |
$10,201.68
|
| Rate for Payer: Quartz Commercial |
$13,532.84
|
| Rate for Payer: Quartz Medicare Advantage |
$12,491.86
|
| Rate for Payer: The Alliance Commercial |
$10,409.88
|
| Rate for Payer: WEA Trust Commercial |
$11,450.87
|
| Rate for Payer: WPS Commercial |
$15,420.64
|
|
|
CORONARY ARTERY BYPASS GRAFT 3 VESSEL
|
Facility
|
IP
|
$20,019.00
|
|
| Hospital Charge Code |
2959902
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$10,201.68 |
| Max. Negotiated Rate |
$19,154.18 |
| Rate for Payer: Aetna Commercial |
$18,737.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,904.99
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,034.47
|
| Rate for Payer: Cash Price |
$6,005.70
|
| Rate for Payer: Cigna Commercial |
$19,154.18
|
| Rate for Payer: Health EOS Commercial |
$18,529.59
|
| Rate for Payer: HFN Commercial |
$19,154.18
|
| Rate for Payer: Multiplan Commercial |
$16,655.81
|
| Rate for Payer: Preferred Network Access Commercial |
$19,154.18
|
| Rate for Payer: Quartz Beloit One Network |
$10,201.68
|
| Rate for Payer: Quartz Commercial |
$12,491.86
|
| Rate for Payer: WEA Trust Commercial |
$11,450.87
|
| Rate for Payer: WPS Commercial |
$15,420.64
|
|
|
CORONARY ARTERY BYPASS GRAFT 4 VESSEL
|
Facility
|
IP
|
$18,589.00
|
|
| Hospital Charge Code |
2959903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$9,472.95 |
| Max. Negotiated Rate |
$17,785.96 |
| Rate for Payer: Aetna Commercial |
$17,399.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,626.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,246.26
|
| Rate for Payer: Cash Price |
$5,576.70
|
| Rate for Payer: Cigna Commercial |
$17,785.96
|
| Rate for Payer: Health EOS Commercial |
$17,205.98
|
| Rate for Payer: HFN Commercial |
$17,785.96
|
| Rate for Payer: Multiplan Commercial |
$15,466.05
|
| Rate for Payer: Preferred Network Access Commercial |
$17,785.96
|
| Rate for Payer: Quartz Beloit One Network |
$9,472.95
|
| Rate for Payer: Quartz Commercial |
$11,599.54
|
| Rate for Payer: WEA Trust Commercial |
$10,632.91
|
| Rate for Payer: WPS Commercial |
$14,319.11
|
|
|
CORONARY ARTERY BYPASS GRAFT 4 VESSEL
|
Facility
|
OP
|
$18,589.00
|
|
| Hospital Charge Code |
2959903
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$5,413.12 |
| Max. Negotiated Rate |
$17,785.96 |
| Rate for Payer: Aetna Commercial |
$17,399.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,626.00
|
| Rate for Payer: Aetna Managed Medicare |
$5,413.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,566.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,666.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$9,279.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,246.26
|
| Rate for Payer: Cash Price |
$5,576.70
|
| Rate for Payer: Cigna Commercial |
$17,785.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,818.80
|
| Rate for Payer: Health EOS Commercial |
$17,205.98
|
| Rate for Payer: HFN Commercial |
$17,785.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,499.42
|
| Rate for Payer: Multiplan Commercial |
$15,466.05
|
| Rate for Payer: NAPHCARE Commercial |
$11,599.54
|
| Rate for Payer: Preferred Network Access Commercial |
$17,785.96
|
| Rate for Payer: Quartz Beloit One Network |
$9,472.95
|
| Rate for Payer: Quartz Commercial |
$12,566.16
|
| Rate for Payer: Quartz Medicare Advantage |
$11,599.54
|
| Rate for Payer: The Alliance Commercial |
$9,666.28
|
| Rate for Payer: WEA Trust Commercial |
$10,632.91
|
| Rate for Payer: WPS Commercial |
$14,319.11
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$62,781.10
|
|
|
Service Code
|
APR-DRG 1654
|
| Min. Negotiated Rate |
$55,766.09 |
| Max. Negotiated Rate |
$62,781.10 |
| Rate for Payer: Anthem Medicaid |
$60,116.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$60,116.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$60,116.36
|
| Rate for Payer: Dean Health Medicaid |
$60,116.36
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$55,766.09
|
| Rate for Payer: Managed Health Services Medicaid |
$62,781.10
|
| Rate for Payer: Molina Healthcare Medicaid |
$60,116.36
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$60,116.36
|
| Rate for Payer: United Healthcare Medicaid |
$60,116.36
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$33,670.31
|
|
|
Service Code
|
APR-DRG 1651
|
| Min. Negotiated Rate |
$29,908.07 |
| Max. Negotiated Rate |
$33,670.31 |
| Rate for Payer: Anthem Medicaid |
$32,241.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$32,241.18
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$32,241.18
|
| Rate for Payer: Dean Health Medicaid |
$32,241.18
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,908.07
|
| Rate for Payer: Managed Health Services Medicaid |
$33,670.31
|
| Rate for Payer: Molina Healthcare Medicaid |
$32,241.18
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$32,241.18
|
| Rate for Payer: United Healthcare Medicaid |
$32,241.18
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$46,647.41
|
|
|
Service Code
|
APR-DRG 1653
|
| Min. Negotiated Rate |
$41,435.14 |
| Max. Negotiated Rate |
$46,647.41 |
| Rate for Payer: Anthem Medicaid |
$44,667.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$44,667.46
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$44,667.46
|
| Rate for Payer: Dean Health Medicaid |
$44,667.46
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$41,435.14
|
| Rate for Payer: Managed Health Services Medicaid |
$46,647.41
|
| Rate for Payer: Molina Healthcare Medicaid |
$44,667.46
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$44,667.46
|
| Rate for Payer: United Healthcare Medicaid |
$44,667.46
|
|
|
CORONARY BYPASS WITH AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$37,616.05
