|
Hearing Aid Supplies / Accessories
|
Facility
|
IP
|
$142.00
|
|
|
Service Code
|
HCPCS V5267
|
| Hospital Charge Code |
1228811
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$69.58 |
| Max. Negotiated Rate |
$130.64 |
| Rate for Payer: Aetna Commercial |
$127.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$75.26
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$130.64
|
| Rate for Payer: Health EOS Commercial |
$126.38
|
| Rate for Payer: HFN Commercial |
$130.64
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: NAPHCARE Commercial |
$85.20
|
| Rate for Payer: Preferred Network Access Commercial |
$130.64
|
| Rate for Payer: Quartz Beloit One Network |
$69.58
|
| Rate for Payer: Quartz Commercial |
$85.20
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
Hearing Aid Supplies / Accessories
|
Professional
|
Both
|
$142.00
|
|
|
Service Code
|
HCPCS V5267
|
| Hospital Charge Code |
1228811
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$62.48 |
| Max. Negotiated Rate |
$134.90 |
| Rate for Payer: Aetna Commercial |
$134.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$122.12
|
| Rate for Payer: Cash Price |
$42.60
|
| Rate for Payer: Cigna Commercial |
$134.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$71.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$85.20
|
| Rate for Payer: Health EOS Commercial |
$129.22
|
| Rate for Payer: HFN Commercial |
$134.90
|
| Rate for Payer: Multiplan Commercial |
$113.60
|
| Rate for Payer: Preferred Network Access Commercial |
$134.90
|
| Rate for Payer: Quartz Beloit One Network |
$62.48
|
| Rate for Payer: Quartz Commercial |
$80.94
|
| Rate for Payer: The Alliance Commercial |
$71.00
|
| Rate for Payer: WEA Trust Commercial |
$78.10
|
| Rate for Payer: WPS Commercial |
$105.18
|
|
|
Hearing Service
|
Facility
|
OP
|
$307.00
|
|
|
Service Code
|
HCPCS V5299
|
| Hospital Charge Code |
3243701
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$85.96 |
| Max. Negotiated Rate |
$1,228.00 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Aetna Managed Medicare |
$85.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$199.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$153.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$147.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$171.80
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$230.25
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$199.55
|
| Rate for Payer: Quartz Medicare Advantage |
$184.20
|
| Rate for Payer: The Alliance Commercial |
$1,228.00
|
| Rate for Payer: United Healthcare PPO |
$230.25
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
Hearing Service
|
Facility
|
IP
|
$307.00
|
|
|
Service Code
|
HCPCS V5299
|
| Hospital Charge Code |
3243701
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$150.43 |
| Max. Negotiated Rate |
$282.44 |
| Rate for Payer: Aetna Commercial |
$276.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$162.71
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$282.44
|
| Rate for Payer: Health EOS Commercial |
$273.23
|
| Rate for Payer: HFN Commercial |
$282.44
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: NAPHCARE Commercial |
$184.20
|
| Rate for Payer: Preferred Network Access Commercial |
$282.44
|
| Rate for Payer: Quartz Beloit One Network |
$150.43
|
| Rate for Payer: Quartz Commercial |
$184.20
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
Hearing Service
|
Professional
|
Both
|
$307.00
|
|
|
Service Code
|
HCPCS V5299
|
| Hospital Charge Code |
3243701
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$135.08 |
| Max. Negotiated Rate |
$291.65 |
| Rate for Payer: Aetna Commercial |
$291.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$264.02
|
| Rate for Payer: Cash Price |
$92.10
|
| Rate for Payer: Cigna Commercial |
$291.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$153.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$184.20
|
| Rate for Payer: Health EOS Commercial |
$279.37
|
| Rate for Payer: HFN Commercial |
$291.65
|
| Rate for Payer: Multiplan Commercial |
$245.60
|
| Rate for Payer: Preferred Network Access Commercial |
$291.65
|
| Rate for Payer: Quartz Beloit One Network |
$135.08
|
| Rate for Payer: Quartz Commercial |
$174.99
|
| Rate for Payer: The Alliance Commercial |
$153.50
|
| Rate for Payer: WEA Trust Commercial |
$168.85
|
| Rate for Payer: WPS Commercial |
$227.39
|
|
|
HEART FAILURE AND SHOCK WITH CC
|
Facility
|
IP
|
$23,091.00
|
|
|
Service Code
|
MSDRG 292
|
| Min. Negotiated Rate |
$8,306.22 |
| Max. Negotiated Rate |
$23,091.00 |
| Rate for Payer: Aetna Managed Medicare |
$8,306.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,042.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,829.66
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,139.08
|
