Antithrombin III, Activity
|
Professional
|
$682.00
|
|
Service Code
|
CPT 85300
|
Hospital Charge Code |
980026
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$11.85 |
Max. Negotiated Rate |
$647.90 |
Rate for Payer: Aetna Commercial |
$647.90
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
Rate for Payer: Aetna Managed Medicare |
$11.85
|
Rate for Payer: Anthem Medicare Advantage |
$11.85
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.85
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.85
|
Rate for Payer: Cash Price |
$204.60
|
Rate for Payer: Cash Price |
$204.60
|
Rate for Payer: Cigna Commercial |
$647.90
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$341.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$11.85
|
Rate for Payer: Health EOS Commercial |
$620.62
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41.83
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$41.83
|
Rate for Payer: Independent Care Health Plan Medicare |
$11.85
|
Rate for Payer: Multiplan Commercial |
$545.60
|
Rate for Payer: Preferred Network Access Commercial |
$647.90
|
Rate for Payer: Quartz Beloit One Network |
$300.08
|
Rate for Payer: Quartz Commercial |
$388.74
|
Rate for Payer: Quartz Medicare Advantage |
$11.85
|
Rate for Payer: The Alliance Commercial |
$46.81
|
Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
Rate for Payer: WEA Trust Commercial |
$375.10
|
Rate for Payer: WPS Commercial |
$52.14
|
|
Antithrombin III, Activity
|
Facility
OP
|
$682.00
|
|
Service Code
|
CPT 85300
|
Hospital Charge Code |
980026
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$11.85 |
Max. Negotiated Rate |
$2,728.00 |
Rate for Payer: Aetna Commercial |
$613.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$586.52
|
Rate for Payer: Aetna Managed Medicare |
$11.85
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.44
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20.74
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19.67
|
Rate for Payer: Anthem Medicaid |
$12.24
|
Rate for Payer: Anthem Medicare Advantage |
$11.85
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$11.85
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$11.85
|
Rate for Payer: Cash Price |
$204.60
|
Rate for Payer: Cash Price |
$204.60
|
Rate for Payer: Cigna Commercial |
$627.44
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$11.85
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$12.24
|
Rate for Payer: Dean Health Medicaid |
$12.24
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$11.85
|
Rate for Payer: Health EOS Commercial |
$606.98
|
Rate for Payer: HFN Commercial |
$627.44
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$44.08
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$11.85
|
Rate for Payer: Independent Care Health Plan Medicaid |
$12.24
|
Rate for Payer: Independent Care Health Plan Medicare |
$11.85
|
Rate for Payer: Managed Health Services Medicaid |
$12.73
|
Rate for Payer: Managed Health Services Medicare Advantage |
$11.85
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$11.85
|
Rate for Payer: Multiplan Commercial |
$545.60
|
Rate for Payer: NAPHCARE Commercial |
$17.78
|
Rate for Payer: Preferred Network Access Commercial |
$627.44
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$12.24
|
Rate for Payer: Quartz Beloit One Network |
$334.18
|
Rate for Payer: Quartz Commercial |
$443.30
|
Rate for Payer: Quartz Medicare Advantage |
$11.85
|
Rate for Payer: The Alliance Commercial |
$2,728.00
|
Rate for Payer: United Healthcare Medicaid |
$12.24
|
Rate for Payer: United Healthcare Medicare Advantage |
$11.85
|
Rate for Payer: United Healthcare PPO |
$511.50
|
Rate for Payer: WEA Trust Commercial |
$375.10
|
Rate for Payer: Wellcare Medicare |
$11.85
|
Rate for Payer: WMAP Medicaid |
$12.24
|
Rate for Payer: WPS Commercial |
$505.16
|
|
Antithrombin III, Activity
|
Facility
IP
|
$682.00
|
|
Service Code
|
CPT 85300
|
Hospital Charge Code |
980026
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$334.18 |
Max. Negotiated Rate |
$627.44 |
Rate for Payer: Aetna Commercial |
$613.80
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$361.46
|
Rate for Payer: Cash Price |
$204.60
|
