|
Hearing Aid Supplies / Accessories
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS V5267
|
| Hospital Charge Code |
1228811
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$64.98 |
| Max. Negotiated Rate |
$140.30 |
| Rate for Payer: Aetna Commercial |
$140.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$140.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$73.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.61
|
| Rate for Payer: Health EOS Commercial |
$134.39
|
| Rate for Payer: HFN Commercial |
$140.30
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: Preferred Network Access Commercial |
$140.30
|
| Rate for Payer: Quartz Beloit One Network |
$64.98
|
| Rate for Payer: Quartz Commercial |
$84.18
|
| Rate for Payer: The Alliance Commercial |
$73.84
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
Hearing Aid Supplies / Accessories
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS V5267
|
| Hospital Charge Code |
1228811
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$72.36 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$88.61
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
Hearing Aid Supplies / Accessories
|
Facility
|
OP
|
$142.00
|
|
|
Service Code
|
HCPCS V5267
|
| Hospital Charge Code |
1228811
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$41.35 |
| Max. Negotiated Rate |
$135.87 |
| Rate for Payer: Aetna Commercial |
$132.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.00
|
| Rate for Payer: Aetna Managed Medicare |
$41.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$95.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$73.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$70.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.27
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$135.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$82.64
|
| Rate for Payer: Health EOS Commercial |
$131.44
|
| Rate for Payer: HFN Commercial |
$135.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$110.76
|
| Rate for Payer: Multiplan Commercial |
$118.14
|
| Rate for Payer: NAPHCARE Commercial |
$88.61
|
| Rate for Payer: Preferred Network Access Commercial |
$135.87
|
| Rate for Payer: Quartz Beloit One Network |
$72.36
|
| Rate for Payer: Quartz Commercial |
$95.99
|
| Rate for Payer: Quartz Medicare Advantage |
$88.61
|
| Rate for Payer: The Alliance Commercial |
$73.84
|
| Rate for Payer: United Healthcare PPO |
$110.76
|
| Rate for Payer: WEA Trust Commercial |
$81.22
|
| Rate for Payer: WPS Commercial |
$109.38
|
|
|
Hearing Service
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS V5299
|
| Hospital Charge Code |
3243701
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$140.48 |
| Max. Negotiated Rate |
$303.32 |
| Rate for Payer: Aetna Commercial |
$303.32
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$303.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$159.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$191.57
|
| Rate for Payer: Health EOS Commercial |
$290.54
|
| Rate for Payer: HFN Commercial |
$303.32
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: Preferred Network Access Commercial |
$303.32
|
| Rate for Payer: Quartz Beloit One Network |
$140.48
|
| Rate for Payer: Quartz Commercial |
$181.99
|
| Rate for Payer: The Alliance Commercial |
$159.64
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
Hearing Service
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS V5299
|
| Hospital Charge Code |
3243701
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$89.40 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Aetna Managed Medicare |
$89.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$207.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$159.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$153.25
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$178.67
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$239.46
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: NAPHCARE Commercial |
$191.57
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$207.53
|
| Rate for Payer: Quartz Medicare Advantage |
$191.57
|
| Rate for Payer: The Alliance Commercial |
$159.64
|
| Rate for Payer: United Healthcare PPO |
$239.46
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
Hearing Service
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS V5299
|
| Hospital Charge Code |
3243701
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$156.45 |
| Max. Negotiated Rate |
$293.74 |
| Rate for Payer: Aetna Commercial |
$287.35
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$274.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$169.22
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$293.74
|
| Rate for Payer: Health EOS Commercial |
$284.16
|
| Rate for Payer: HFN Commercial |
$293.74
|
| Rate for Payer: Multiplan Commercial |