| Rate for Payer: Anthem Medicare Advantage |
$8,306.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$8,306.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$8,306.22
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$8,306.22
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14,585.58
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$8,306.22
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,701.75
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$8,306.22
|
| Rate for Payer: Independent Care Health Plan Medicare |
$8,306.22
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$8,306.22
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$8,306.22
|
| Rate for Payer: NAPHCARE Commercial |
$12,459.33
|
| Rate for Payer: Quartz Medicare Advantage |
$8,306.22
|
| Rate for Payer: The Alliance Commercial |
$23,091.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$8,306.22
|
| Rate for Payer: United Healthcare PPO |
$13,002.53
|
| Rate for Payer: Wellcare Medicare |
$8,306.22
|
|
|
HEART FAILURE AND SHOCK WITH MCC
|
Facility
|
IP
|
$34,454.00
|
|
|
Service Code
|
MSDRG 291
|
| Min. Negotiated Rate |
$12,393.58 |
| Max. Negotiated Rate |
$34,454.00 |
| Rate for Payer: Aetna Managed Medicare |
$12,393.58
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,854.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,583.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,555.84
|
| Rate for Payer: Anthem Medicare Advantage |
$12,393.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,393.58
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,393.58
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,393.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,708.77
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,393.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$25,036.05
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,393.58
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,393.58
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,393.58
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,393.58
|
| Rate for Payer: NAPHCARE Commercial |
$18,590.37
|
| Rate for Payer: Quartz Medicare Advantage |
$12,393.58
|
| Rate for Payer: The Alliance Commercial |
$34,454.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,393.58
|
| Rate for Payer: United Healthcare PPO |
$19,490.89
|
| Rate for Payer: Wellcare Medicare |
$12,393.58
|
|
|
HEART FAILURE AND SHOCK WITHOUT CC/MCC
|
Facility
|
IP
|
$15,248.00
|
|
|
Service Code
|
MSDRG 293
|
| Min. Negotiated Rate |
$5,485.06 |
| Max. Negotiated Rate |
$15,248.00 |
| Rate for Payer: Aetna Managed Medicare |
$5,485.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,748.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,005.36
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,555.68
|
| Rate for Payer: Anthem Medicare Advantage |
$5,485.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,485.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,485.06
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,485.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,497.59
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,485.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,949.25
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,485.06
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,485.06
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,485.06
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,485.06
|
| Rate for Payer: NAPHCARE Commercial |
$8,227.59
|
| Rate for Payer: Quartz Medicare Advantage |
$5,485.06
|
| Rate for Payer: The Alliance Commercial |
$15,248.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,485.06
|
| Rate for Payer: United Healthcare PPO |
$8,524.13
|
| Rate for Payer: Wellcare Medicare |
$5,485.06
|
|
|
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 |
$235.17 |
| Max. Negotiated Rate |
$1,159.00 |
| Rate for Payer: Aetna Commercial |
$1,159.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,049.20
|
| 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 |
$1,159.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$264.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$732.00
|
| Rate for Payer: Health EOS Commercial |
$1,110.20
|
| Rate for Payer: HFN Commercial |
$1,159.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$235.17
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$235.17
|
| Rate for Payer: Multiplan Commercial |
$976.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,159.00
|
| Rate for Payer: Quartz Beloit One Network |
$536.80
|
| Rate for Payer: Quartz Commercial |
$695.40
|
| Rate for Payer: The Alliance Commercial |
$610.00
|
| Rate for Payer: United Healthcare Medicaid |
$264.23
|
| Rate for Payer: WEA Trust Commercial |
$671.00
|
| Rate for Payer: WPS Commercial |
$903.65
|
|
|
HEART HUGGER LARGE GT1500