Rate for Payer: Cigna Commercial |
$627.44
|
Rate for Payer: Health EOS Commercial |
$606.98
|
Rate for Payer: HFN Commercial |
$627.44
|
Rate for Payer: Multiplan Commercial |
$545.60
|
Rate for Payer: NAPHCARE Commercial |
$409.20
|
Rate for Payer: Preferred Network Access Commercial |
$627.44
|
Rate for Payer: Quartz Beloit One Network |
$334.18
|
Rate for Payer: Quartz Commercial |
$409.20
|
Rate for Payer: WEA Trust Commercial |
$375.10
|
Rate for Payer: WPS Commercial |
$505.16
|
|
Antithrombin III, Antigen
|
Facility
IP
|
$976.00
|
|
Service Code
|
CPT 85301
|
Hospital Charge Code |
980027
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$478.24 |
Max. Negotiated Rate |
$897.92 |
Rate for Payer: Aetna Commercial |
$878.40
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.28
|
Rate for Payer: Cash Price |
$292.80
|
Rate for Payer: Cigna Commercial |
$897.92
|
Rate for Payer: Health EOS Commercial |
$868.64
|
Rate for Payer: HFN Commercial |
$897.92
|
Rate for Payer: Multiplan Commercial |
$780.80
|
Rate for Payer: NAPHCARE Commercial |
$585.60
|
Rate for Payer: Preferred Network Access Commercial |
$897.92
|
Rate for Payer: Quartz Beloit One Network |
$478.24
|
Rate for Payer: Quartz Commercial |
$585.60
|
Rate for Payer: WEA Trust Commercial |
$536.80
|
Rate for Payer: WPS Commercial |
$722.92
|
|
Antithrombin III, Antigen
|
Professional
|
$976.00
|
|
Service Code
|
CPT 85301
|
Hospital Charge Code |
980027
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$10.81 |
Max. Negotiated Rate |
$927.20 |
Rate for Payer: Aetna Commercial |
$927.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$839.36
|
Rate for Payer: Aetna Managed Medicare |
$10.81
|
Rate for Payer: Anthem Medicare Advantage |
$10.81
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.81
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.81
|
Rate for Payer: Cash Price |
$292.80
|
Rate for Payer: Cash Price |
$292.80
|
Rate for Payer: Cigna Commercial |
$927.20
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$488.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$10.81
|
Rate for Payer: Health EOS Commercial |
$888.16
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38.16
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$38.16
|
Rate for Payer: Independent Care Health Plan Medicare |
$10.81
|
Rate for Payer: Multiplan Commercial |
$780.80
|
Rate for Payer: Preferred Network Access Commercial |
$927.20
|
Rate for Payer: Quartz Beloit One Network |
$429.44
|
Rate for Payer: Quartz Commercial |
$556.32
|
Rate for Payer: Quartz Medicare Advantage |
$10.81
|
Rate for Payer: The Alliance Commercial |
$42.70
|
Rate for Payer: United Healthcare Medicare Advantage |
$10.81
|
Rate for Payer: WEA Trust Commercial |
$536.80
|
Rate for Payer: WPS Commercial |
$47.56
|
|
Antithrombin III, Antigen
|
Facility
OP
|
$976.00
|
|
Service Code
|
CPT 85301
|
Hospital Charge Code |
980027
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$10.81 |
Max. Negotiated Rate |
$3,904.00 |
Rate for Payer: Aetna Commercial |
$878.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$839.36
|
Rate for Payer: Aetna Managed Medicare |
$10.81
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40.54
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18.92
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17.94
|
Rate for Payer: Anthem Medicaid |
$11.17
|
Rate for Payer: Anthem Medicare Advantage |
$10.81
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$517.28
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10.81
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10.81
|
Rate for Payer: Cash Price |
$292.80
|
Rate for Payer: Cash Price |
$292.80
|
Rate for Payer: Cigna Commercial |
$897.92
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10.81
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$11.17
|
Rate for Payer: Dean Health Medicaid |
$11.17
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10.81
|
Rate for Payer: Health EOS Commercial |
$868.64
|
Rate for Payer: HFN Commercial |
$897.92
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40.21
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10.81
|
Rate for Payer: Independent Care Health Plan Medicaid |