|
|
|
Service Code
|
APR-DRG 1652
|
| Min. Negotiated Rate |
$33,412.92 |
| Max. Negotiated Rate |
$37,616.05 |
| Rate for Payer: Anthem Medicaid |
$36,019.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$36,019.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$36,019.44
|
| Rate for Payer: Dean Health Medicaid |
$36,019.44
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$33,412.92
|
| Rate for Payer: Managed Health Services Medicaid |
$37,616.05
|
| Rate for Payer: Molina Healthcare Medicaid |
$36,019.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$36,019.44
|
| Rate for Payer: United Healthcare Medicaid |
$36,019.44
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITH MCC
|
Facility
|
IP
|
$215,987.20
|
|
|
Service Code
|
MSDRG 233
|
| Min. Negotiated Rate |
$59,055.22 |
| Max. Negotiated Rate |
$215,987.20 |
| Rate for Payer: Aetna Managed Medicare |
$59,055.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$166,812.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$127,860.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$121,475.50
|
| Rate for Payer: Anthem Medicare Advantage |
$59,055.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$59,055.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$59,055.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$59,055.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$134,848.94
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$59,055.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$158,175.89
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$59,055.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$59,055.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$59,055.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$59,055.22
|
| Rate for Payer: NAPHCARE Commercial |
$88,582.84
|
| Rate for Payer: Quartz Medicare Advantage |
$59,055.22
|
| Rate for Payer: The Alliance Commercial |
$215,987.20
|
| Rate for Payer: United Healthcare Medicare Advantage |
$59,055.22
|
| Rate for Payer: United Healthcare PPO |
$123,141.96
|
| Rate for Payer: Wellcare Medicare |
$59,055.22
|
|
|
CORONARY BYPASS WITH CARDIAC CATHETERIZATION OR OPEN ABLATION WITHOUT MCC
|
Facility
|
IP
|
$144,052.48
|
|
|
Service Code
|
MSDRG 234
|
| Min. Negotiated Rate |
$42,341.22 |
| Max. Negotiated Rate |
$144,052.48 |
| Rate for Payer: Aetna Managed Medicare |
$42,341.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$119,191.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$91,359.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$86,797.50
|
| Rate for Payer: Anthem Medicare Advantage |
$42,341.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$42,341.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$42,341.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$42,341.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$96,353.18
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$42,341.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$105,413.46
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$42,341.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$42,341.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$42,341.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$42,341.22
|
| Rate for Payer: NAPHCARE Commercial |
$63,511.83
|
| Rate for Payer: Quartz Medicare Advantage |
$42,341.22
|
| Rate for Payer: The Alliance Commercial |
$144,052.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$42,341.22
|
| Rate for Payer: United Healthcare PPO |
$82,065.69
|
| Rate for Payer: Wellcare Medicare |
$42,341.22
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$28,321.64
|
|
|
Service Code
|
APR-DRG 1661
|
| Min. Negotiated Rate |
$25,157.05 |
| Max. Negotiated Rate |
$28,321.64 |
| Rate for Payer: Anthem Medicaid |
$27,119.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$27,119.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$27,119.53
|
| Rate for Payer: Dean Health Medicaid |
$27,119.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$25,157.05
|
| Rate for Payer: Managed Health Services Medicaid |
$28,321.64
|
| Rate for Payer: Molina Healthcare Medicaid |
$27,119.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$27,119.53
|
| Rate for Payer: United Healthcare Medicaid |
$27,119.53
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$32,881.16
|
|
|
Service Code
|
APR-DRG 1662
|
| Min. Negotiated Rate |
$29,207.10 |
| Max. Negotiated Rate |
$32,881.16 |
| Rate for Payer: Anthem Medicaid |
$31,485.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$31,485.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$31,485.53
|
| Rate for Payer: Dean Health Medicaid |
$31,485.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$29,207.10
|
| Rate for Payer: Managed Health Services Medicaid |
$32,881.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$31,485.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$31,485.53
|
| Rate for Payer: United Healthcare Medicaid |
$31,485.53
|
|
|
CORONARY BYPASS WITHOUT AMI OR COMPLEX PRINCIPAL DIAGNOSIS
|
Facility
|
IP
|
$41,035.69
|
|
|
Service Code
|
APR-DRG 1663
|
| Min. Negotiated Rate |
$36,450.46 |
| Max. Negotiated Rate |
$41,035.69 |
| Rate for Payer: Anthem Medicaid |
$39,293.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$39,293.94
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$39,293.94
|
| Rate for Payer: Dean Health Medicaid |
$39,293.94
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$36,450.46
|
| Rate for Payer: Managed Health Services Medicaid |
$41,035.69
|
| Rate for Payer: Molina Healthcare Medicaid |
$39,293.94
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$39,293.94
|
| Rate for Payer: United Healthcare Medicaid |
$39,293.94
|
|