$255.42
|
| Rate for Payer: Preferred Network Access Commercial |
$293.74
|
| Rate for Payer: Quartz Beloit One Network |
$156.45
|
| Rate for Payer: Quartz Commercial |
$191.57
|
| Rate for Payer: WEA Trust Commercial |
$175.60
|
| Rate for Payer: WPS Commercial |
$236.48
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
|
IP
|
$150,990.30
|
|
|
Service Code
|
APR-DRG 0023
|
| Min. Negotiated Rate |
$134,119.00 |
| Max. Negotiated Rate |
$150,990.30 |
| Rate for Payer: Anthem Medicaid |
$144,581.53
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$144,581.53
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$144,581.53
|
| Rate for Payer: Dean Health Medicaid |
$144,581.53
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$134,119.00
|
| Rate for Payer: Managed Health Services Medicaid |
$150,990.30
|
| Rate for Payer: Molina Healthcare Medicaid |
$144,581.53
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$144,581.53
|
| Rate for Payer: United Healthcare Medicaid |
$144,581.53
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
|
IP
|
$114,338.76
|
|
|
Service Code
|
APR-DRG 0022
|
| Min. Negotiated Rate |
$101,562.82 |
| Max. Negotiated Rate |
$114,338.76 |
| Rate for Payer: Anthem Medicaid |
$109,485.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$109,485.67
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$109,485.67
|
| Rate for Payer: Dean Health Medicaid |
$109,485.67
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$101,562.82
|
| Rate for Payer: Managed Health Services Medicaid |
$114,338.76
|
| Rate for Payer: Molina Healthcare Medicaid |
$109,485.67
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$109,485.67
|
| Rate for Payer: United Healthcare Medicaid |
$109,485.67
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
|
IP
|
$101,098.61
|
|
|
Service Code
|
APR-DRG 0021
|
| Min. Negotiated Rate |
$89,802.10 |
| Max. Negotiated Rate |
$101,098.61 |
| Rate for Payer: Anthem Medicaid |
$96,807.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$96,807.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$96,807.49
|
| Rate for Payer: Dean Health Medicaid |
$96,807.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$89,802.10
|
| Rate for Payer: Managed Health Services Medicaid |
$101,098.61
|
| Rate for Payer: Molina Healthcare Medicaid |
$96,807.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$96,807.49
|
| Rate for Payer: United Healthcare Medicaid |
$96,807.49
|
|
|
HEART AND/OR LUNG TRANSPLANT
|
Facility
|
IP
|
$277,253.96
|
|
|
Service Code
|
APR-DRG 0024
|
| Min. Negotiated Rate |
$246,274.27 |
| Max. Negotiated Rate |
$277,253.96 |
| Rate for Payer: Anthem Medicaid |
$265,485.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$265,485.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$265,485.95
|
| Rate for Payer: Dean Health Medicaid |
$265,485.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$246,274.27
|
| Rate for Payer: Managed Health Services Medicaid |
$277,253.96
|
| Rate for Payer: Molina Healthcare Medicaid |
$265,485.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$265,485.95
|
| Rate for Payer: United Healthcare Medicaid |
$265,485.95
|
|
|
HEART FAILURE
|
Facility
|
OP
|
$98.27
|
|
|
Service Code
|
EAPG 00594
|
| Min. Negotiated Rate |
$94.49 |
| Max. Negotiated Rate |
$98.27 |
| Rate for Payer: Anthem Medicaid |
$94.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$94.49
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$94.49
|
| Rate for Payer: Dean Health Medicaid |
$94.49
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$94.49
|
| Rate for Payer: Managed Health Services Medicaid |
$98.27
|
| Rate for Payer: Molina Healthcare Medicaid |
$94.49
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$94.49
|
| Rate for Payer: United Healthcare Medicaid |
$94.49
|
|
|
HEART FAILURE
|
Facility
|
IP
|
$4,647.20
|
|
|
Service Code
|
APR-DRG 1941
|
| Min. Negotiated Rate |
$4,127.94 |
| Max. Negotiated Rate |
$4,647.20 |
| Rate for Payer: Anthem Medicaid |
$4,449.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$4,449.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4,449.95
|
| Rate for Payer: Dean Health Medicaid |
$4,449.95
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4,127.94
|
| Rate for Payer: Managed Health Services Medicaid |
$4,647.20
|
| Rate for Payer: Molina Healthcare Medicaid |
$4,449.95
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4,449.95
|
| Rate for Payer: United Healthcare Medicaid |
$4,449.95
|
|
|
HEART FAILURE
|
Facility
|
IP
|
$10,609.66
|
|
|
Service Code
|
APR-DRG 1943
|
| Min. Negotiated Rate |
$9,424.16 |
| Max. Negotiated Rate |
$10,609.66 |
| Rate for Payer: Anthem Medicaid |
$10,159.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$10,159.33
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$10,159.33
|
| Rate for Payer: Dean Health Medicaid |