$11.17
|
Rate for Payer: Independent Care Health Plan Medicare |
$10.81
|
Rate for Payer: Managed Health Services Medicaid |
$11.62
|
Rate for Payer: Managed Health Services Medicare Advantage |
$10.81
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10.81
|
Rate for Payer: Multiplan Commercial |
$780.80
|
Rate for Payer: NAPHCARE Commercial |
$16.22
|
Rate for Payer: Preferred Network Access Commercial |
$897.92
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$11.17
|
Rate for Payer: Quartz Beloit One Network |
$478.24
|
Rate for Payer: Quartz Commercial |
$634.40
|
Rate for Payer: Quartz Medicare Advantage |
$10.81
|
Rate for Payer: The Alliance Commercial |
$3,904.00
|
Rate for Payer: United Healthcare Medicaid |
$11.17
|
Rate for Payer: United Healthcare Medicare Advantage |
$10.81
|
Rate for Payer: United Healthcare PPO |
$732.00
|
Rate for Payer: WEA Trust Commercial |
$536.80
|
Rate for Payer: Wellcare Medicare |
$10.81
|
Rate for Payer: WMAP Medicaid |
$11.17
|
Rate for Payer: WPS Commercial |
$722.92
|
|
Anti-Ustekinumab Ab
|
Facility
IP
|
$252.00
|
|
Service Code
|
CPT 83520
|
Hospital Charge Code |
5542921
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$123.48 |
Max. Negotiated Rate |
$231.84 |
Rate for Payer: Aetna Commercial |
$226.80
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.56
|
Rate for Payer: Cash Price |
$75.60
|
Rate for Payer: Cigna Commercial |
$231.84
|
Rate for Payer: Health EOS Commercial |
$224.28
|
Rate for Payer: HFN Commercial |
$231.84
|
Rate for Payer: Multiplan Commercial |
$201.60
|
Rate for Payer: NAPHCARE Commercial |
$151.20
|
Rate for Payer: Preferred Network Access Commercial |
$231.84
|
Rate for Payer: Quartz Beloit One Network |
$123.48
|
Rate for Payer: Quartz Commercial |
$151.20
|
Rate for Payer: WEA Trust Commercial |
$138.60
|
Rate for Payer: WPS Commercial |
$186.66
|
|
Anti-Ustekinumab Ab
|
Professional
|
$252.00
|
|
Service Code
|
CPT 83520
|
Hospital Charge Code |
5542921
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$17.27 |
Max. Negotiated Rate |
$239.40 |
Rate for Payer: Aetna Commercial |
$239.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.72
|
Rate for Payer: Aetna Managed Medicare |
$17.27
|
Rate for Payer: Anthem Medicare Advantage |
$17.27
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
Rate for Payer: Cash Price |
$75.60
|
Rate for Payer: Cash Price |
$75.60
|
Rate for Payer: Cigna Commercial |
$239.40
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$126.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$17.27
|
Rate for Payer: Health EOS Commercial |
$229.32
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$60.96
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$60.96
|
Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
Rate for Payer: Multiplan Commercial |
$201.60
|
Rate for Payer: Preferred Network Access Commercial |
$239.40
|
Rate for Payer: Quartz Beloit One Network |
$110.88
|
Rate for Payer: Quartz Commercial |
$143.64
|
Rate for Payer: Quartz Medicare Advantage |
$17.27
|
Rate for Payer: The Alliance Commercial |
$68.22
|
Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
Rate for Payer: WEA Trust Commercial |
$138.60
|
Rate for Payer: WPS Commercial |
$75.99
|
|
Anti-Ustekinumab Ab
|
Facility
OP
|
$252.00
|
|
Service Code
|
CPT 83520
|
Hospital Charge Code |
5542921
|
Hospital Revenue Code
|
300
|
Min. Negotiated Rate |
$17.27 |
Max. Negotiated Rate |
$1,008.00 |
Rate for Payer: Aetna Commercial |
$226.80
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$216.72
|
Rate for Payer: Aetna Managed Medicare |
$17.27
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$64.76
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30.22
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28.67
|
Rate for Payer: Anthem Medicaid |
$17.85
|
Rate for Payer: Anthem Medicare Advantage |
$17.27
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$133.56
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17.27
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17.27
|
Rate for Payer: Cash Price |
$75.60
|
Rate for Payer: Cash Price |
$75.60
|
Rate for Payer: Cigna Commercial |
$231.84