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
HCPCS L0450
|
| Hospital Charge Code |
5415310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$130.60 |
| Max. Negotiated Rate |
$4,972.00 |
| Rate for Payer: Aetna Commercial |
$1,118.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.98
|
| Rate for Payer: Aetna Managed Medicare |
$348.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$130.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$130.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$130.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.79
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna Commercial |
$1,143.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$695.58
|
| Rate for Payer: Health EOS Commercial |
$1,106.27
|
| Rate for Payer: HFN Commercial |
$1,143.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$932.25
|
| Rate for Payer: Multiplan Commercial |
$994.40
|
| Rate for Payer: NAPHCARE Commercial |
$745.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,143.56
|
| Rate for Payer: Quartz Beloit One Network |
$609.07
|
| Rate for Payer: Quartz Commercial |
$807.95
|
| Rate for Payer: Quartz Medicare Advantage |
$745.80
|
| Rate for Payer: The Alliance Commercial |
$4,972.00
|
| Rate for Payer: WEA Trust Commercial |
$683.65
|
| Rate for Payer: WPS Commercial |
$920.69
|
|
|
HEART HUGGER LARGE GT1500
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
HCPCS L0450
|
| Hospital Charge Code |
5415310
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.07 |
| Max. Negotiated Rate |
$1,143.56 |
| Rate for Payer: Aetna Commercial |
$1,118.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.79
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna Commercial |
$1,143.56
|
| Rate for Payer: Health EOS Commercial |
$1,106.27
|
| Rate for Payer: HFN Commercial |
$1,143.56
|
| Rate for Payer: Multiplan Commercial |
$994.40
|
| Rate for Payer: NAPHCARE Commercial |
$745.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,143.56
|
| Rate for Payer: Quartz Beloit One Network |
$609.07
|
| Rate for Payer: Quartz Commercial |
$745.80
|
| Rate for Payer: WEA Trust Commercial |
$683.65
|
| Rate for Payer: WPS Commercial |
$920.69
|
|
|
HEART HUGGER REGULAR GT1000
|
Facility
|
OP
|
$1,243.00
|
|
|
Service Code
|
HCPCS L4050
|
| Hospital Charge Code |
5415309
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$219.32 |
| Max. Negotiated Rate |
$4,972.00 |
| Rate for Payer: Aetna Commercial |
$1,118.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.98
|
| Rate for Payer: Aetna Managed Medicare |
$348.04
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$219.32
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$219.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$219.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.79
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna Commercial |
$1,143.56
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$695.58
|
| Rate for Payer: Health EOS Commercial |
$1,106.27
|
| Rate for Payer: HFN Commercial |
$1,143.56
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$932.25
|
| Rate for Payer: Multiplan Commercial |
$994.40
|
| Rate for Payer: NAPHCARE Commercial |
$745.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,143.56
|
| Rate for Payer: Quartz Beloit One Network |
$609.07
|
| Rate for Payer: Quartz Commercial |
$807.95
|
| Rate for Payer: Quartz Medicare Advantage |
$745.80
|
| Rate for Payer: The Alliance Commercial |
$4,972.00
|
| Rate for Payer: WEA Trust Commercial |
$683.65
|
| Rate for Payer: WPS Commercial |
$920.69
|
|
|
HEART HUGGER REGULAR GT1000
|
Facility
|
IP
|
$1,243.00
|
|
|
Service Code
|
HCPCS L4050
|
| Hospital Charge Code |
5415309
|
|
Hospital Revenue Code
|
274
|
| Min. Negotiated Rate |
$609.07 |
| Max. Negotiated Rate |
$1,143.56 |
| Rate for Payer: Aetna Commercial |
$1,118.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,068.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$658.79
|
| Rate for Payer: Cash Price |
$372.90
|
| Rate for Payer: Cigna Commercial |
$1,143.56
|
| Rate for Payer: Health EOS Commercial |
$1,106.27
|
| Rate for Payer: HFN Commercial |
$1,143.56
|
| Rate for Payer: Multiplan Commercial |
$994.40
|
| Rate for Payer: NAPHCARE Commercial |
$745.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,143.56
|
| Rate for Payer: Quartz Beloit One Network |
$609.07
|
| Rate for Payer: Quartz Commercial |
$745.80
|
| Rate for Payer: WEA Trust Commercial |
$683.65
|
| Rate for Payer: WPS Commercial |
$920.69
|
|
|
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 |
$185.42 |
| Max. Negotiated Rate |
$1,058.30 |
| Rate for Payer: Aetna Commercial |
$1,058.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$958.04
|
| 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 |
$1,058.30