$10,159.33
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$9,424.16
|
| Rate for Payer: Managed Health Services Medicaid |
$10,609.66
|
| Rate for Payer: Molina Healthcare Medicaid |
$10,159.33
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$10,159.33
|
| Rate for Payer: United Healthcare Medicaid |
$10,159.33
|
|
|
HEART FAILURE
|
Facility
|
IP
|
$20,430.16
|
|
|
Service Code
|
APR-DRG 1944
|
| Min. Negotiated Rate |
$18,147.34 |
| Max. Negotiated Rate |
$20,430.16 |
| Rate for Payer: Anthem Medicaid |
$19,563.01
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$19,563.01
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$19,563.01
|
| Rate for Payer: Dean Health Medicaid |
$19,563.01
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$18,147.34
|
| Rate for Payer: Managed Health Services Medicaid |
$20,430.16
|
| Rate for Payer: Molina Healthcare Medicaid |
$19,563.01
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$19,563.01
|
| Rate for Payer: United Healthcare Medicaid |
$19,563.01
|
|
|
HEART FAILURE
|
Facility
|
IP
|
$6,488.55
|
|
|
Service Code
|
APR-DRG 1942
|
| Min. Negotiated Rate |
$5,763.53 |
| Max. Negotiated Rate |
$6,488.55 |
| Rate for Payer: Anthem Medicaid |
$6,213.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicaid HMO |
$6,213.14
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$6,213.14
|
| Rate for Payer: Dean Health Medicaid |
$6,213.14
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$5,763.53
|
| Rate for Payer: Managed Health Services Medicaid |
$6,488.55
|
| Rate for Payer: Molina Healthcare Medicaid |
$6,213.14
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$6,213.14
|
| Rate for Payer: United Healthcare Medicaid |
$6,213.14
|
|
|
HEART FAILURE AND SHOCK WITH CC
|
Facility
|
IP
|
$24,014.64
|
|
|
Service Code
|
MSDRG 292
|
| Min. Negotiated Rate |
$7,008.59 |
| Max. Negotiated Rate |
$24,014.64 |
| Rate for Payer: Aetna Managed Medicare |
$7,008.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,524.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,198.88
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,489.86
|
| Rate for Payer: Anthem Medicare Advantage |
$7,008.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$7,008.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$7,008.59
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$7,008.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,974.98
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$7,008.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,369.82
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$7,008.59
|
| Rate for Payer: Independent Care Health Plan Medicare |
$7,008.59
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$7,008.59
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$7,008.59
|
| Rate for Payer: NAPHCARE Commercial |
$10,512.89
|
| Rate for Payer: Quartz Medicare Advantage |
$7,008.59
|
| Rate for Payer: The Alliance Commercial |
$24,014.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$7,008.59
|
| Rate for Payer: United Healthcare PPO |
$13,522.63
|
| Rate for Payer: Wellcare Medicare |
$7,008.59
|
|
|
HEART FAILURE AND SHOCK WITH MCC
|
Facility
|
IP
|
$35,832.16
|
|
|
Service Code
|
MSDRG 291
|
| Min. Negotiated Rate |
$10,338.37 |
| Max. Negotiated Rate |
$35,832.16 |
| Rate for Payer: Aetna Managed Medicare |
$10,338.37
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,011.49
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,470.58
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,398.45
|
| Rate for Payer: Anthem Medicare Advantage |
$10,338.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,338.37
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,338.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,338.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,644.15
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,338.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,037.49
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,338.37
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,338.37
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,338.37
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,338.37
|
| Rate for Payer: NAPHCARE Commercial |
$15,507.55
|
| Rate for Payer: Quartz Medicare Advantage |
$10,338.37
|
| Rate for Payer: The Alliance Commercial |
$35,832.16
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,338.37
|
| Rate for Payer: United Healthcare PPO |
$20,270.53
|
| Rate for Payer: Wellcare Medicare |
$10,338.37
|
|
|
HEART FAILURE AND SHOCK WITHOUT CC/MCC
|
Facility
|
IP
|
$15,857.92
|
|
|
Service Code
|
MSDRG 293
|
| Min. Negotiated Rate |
$4,841.31 |
| Max. Negotiated Rate |
$15,857.92 |
| Rate for Payer: Aetna Managed Medicare |
$4,841.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$12,349.67