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17.27
|
Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$17.85
|
Rate for Payer: Dean Health Medicaid |
$17.85
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17.27
|
Rate for Payer: Health EOS Commercial |
$224.28
|
Rate for Payer: HFN Commercial |
$231.84
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64.24
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17.27
|
Rate for Payer: Independent Care Health Plan Medicaid |
$17.85
|
Rate for Payer: Independent Care Health Plan Medicare |
$17.27
|
Rate for Payer: Managed Health Services Medicaid |
$18.56
|
Rate for Payer: Managed Health Services Medicare Advantage |
$17.27
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17.27
|
Rate for Payer: Multiplan Commercial |
$201.60
|
Rate for Payer: NAPHCARE Commercial |
$25.90
|
Rate for Payer: Preferred Network Access Commercial |
$231.84
|
Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$17.85
|
Rate for Payer: Quartz Beloit One Network |
$123.48
|
Rate for Payer: Quartz Commercial |
$163.80
|
Rate for Payer: Quartz Medicare Advantage |
$17.27
|
Rate for Payer: The Alliance Commercial |
$1,008.00
|
Rate for Payer: United Healthcare Medicaid |
$17.85
|
Rate for Payer: United Healthcare Medicare Advantage |
$17.27
|
Rate for Payer: United Healthcare PPO |
$189.00
|
Rate for Payer: WEA Trust Commercial |
$138.60
|
Rate for Payer: Wellcare Medicare |
$17.27
|
Rate for Payer: WMAP Medicaid |
$17.85
|
Rate for Payer: WPS Commercial |
$186.66
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITH MCC
|
Facility
IP
|
$182,559.00
|
|
Service Code
|
MS-DRG 268
|
Min. Negotiated Rate |
$65,668.77 |
Max. Negotiated Rate |
$182,559.00 |
Rate for Payer: Aetna Managed Medicare |
$65,668.77
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$143,713.00
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$110,154.85
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$104,654.30
|
Rate for Payer: Anthem Medicare Advantage |
$65,668.77
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$65,668.77
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$65,668.77
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$65,668.77
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$116,175.86
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$65,668.77
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$133,666.70
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$65,668.77
|
Rate for Payer: Independent Care Health Plan Medicare |
$65,668.77
|
Rate for Payer: Managed Health Services Medicare Advantage |
$65,668.77
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$65,668.77
|
Rate for Payer: NAPHCARE Commercial |
$98,503.16
|
Rate for Payer: Quartz Medicare Advantage |
$65,668.77
|
Rate for Payer: The Alliance Commercial |
$182,559.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$65,668.77
|
Rate for Payer: United Healthcare PPO |
$104,061.20
|
Rate for Payer: Wellcare Medicare |
$65,668.77
|
|
AORTIC AND HEART ASSIST PROCEDURES EXCEPT PULSATION BALLOON WITHOUT MCC
|
Facility
IP
|
$110,881.00
|
|
Service Code
|
MS-DRG 269
|
Min. Negotiated Rate |
$39,885.18 |
Max. Negotiated Rate |
$110,881.00 |
Rate for Payer: Aetna Managed Medicare |
$39,885.18
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$87,276.80
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$66,896.96
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$63,556.48
|
Rate for Payer: Anthem Medicare Advantage |
$39,885.18
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$39,885.18
|
Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$39,885.18
|
Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$39,885.18
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$70,553.52
|
Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$39,885.18
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$81,092.70
|
Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$39,885.18
|
Rate for Payer: Independent Care Health Plan Medicare |
$39,885.18
|
Rate for Payer: Managed Health Services Medicare Advantage |
$39,885.18
|
Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$39,885.18
|
Rate for Payer: NAPHCARE Commercial |
$59,827.77
|