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$185.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$668.40
|
| Rate for Payer: Health EOS Commercial |
$1,013.74
|
| Rate for Payer: HFN Commercial |
$1,058.30
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$620.61
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$620.61
|
| Rate for Payer: Multiplan Commercial |
$891.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,058.30
|
| Rate for Payer: Quartz Beloit One Network |
$490.16
|
| Rate for Payer: Quartz Commercial |
$634.98
|
| Rate for Payer: The Alliance Commercial |
$557.00
|
| Rate for Payer: United Healthcare Medicaid |
$185.42
|
| Rate for Payer: WEA Trust Commercial |
$612.70
|
| Rate for Payer: WPS Commercial |
$825.14
|
|
|
HEART RETURN, OPEN
|
Facility
|
IP
|
$15,504.00
|
|
| Hospital Charge Code |
2960526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,596.96 |
| Max. Negotiated Rate |
$14,263.68 |
| Rate for Payer: Aetna Commercial |
$13,953.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,333.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,217.12
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cigna Commercial |
$14,263.68
|
| Rate for Payer: Health EOS Commercial |
$13,798.56
|
| Rate for Payer: HFN Commercial |
$14,263.68
|
| Rate for Payer: Multiplan Commercial |
$12,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,302.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,263.68
|
| Rate for Payer: Quartz Beloit One Network |
$7,596.96
|
| Rate for Payer: Quartz Commercial |
$9,302.40
|
| Rate for Payer: WEA Trust Commercial |
$8,527.20
|
| Rate for Payer: WPS Commercial |
$11,483.81
|
|
|
HEART RETURN, OPEN
|
Facility
|
OP
|
$15,504.00
|
|
| Hospital Charge Code |
2960526
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,341.12 |
| Max. Negotiated Rate |
$62,016.00 |
| Rate for Payer: Aetna Commercial |
$13,953.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,333.44
|
| Rate for Payer: Aetna Managed Medicare |
$4,341.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,077.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,752.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,441.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,217.12
|
| Rate for Payer: Cash Price |
$4,651.20
|
| Rate for Payer: Cigna Commercial |
$14,263.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,676.04
|
| Rate for Payer: Health EOS Commercial |
$13,798.56
|
| Rate for Payer: HFN Commercial |
$14,263.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,628.00
|
| Rate for Payer: Multiplan Commercial |
$12,403.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,302.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,263.68
|
| Rate for Payer: Quartz Beloit One Network |
$7,596.96
|
| Rate for Payer: Quartz Commercial |
$10,077.60
|
| Rate for Payer: Quartz Medicare Advantage |
$9,302.40
|
| Rate for Payer: The Alliance Commercial |
$62,016.00
|
| Rate for Payer: WEA Trust Commercial |
$8,527.20
|
| Rate for Payer: WPS Commercial |
$11,483.81
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITH MCC
|
Facility
|
IP
|
$720,763.00
|
|
|
Service Code
|
MSDRG 001
|
| Min. Negotiated Rate |
$259,267.17 |
| Max. Negotiated Rate |
$720,763.00 |
| Rate for Payer: Aetna Managed Medicare |
$259,267.17
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$568,558.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$435,795.10
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$414,033.80
|
| Rate for Payer: Anthem Medicare Advantage |
$259,267.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$259,267.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$259,267.17
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$259,267.17
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$459,615.46
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$259,267.17
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$528,422.70
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$259,267.17
|
| Rate for Payer: Independent Care Health Plan Medicare |
$259,267.17
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$259,267.17
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$259,267.17
|
| Rate for Payer: NAPHCARE Commercial |
$388,900.76
|
| Rate for Payer: Quartz Medicare Advantage |
$259,267.17
|
| Rate for Payer: The Alliance Commercial |
$720,763.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$259,267.17
|
| Rate for Payer: Wellcare Medicare |
$259,267.17
|
|
|
HEART TRANSPLANT OR IMPLANT OF HEART ASSIST SYSTEM WITHOUT MCC
|
Facility
|
IP
|
$325,842.00
|
|
|
Service Code
|
MSDRG 002
|
| Min. Negotiated Rate |
$117,209.19 |
| Max. Negotiated Rate |
$325,842.00 |
| Rate for Payer: Aetna Managed Medicare |
$117,209.19