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,465.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,993.24
|
| Rate for Payer: Anthem Medicare Advantage |
$4,841.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4,841.31
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4,841.31
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4,841.31
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,983.32
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4,841.31
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,387.22
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4,841.31
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4,841.31
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4,841.31
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4,841.31
|
| Rate for Payer: NAPHCARE Commercial |
$7,261.97
|
| Rate for Payer: Quartz Medicare Advantage |
$4,841.31
|
| Rate for Payer: The Alliance Commercial |
$15,857.92
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4,841.31
|
| Rate for Payer: United Healthcare PPO |
$8,865.10
|
| Rate for Payer: Wellcare Medicare |
$4,841.31
|
|
|
HEART FLOW RESERVE MEASURE 9357126
|
Professional
|
Both
|
$1,220.00
|
|
|
Service Code
|
CPT 93571 26
|
| Hospital Charge Code |
3015416
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$86.95 |
| Max. Negotiated Rate |
$1,205.36 |
| Rate for Payer: Aetna Commercial |
$1,205.36
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,091.17
|
| Rate for Payer: Aetna Managed Medicare |
$86.95
|
| Rate for Payer: Anthem Medicare Advantage |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$86.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$86.95
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cash Price |
$366.00
|
| Rate for Payer: Cigna Commercial |
$1,205.36
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$99.78
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$86.95
|
| Rate for Payer: Health EOS Commercial |
$1,154.61
|
| Rate for Payer: HFN Commercial |
$1,205.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$244.58
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$244.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$86.95
|
| Rate for Payer: Multiplan Commercial |
$1,015.04
|
| Rate for Payer: NAPHCARE Commercial |
$130.43
|
| Rate for Payer: Preferred Network Access Commercial |
$1,205.36
|
| Rate for Payer: Quartz Beloit One Network |
$558.27
|
| Rate for Payer: Quartz Commercial |
$723.22
|
| Rate for Payer: Quartz Medicare Advantage |
$86.95
|
| Rate for Payer: The Alliance Commercial |
$330.43
|
| Rate for Payer: United Healthcare Medicaid |
$99.78
|
| Rate for Payer: United Healthcare Medicare Advantage |
$86.95
|
| Rate for Payer: WEA Trust Commercial |
$697.84
|
| Rate for Payer: WPS Commercial |
$347.82
|
|
|
HEART HUGGER LARGE GT1500
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
HCPCS L0450
|
| Hospital Charge Code |
5415310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$633.43 |
| Max. Negotiated Rate |
$1,189.30 |
| Rate for Payer: Aetna Commercial |
$1,163.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.14
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna Commercial |
$1,189.30
|
| Rate for Payer: Health EOS Commercial |
$1,150.52
|
| Rate for Payer: HFN Commercial |
$1,189.30
|
| Rate for Payer: Multiplan Commercial |
$1,034.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.30
|
| Rate for Payer: Quartz Beloit One Network |
$633.43
|
| Rate for Payer: Quartz Commercial |
$775.63
|
| Rate for Payer: WEA Trust Commercial |
$711.00
|
| Rate for Payer: WPS Commercial |
$957.48
|
|
|
HEART HUGGER LARGE GT1500
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
HCPCS L0450
|
| Hospital Charge Code |
5415310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$135.82 |
| Max. Negotiated Rate |
$1,189.30 |
| Rate for Payer: Aetna Commercial |
$1,163.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.74
|
| Rate for Payer: Aetna Managed Medicare |
$361.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$135.82
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$135.82
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$135.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.14
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna Commercial |
$1,189.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$723.43
|
| Rate for Payer: Health EOS Commercial |
$1,150.52
|
| Rate for Payer: HFN Commercial |
$1,189.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$969.54
|
| Rate for Payer: Multiplan Commercial |
$1,034.18
|
| Rate for Payer: NAPHCARE Commercial |
$775.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.30
|
| Rate for Payer: Quartz Beloit One Network |
$633.43
|
| Rate for Payer: Quartz Commercial |
$840.27
|
| Rate for Payer: Quartz Medicare Advantage |
$775.63
|
| Rate for Payer: The Alliance Commercial |
$512.39
|