Rate for Payer: Quartz Medicare Advantage |
$39,885.18
|
Rate for Payer: The Alliance Commercial |
$110,881.00
|
Rate for Payer: United Healthcare Medicare Advantage |
$39,885.18
|
Rate for Payer: United Healthcare PPO |
$63,131.71
|
Rate for Payer: Wellcare Medicare |
$39,885.18
|
|
AORTIC VALVE 16MM AP360 #505DA16
|
Facility
OP
|
$34,778.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2973948
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,196.24 |
Max. Negotiated Rate |
$31,995.76 |
Rate for Payer: Aetna Commercial |
$31,300.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29,909.08
|
Rate for Payer: Aetna Managed Medicare |
$9,737.84
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,605.70
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,389.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,693.44
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,432.34
|
Rate for Payer: Cash Price |
$10,433.40
|
Rate for Payer: Cash Price |
$10,433.40
|
Rate for Payer: Cigna Commercial |
$31,995.76
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$19,461.77
|
Rate for Payer: Health EOS Commercial |
$30,952.42
|
Rate for Payer: HFN Commercial |
$31,995.76
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,083.50
|
Rate for Payer: Multiplan Commercial |
$27,822.40
|
Rate for Payer: NAPHCARE Commercial |
$20,866.80
|
Rate for Payer: Preferred Network Access Commercial |
$31,995.76
|
Rate for Payer: Quartz Beloit One Network |
$17,041.22
|
Rate for Payer: Quartz Commercial |
$22,605.70
|
Rate for Payer: Quartz Medicare Advantage |
$20,866.80
|
Rate for Payer: The Alliance Commercial |
$1,196.24
|
Rate for Payer: WEA Trust Commercial |
$19,127.90
|
Rate for Payer: WPS Commercial |
$25,760.06
|
|
AORTIC VALVE 16MM AP360 #505DA16
|
Facility
IP
|
$34,778.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2973948
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17,041.22 |
Max. Negotiated Rate |
$31,995.76 |
Rate for Payer: Aetna Commercial |
$31,300.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,432.34
|
Rate for Payer: Cash Price |
$10,433.40
|
Rate for Payer: Cigna Commercial |
$31,995.76
|
Rate for Payer: Health EOS Commercial |
$30,952.42
|
Rate for Payer: HFN Commercial |
$31,995.76
|
Rate for Payer: Multiplan Commercial |
$27,822.40
|
Rate for Payer: NAPHCARE Commercial |
$20,866.80
|
Rate for Payer: Preferred Network Access Commercial |
$31,995.76
|
Rate for Payer: Quartz Beloit One Network |
$17,041.22
|
Rate for Payer: Quartz Commercial |
$20,866.80
|
Rate for Payer: WEA Trust Commercial |
$19,127.90
|
Rate for Payer: WPS Commercial |
$25,760.06
|
|
AORTIC VALVE 18MM AP360 #505DA18
|
Facility
OP
|
$34,778.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2973947
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,196.24 |
Max. Negotiated Rate |
$31,995.76 |
Rate for Payer: Aetna Commercial |
$31,300.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29,909.08
|
Rate for Payer: Aetna Managed Medicare |
$9,737.84
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,605.70
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,389.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,693.44
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,432.34
|
Rate for Payer: Cash Price |
$10,433.40
|
Rate for Payer: Cash Price |
$10,433.40
|
Rate for Payer: Cigna Commercial |
$31,995.76
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$19,461.77
|
Rate for Payer: Health EOS Commercial |
$30,952.42
|
Rate for Payer: HFN Commercial |
$31,995.76
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,083.50
|
Rate for Payer: Multiplan Commercial |
$27,822.40
|
Rate for Payer: NAPHCARE Commercial |
$20,866.80
|
Rate for Payer: Preferred Network Access Commercial |
$31,995.76
|
Rate for Payer: Quartz Beloit One Network |
$17,041.22
|
Rate for Payer: Quartz Commercial |
$22,605.70
|
Rate for Payer: Quartz Medicare Advantage |
$20,866.80
|
Rate for Payer: The Alliance Commercial |
$1,196.24
|
Rate for Payer: WEA Trust Commercial |
$19,127.90
|
Rate for Payer: WPS Commercial |
$25,760.06
|
|
AORTIC VALVE 18MM AP360 #505DA18
|
Facility
IP
|
$34,778.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2973947