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$256,795.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$196,831.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$187,002.72
|
| Rate for Payer: Anthem Medicare Advantage |
$117,209.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$117,209.19
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$117,209.19
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$117,209.19
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$207,590.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$117,209.19
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$238,760.00
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$117,209.19
|
| Rate for Payer: Independent Care Health Plan Medicare |
$117,209.19
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$117,209.19
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$117,209.19
|
| Rate for Payer: NAPHCARE Commercial |
$175,813.78
|
| Rate for Payer: Quartz Medicare Advantage |
$117,209.19
|
| Rate for Payer: The Alliance Commercial |
$325,842.00
|
| Rate for Payer: United Healthcare Medicare Advantage |
$117,209.19
|
| Rate for Payer: United Healthcare PPO |
$185,877.68
|
| Rate for Payer: Wellcare Medicare |
$117,209.19
|
|
|
HEART VALVE 21mm MOSAIC PORCIN
|
Facility
|
IP
|
$50,031.00
|
|
| Hospital Charge Code |
2965346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,515.19 |
| Max. Negotiated Rate |
$46,028.52 |
| Rate for Payer: Aetna Commercial |
$45,027.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43,026.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26,516.43
|
| Rate for Payer: Cash Price |
$15,009.30
|
| Rate for Payer: Cigna Commercial |
$46,028.52
|
| Rate for Payer: Health EOS Commercial |
$44,527.59
|
| Rate for Payer: HFN Commercial |
$46,028.52
|
| Rate for Payer: Multiplan Commercial |
$40,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$30,018.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46,028.52
|
| Rate for Payer: Quartz Beloit One Network |
$24,515.19
|
| Rate for Payer: Quartz Commercial |
$30,018.60
|
| Rate for Payer: WEA Trust Commercial |
$27,517.05
|
| Rate for Payer: WPS Commercial |
$37,057.96
|
|
|
HEART VALVE 21mm MOSAIC PORCIN
|
Facility
|
OP
|
$50,031.00
|
|
| Hospital Charge Code |
2965346
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,008.68 |
| Max. Negotiated Rate |
$200,124.00 |
| Rate for Payer: Aetna Commercial |
$45,027.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43,026.66
|
| Rate for Payer: Aetna Managed Medicare |
$14,008.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,520.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,015.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,014.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26,516.43
|
| Rate for Payer: Cash Price |
$15,009.30
|
| Rate for Payer: Cigna Commercial |
$46,028.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,997.35
|
| Rate for Payer: Health EOS Commercial |
$44,527.59
|
| Rate for Payer: HFN Commercial |
$46,028.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,523.25
|
| Rate for Payer: Multiplan Commercial |
$40,024.80
|
| Rate for Payer: NAPHCARE Commercial |
$30,018.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46,028.52
|
| Rate for Payer: Quartz Beloit One Network |
$24,515.19
|
| Rate for Payer: Quartz Commercial |
$32,520.15
|
| Rate for Payer: Quartz Medicare Advantage |
$30,018.60
|
| Rate for Payer: The Alliance Commercial |
$200,124.00
|
| Rate for Payer: WEA Trust Commercial |
$27,517.05
|
| Rate for Payer: WPS Commercial |
$37,057.96
|
|
|
HEART VALVE 31MM MECHANICAL #500DM31
|
Facility
|
OP
|
$29,013.00
|
|
| Hospital Charge Code |
2973944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,123.64 |
| Max. Negotiated Rate |
$116,052.00 |
| Rate for Payer: Aetna Commercial |
$26,111.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,951.18
|
| Rate for Payer: Aetna Managed Medicare |
$8,123.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,858.45
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,506.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,926.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,376.89
|
| Rate for Payer: Cash Price |
$8,703.90
|
| Rate for Payer: Cigna Commercial |
$26,691.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,235.67
|
| Rate for Payer: Health EOS Commercial |
$25,821.57
|
| Rate for Payer: HFN Commercial |
$26,691.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,759.75
|
| Rate for Payer: Multiplan Commercial |
$23,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$17,407.80
|
| Rate for Payer: Preferred Network Access Commercial |
$26,691.96
|
| Rate for Payer: Quartz Beloit One Network |
$14,216.37
|
| Rate for Payer: Quartz Commercial |
$18,858.45
|
| Rate for Payer: Quartz Medicare Advantage |
$17,407.80
|
| Rate for Payer: The Alliance Commercial |
$116,052.00
|