| Rate for Payer: WEA Trust Commercial |
$711.00
|
| Rate for Payer: WPS Commercial |
$957.48
|
|
|
HEART HUGGER REGULAR GT1000
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
HCPCS L4050
|
| Hospital Charge Code |
5415309
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$633.43 |
| Max. Negotiated Rate |
$1,189.30 |
| Rate for Payer: Aetna Commercial |
$1,163.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.14
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna Commercial |
$1,189.30
|
| Rate for Payer: Health EOS Commercial |
$1,150.52
|
| Rate for Payer: HFN Commercial |
$1,189.30
|
| Rate for Payer: Multiplan Commercial |
$1,034.18
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.30
|
| Rate for Payer: Quartz Beloit One Network |
$633.43
|
| Rate for Payer: Quartz Commercial |
$775.63
|
| Rate for Payer: WEA Trust Commercial |
$711.00
|
| Rate for Payer: WPS Commercial |
$957.48
|
|
|
HEART HUGGER REGULAR GT1000
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
HCPCS L4050
|
| Hospital Charge Code |
5415309
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$228.09 |
| Max. Negotiated Rate |
$2,102.34 |
| Rate for Payer: Aetna Commercial |
$1,163.45
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,111.74
|
| Rate for Payer: Aetna Managed Medicare |
$361.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$228.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$228.09
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$228.09
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$685.14
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna Commercial |
$1,189.30
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$723.43
|
| Rate for Payer: Health EOS Commercial |
$1,150.52
|
| Rate for Payer: HFN Commercial |
$1,189.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$969.54
|
| Rate for Payer: Multiplan Commercial |
$1,034.18
|
| Rate for Payer: NAPHCARE Commercial |
$775.63
|
| Rate for Payer: Preferred Network Access Commercial |
$1,189.30
|
| Rate for Payer: Quartz Beloit One Network |
$633.43
|
| Rate for Payer: Quartz Commercial |
$840.27
|
| Rate for Payer: Quartz Medicare Advantage |
$775.63
|
| Rate for Payer: The Alliance Commercial |
$2,102.34
|
| Rate for Payer: WEA Trust Commercial |
$711.00
|
| Rate for Payer: WPS Commercial |
$957.48
|
|
|
HEART/LUNG RESUSCITATION CPR 92950
|
Professional
|
Both
|
$1,114.00
|
|
|
Service Code
|
CPT 92950
|
| Hospital Charge Code |
3015349
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$165.47 |
| Max. Negotiated Rate |
$1,100.63 |
| Rate for Payer: Aetna Commercial |
$1,100.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$996.36
|
| Rate for Payer: Aetna Managed Medicare |
$165.47
|
| Rate for Payer: Anthem Medicare Advantage |
$165.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$165.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$165.47
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cash Price |
$334.20
|
| Rate for Payer: Cigna Commercial |
$1,100.63
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$192.84
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$165.47
|
| Rate for Payer: Health EOS Commercial |
$1,054.29
|
| Rate for Payer: HFN Commercial |
$1,100.63
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$645.43
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$645.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$165.47
|
| Rate for Payer: Multiplan Commercial |
$926.85
|
| Rate for Payer: NAPHCARE Commercial |
$248.21
|
| Rate for Payer: Preferred Network Access Commercial |
$1,100.63
|
| Rate for Payer: Quartz Beloit One Network |
$509.77
|
| Rate for Payer: Quartz Commercial |
$660.38
|
| Rate for Payer: Quartz Medicare Advantage |
$165.47
|
| Rate for Payer: The Alliance Commercial |
$628.80
|
| Rate for Payer: United Healthcare Medicaid |
$192.84
|
| Rate for Payer: United Healthcare Medicare Advantage |
$165.47
|
| Rate for Payer: WEA Trust Commercial |
$637.21
|
| Rate for Payer: WPS Commercial |
$661.90
|
|
|
HEART RETURN, OPEN
|
Facility
|
IP
|
$15,504.00
|
|
| Hospital Charge Code |
2960526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,900.84 |
| Max. Negotiated Rate |
$14,834.23 |
| Rate for Payer: Aetna Commercial |
$14,511.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,866.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,545.80
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cigna Commercial |
$14,834.23
|
| Rate for Payer: Health EOS Commercial |
$14,350.50
|
| Rate for Payer: HFN Commercial |
$14,834.23
|
| Rate for Payer: Multiplan Commercial |
$12,899.33
|
| Rate for Payer: Preferred Network Access Commercial |
$14,834.23
|
| Rate for Payer: Quartz Beloit One Network |
$7,900.84
|
| Rate for Payer: Quartz Commercial |
$9,674.50
|
| Rate for Payer: WEA Trust Commercial |
$8,868.29
|
| Rate for Payer: WPS Commercial |
$11,942.73
|
|