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17,041.22 |
Max. Negotiated Rate |
$31,995.76 |
Rate for Payer: Aetna Commercial |
$31,300.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,432.34
|
Rate for Payer: Cash Price |
$10,433.40
|
Rate for Payer: Cigna Commercial |
$31,995.76
|
Rate for Payer: Health EOS Commercial |
$30,952.42
|
Rate for Payer: HFN Commercial |
$31,995.76
|
Rate for Payer: Multiplan Commercial |
$27,822.40
|
Rate for Payer: NAPHCARE Commercial |
$20,866.80
|
Rate for Payer: Preferred Network Access Commercial |
$31,995.76
|
Rate for Payer: Quartz Beloit One Network |
$17,041.22
|
Rate for Payer: Quartz Commercial |
$20,866.80
|
Rate for Payer: WEA Trust Commercial |
$19,127.90
|
Rate for Payer: WPS Commercial |
$25,760.06
|
|
AORTIC VALVE 19MM MOSAIC ULTRA 305U219
|
Facility
OP
|
$38,439.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2973954
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,196.24 |
Max. Negotiated Rate |
$35,363.88 |
Rate for Payer: Aetna Commercial |
$34,595.10
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$33,057.54
|
Rate for Payer: Aetna Managed Medicare |
$10,762.92
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,985.35
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,219.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,450.72
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,372.67
|
Rate for Payer: Cash Price |
$11,531.70
|
Rate for Payer: Cash Price |
$11,531.70
|
Rate for Payer: Cigna Commercial |
$35,363.88
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$21,510.46
|
Rate for Payer: Health EOS Commercial |
$34,210.71
|
Rate for Payer: HFN Commercial |
$35,363.88
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,829.25
|
Rate for Payer: Multiplan Commercial |
$30,751.20
|
Rate for Payer: NAPHCARE Commercial |
$23,063.40
|
Rate for Payer: Preferred Network Access Commercial |
$35,363.88
|
Rate for Payer: Quartz Beloit One Network |
$18,835.11
|
Rate for Payer: Quartz Commercial |
$24,985.35
|
Rate for Payer: Quartz Medicare Advantage |
$23,063.40
|
Rate for Payer: The Alliance Commercial |
$1,196.24
|
Rate for Payer: WEA Trust Commercial |
$21,141.45
|
Rate for Payer: WPS Commercial |
$28,471.77
|
|
AORTIC VALVE 19MM MOSAIC ULTRA 305U219
|
Facility
IP
|
$38,439.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2973954
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$18,835.11 |
Max. Negotiated Rate |
$35,363.88 |
Rate for Payer: Aetna Commercial |
$34,595.10
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$20,372.67
|
Rate for Payer: Cash Price |
$11,531.70
|
Rate for Payer: Cigna Commercial |
$35,363.88
|
Rate for Payer: Health EOS Commercial |
$34,210.71
|
Rate for Payer: HFN Commercial |
$35,363.88
|
Rate for Payer: Multiplan Commercial |
$30,751.20
|
Rate for Payer: NAPHCARE Commercial |
$23,063.40
|
Rate for Payer: Preferred Network Access Commercial |
$35,363.88
|
Rate for Payer: Quartz Beloit One Network |
$18,835.11
|
Rate for Payer: Quartz Commercial |
$23,063.40
|
Rate for Payer: WEA Trust Commercial |
$21,141.45
|
Rate for Payer: WPS Commercial |
$28,471.77
|
|
AORTIC VALVE 19MM TRIFECTA TF-19A
|
Facility
OP
|
$53,878.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2966066
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,196.24 |
Max. Negotiated Rate |
$49,567.76 |
Rate for Payer: Aetna Commercial |
$48,490.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$46,335.08
|
Rate for Payer: Aetna Managed Medicare |
$15,085.84
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,020.70
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,939.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,861.44
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28,555.34
|
Rate for Payer: Cash Price |
$16,163.40
|
Rate for Payer: Cash Price |
$16,163.40
|
Rate for Payer: Cigna Commercial |
$49,567.76
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$30,150.13
|
Rate for Payer: Health EOS Commercial |
$47,951.42
|
Rate for Payer: HFN Commercial |
$49,567.76
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,408.50
|
Rate for Payer: Multiplan Commercial |
$43,102.40
|
Rate for Payer: NAPHCARE Commercial |
$32,326.80
|