| Rate for Payer: WEA Trust Commercial |
$15,957.15
|
| Rate for Payer: WPS Commercial |
$21,489.93
|
|
|
HEART VALVE 31MM MECHANICAL #500DM31
|
Facility
|
IP
|
$29,013.00
|
|
| Hospital Charge Code |
2973944
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,216.37 |
| Max. Negotiated Rate |
$26,691.96 |
| Rate for Payer: Aetna Commercial |
$26,111.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,951.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,376.89
|
| Rate for Payer: Cash Price |
$8,703.90
|
| Rate for Payer: Cigna Commercial |
$26,691.96
|
| Rate for Payer: Health EOS Commercial |
$25,821.57
|
| Rate for Payer: HFN Commercial |
$26,691.96
|
| Rate for Payer: Multiplan Commercial |
$23,210.40
|
| Rate for Payer: NAPHCARE Commercial |
$17,407.80
|
| Rate for Payer: Preferred Network Access Commercial |
$26,691.96
|
| Rate for Payer: Quartz Beloit One Network |
$14,216.37
|
| Rate for Payer: Quartz Commercial |
$17,407.80
|
| Rate for Payer: WEA Trust Commercial |
$15,957.15
|
| Rate for Payer: WPS Commercial |
$21,489.93
|
|
|
HEART VALVE 31mm MOSAIC PORCIN
|
Facility
|
OP
|
$47,591.00
|
|
| Hospital Charge Code |
2965347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,325.48 |
| Max. Negotiated Rate |
$190,364.00 |
| Rate for Payer: Aetna Commercial |
$42,831.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40,928.26
|
| Rate for Payer: Aetna Managed Medicare |
$13,325.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,934.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,795.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,843.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25,223.23
|
| Rate for Payer: Cash Price |
$14,277.30
|
| Rate for Payer: Cigna Commercial |
$43,783.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,631.92
|
| Rate for Payer: Health EOS Commercial |
$42,355.99
|
| Rate for Payer: HFN Commercial |
$43,783.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,693.25
|
| Rate for Payer: Multiplan Commercial |
$38,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$28,554.60
|
| Rate for Payer: Preferred Network Access Commercial |
$43,783.72
|
| Rate for Payer: Quartz Beloit One Network |
$23,319.59
|
| Rate for Payer: Quartz Commercial |
$30,934.15
|
| Rate for Payer: Quartz Medicare Advantage |
$28,554.60
|
| Rate for Payer: The Alliance Commercial |
$190,364.00
|
| Rate for Payer: WEA Trust Commercial |
$26,175.05
|
| Rate for Payer: WPS Commercial |
$35,250.65
|
|
|
HEART VALVE 31mm MOSAIC PORCIN
|
Facility
|
IP
|
$47,591.00
|
|
| Hospital Charge Code |
2965347
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,319.59 |
| Max. Negotiated Rate |
$43,783.72 |
| Rate for Payer: Aetna Commercial |
$42,831.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40,928.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25,223.23
|
| Rate for Payer: Cash Price |
$14,277.30
|
| Rate for Payer: Cigna Commercial |
$43,783.72
|
| Rate for Payer: Health EOS Commercial |
$42,355.99
|
| Rate for Payer: HFN Commercial |
$43,783.72
|
| Rate for Payer: Multiplan Commercial |
$38,072.80
|
| Rate for Payer: NAPHCARE Commercial |
$28,554.60
|
| Rate for Payer: Preferred Network Access Commercial |
$43,783.72
|
| Rate for Payer: Quartz Beloit One Network |
$23,319.59
|
| Rate for Payer: Quartz Commercial |
$28,554.60
|
| Rate for Payer: WEA Trust Commercial |
$26,175.05
|
| Rate for Payer: WPS Commercial |
$35,250.65
|
|
|
HEART VALVE PERICARDIAL TISSUE
|
Facility
|
OP
|
$45,119.00
|
|
| Hospital Charge Code |
2965104
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,633.32 |
| Max. Negotiated Rate |
$180,476.00 |
| Rate for Payer: Aetna Commercial |
$40,607.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$38,802.34
|
| Rate for Payer: Aetna Managed Medicare |
$12,633.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,327.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,559.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,657.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,913.07
|
| Rate for Payer: Cash Price |
$13,535.70
|
| Rate for Payer: Cigna Commercial |
$41,509.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,248.59
|
| Rate for Payer: Health EOS Commercial |
$40,155.91
|
| Rate for Payer: HFN Commercial |
$41,509.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$33,839.25
|
| Rate for Payer: Multiplan Commercial |
$36,095.20
|
| Rate for Payer: NAPHCARE Commercial |
$27,071.40
|
| Rate for Payer: Preferred Network Access Commercial |
$41,509.48
|
| Rate for Payer: Quartz Beloit One Network |
$22,108.31
|
| Rate for Payer: Quartz Commercial |
$29,327.35
|
| Rate for Payer: Quartz Medicare Advantage |
$27,071.40
|
| Rate for Payer: The Alliance Commercial |
$180,476.00
|
| Rate for Payer: WEA Trust Commercial |
$24,815.45
|
| Rate for Payer: WPS Commercial |
$33,419.64
|
|