Rate for Payer: Preferred Network Access Commercial |
$49,567.76
|
Rate for Payer: Quartz Beloit One Network |
$26,400.22
|
Rate for Payer: Quartz Commercial |
$35,020.70
|
Rate for Payer: Quartz Medicare Advantage |
$32,326.80
|
Rate for Payer: The Alliance Commercial |
$1,196.24
|
Rate for Payer: WEA Trust Commercial |
$29,632.90
|
Rate for Payer: WPS Commercial |
$39,907.43
|
|
AORTIC VALVE 19MM TRIFECTA TF-19A
|
Facility
IP
|
$53,878.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2966066
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$26,400.22 |
Max. Negotiated Rate |
$49,567.76 |
Rate for Payer: Aetna Commercial |
$48,490.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$28,555.34
|
Rate for Payer: Cash Price |
$16,163.40
|
Rate for Payer: Cigna Commercial |
$49,567.76
|
Rate for Payer: Health EOS Commercial |
$47,951.42
|
Rate for Payer: HFN Commercial |
$49,567.76
|
Rate for Payer: Multiplan Commercial |
$43,102.40
|
Rate for Payer: NAPHCARE Commercial |
$32,326.80
|
Rate for Payer: Preferred Network Access Commercial |
$49,567.76
|
Rate for Payer: Quartz Beloit One Network |
$26,400.22
|
Rate for Payer: Quartz Commercial |
$32,326.80
|
Rate for Payer: WEA Trust Commercial |
$29,632.90
|
Rate for Payer: WPS Commercial |
$39,907.43
|
|
AORTIC VALVE 19MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-19A
|
Facility
OP
|
$28,050.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
5074608
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,196.24 |
Max. Negotiated Rate |
$25,806.00 |
Rate for Payer: Aetna Commercial |
$25,245.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$24,123.00
|
Rate for Payer: Aetna Managed Medicare |
$7,854.00
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,232.50
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,025.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,464.00
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,866.50
|
Rate for Payer: Cash Price |
$8,415.00
|
Rate for Payer: Cash Price |
$8,415.00
|
Rate for Payer: Cigna Commercial |
$25,806.00
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$15,696.78
|
Rate for Payer: Health EOS Commercial |
$24,964.50
|
Rate for Payer: HFN Commercial |
$25,806.00
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,037.50
|
Rate for Payer: Multiplan Commercial |
$22,440.00
|
Rate for Payer: NAPHCARE Commercial |
$16,830.00
|
Rate for Payer: Preferred Network Access Commercial |
$25,806.00
|
Rate for Payer: Quartz Beloit One Network |
$13,744.50
|
Rate for Payer: Quartz Commercial |
$18,232.50
|
Rate for Payer: Quartz Medicare Advantage |
$16,830.00
|
Rate for Payer: The Alliance Commercial |
$1,196.24
|
Rate for Payer: WEA Trust Commercial |
$15,427.50
|
Rate for Payer: WPS Commercial |
$20,776.64
|
|
AORTIC VALVE 19MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-19A
|
Facility
IP
|
$28,050.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
5074608
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$13,744.50 |
Max. Negotiated Rate |
$25,806.00 |
Rate for Payer: Aetna Commercial |
$25,245.00
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$14,866.50
|
Rate for Payer: Cash Price |
$8,415.00
|
Rate for Payer: Cigna Commercial |
$25,806.00
|
Rate for Payer: Health EOS Commercial |
$24,964.50
|
Rate for Payer: HFN Commercial |
$25,806.00
|
Rate for Payer: Multiplan Commercial |
$22,440.00
|
Rate for Payer: NAPHCARE Commercial |
$16,830.00
|
Rate for Payer: Preferred Network Access Commercial |
$25,806.00
|
Rate for Payer: Quartz Beloit One Network |
$13,744.50
|
Rate for Payer: Quartz Commercial |
$16,830.00
|
Rate for Payer: WEA Trust Commercial |
$15,427.50
|
Rate for Payer: WPS Commercial |
$20,776.64
|
|
AORTIC VALVE 20MM AP360 #505DA20
|
Facility
IP
|
$34,778.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2973949
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$17,041.22 |
Max. Negotiated Rate |
$31,995.76 |
Rate for Payer: Aetna Commercial |
$31,300.20
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,432.34
|
Rate for Payer: Cash Price |
$10,433.40
|
Rate for Payer: Cigna Commercial |
$31,995.76
|
Rate for Payer: Health EOS Commercial |
$30,952.42
|
Rate for Payer: HFN Commercial |
$31,995.76
|
Rate for Payer: Multiplan Commercial |
$27,822.40
|
Rate for Payer: NAPHCARE Commercial |
$20,866.80
|
Rate for Payer: Preferred Network Access Commercial |
$31,995.76
|
Rate for Payer: Quartz Beloit One Network |
$17,041.22
|
Rate for Payer: Quartz Commercial |
$20,866.80
|
Rate for Payer: WEA Trust Commercial |
$19,127.90
|
Rate for Payer: WPS Commercial |
$25,760.06
|
|
AORTIC VALVE 20MM AP360 #505DA20
|
Facility
OP
|
$34,778.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2973949
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,196.24 |
Max. Negotiated Rate |
$31,995.76 |
Rate for Payer: Aetna Commercial |
$31,300.20
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$29,909.08
|
Rate for Payer: Aetna Managed Medicare |
$9,737.84
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$22,605.70
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$17,389.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$16,693.44
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$18,432.34
|
Rate for Payer: Cash Price |
$10,433.40
|
Rate for Payer: Cash Price |
$10,433.40
|
Rate for Payer: Cigna Commercial |
$31,995.76
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$19,461.77
|
Rate for Payer: Health EOS Commercial |
$30,952.42
|
Rate for Payer: HFN Commercial |
$31,995.76
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$26,083.50
|
Rate for Payer: Multiplan Commercial |
$27,822.40
|
Rate for Payer: NAPHCARE Commercial |
$20,866.80
|
Rate for Payer: Preferred Network Access Commercial |
$31,995.76
|
Rate for Payer: Quartz Beloit One Network |
$17,041.22
|
Rate for Payer: Quartz Commercial |
$22,605.70
|
Rate for Payer: Quartz Medicare Advantage |
$20,866.80
|
Rate for Payer: The Alliance Commercial |
$1,196.24
|
Rate for Payer: WEA Trust Commercial |
$19,127.90
|
Rate for Payer: WPS Commercial |
$25,760.06
|
|
AORTIC VALVE 21MM MOSAIC ULTRA 305U221
|
Facility
IP
|
$39,917.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2973955
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$19,559.33 |
Max. Negotiated Rate |
$36,723.64 |
Rate for Payer: Aetna Commercial |
$35,925.30
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,156.01
|
Rate for Payer: Cash Price |
$11,975.10
|
Rate for Payer: Cigna Commercial |
$36,723.64
|
Rate for Payer: Health EOS Commercial |
$35,526.13
|
Rate for Payer: HFN Commercial |
$36,723.64
|
Rate for Payer: Multiplan Commercial |
$31,933.60
|
Rate for Payer: NAPHCARE Commercial |
$23,950.20
|
Rate for Payer: Preferred Network Access Commercial |
$36,723.64
|
Rate for Payer: Quartz Beloit One Network |
$19,559.33
|
Rate for Payer: Quartz Commercial |
$23,950.20
|
Rate for Payer: WEA Trust Commercial |
$21,954.35
|
Rate for Payer: WPS Commercial |
$29,566.52
|
|
AORTIC VALVE 21MM MOSAIC ULTRA 305U221
|
Facility
OP
|
$39,917.00
|
|
Service Code
|
HCPCS L8699
|
Hospital Charge Code |
2973955
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$1,196.24 |
Max. Negotiated Rate |
$36,723.64 |
Rate for Payer: Aetna Commercial |
$35,925.30
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,328.62
|
Rate for Payer: Aetna Managed Medicare |
$11,176.76
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,946.05
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,958.50
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,160.16
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,156.01
|
Rate for Payer: Cash Price |
$11,975.10
|
Rate for Payer: Cash Price |
$11,975.10
|
Rate for Payer: Cigna Commercial |
$36,723.64
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$22,337.55
|
Rate for Payer: Health EOS Commercial |
$35,526.13
|
Rate for Payer: HFN Commercial |
$36,723.64
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,937.75
|
Rate for Payer: Multiplan Commercial |
$31,933.60
|
Rate for Payer: NAPHCARE Commercial |
$23,950.20
|
Rate for Payer: Preferred Network Access Commercial |
$36,723.64
|
Rate for Payer: Quartz Beloit One Network |
$19,559.33
|
Rate for Payer: Quartz Commercial |
$25,946.05
|
Rate for Payer: Quartz Medicare Advantage |
$23,950.20
|
Rate for Payer: The Alliance Commercial |
$1,196.24
|
Rate for Payer: WEA Trust Commercial |
$21,954.35
|
Rate for Payer: WPS Commercial |
$29,566.52
|
|