|
AORTIC VALVE 21MM ON-X CONFORM-X SEWING RING ONXACE-21
|
Facility
OP
|
$23,935.00
|
|
| Hospital Charge Code |
5591282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,701.80 |
| Max. Negotiated Rate |
$95,740.00 |
| Rate for Payer: Aetna Commercial |
$21,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,584.10
|
| Rate for Payer: Aetna Managed Medicare |
$6,701.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,488.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,685.55
|
| Rate for Payer: Cash Price |
$7,180.50
|
| Rate for Payer: Cigna Commercial |
$22,020.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,394.03
|
| Rate for Payer: Health EOS Commercial |
$21,302.15
|
| Rate for Payer: HFN Commercial |
$22,020.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,951.25
|
| Rate for Payer: Multiplan Commercial |
$19,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$14,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$22,020.20
|
| Rate for Payer: Quartz Beloit One Network |
$11,728.15
|
| Rate for Payer: Quartz Commercial |
$15,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$14,361.00
|
| Rate for Payer: The Alliance Commercial |
$95,740.00
|
| Rate for Payer: WEA Trust Commercial |
$13,164.25
|
| Rate for Payer: WPS Commercial |
$17,728.65
|
|
|
AORTIC VALVE 21MM ON-X CONFORM-X SEWING RING ONXACE-21
|
Facility
IP
|
$23,935.00
|
|
| Hospital Charge Code |
5591282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,728.15 |
| Max. Negotiated Rate |
$22,020.20 |
| Rate for Payer: Aetna Commercial |
$21,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,685.55
|
| Rate for Payer: Cash Price |
$7,180.50
|
| Rate for Payer: Cigna Commercial |
$22,020.20
|
| Rate for Payer: Health EOS Commercial |
$21,302.15
|
| Rate for Payer: HFN Commercial |
$22,020.20
|
| Rate for Payer: Multiplan Commercial |
$19,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$14,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$22,020.20
|
| Rate for Payer: Quartz Beloit One Network |
$11,728.15
|
| Rate for Payer: Quartz Commercial |
$14,361.00
|
| Rate for Payer: WEA Trust Commercial |
$13,164.25
|
| Rate for Payer: WPS Commercial |
$17,728.65
|
|
|
AORTIC VALVE 21MM TRIFECTA TF-21A
|
Facility
OP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966067
|
|
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 21MM TRIFECTA TF-21A
|
Facility
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966067
|
|
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 21MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-21A
|
Facility
OP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074609
|
|
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 21MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-21A
|
Facility
IP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074609
|
|
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 22MM AP360 #505DA22
|
Facility
IP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973950
|
|
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 22MM AP360 #505DA22
|
Facility
OP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973950
|
|
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 23MM MOSAIC ULTRA 305U23
|
Facility
OP
|
$39,917.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973965
|
|
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
|
|
|
AORTIC VALVE 23MM MOSAIC ULTRA 305U23
|
Facility
IP
|
$39,917.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973965
|
|
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 23MM ON-X CONFORM-X SEWING RING ONXACE-23
|
Facility
IP
|
$23,935.00
|
|
| Hospital Charge Code |
5591402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,728.15 |
| Max. Negotiated Rate |
$22,020.20 |
| Rate for Payer: Aetna Commercial |
$21,541.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,685.55
|
| Rate for Payer: Cash Price |
$7,180.50
|
| Rate for Payer: Cigna Commercial |
$22,020.20
|
| Rate for Payer: Health EOS Commercial |
$21,302.15
|
| Rate for Payer: HFN Commercial |
$22,020.20
|
| Rate for Payer: Multiplan Commercial |
$19,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$14,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$22,020.20
|
| Rate for Payer: Quartz Beloit One Network |
$11,728.15
|
| Rate for Payer: Quartz Commercial |
$14,361.00
|
| Rate for Payer: WEA Trust Commercial |
$13,164.25
|
| Rate for Payer: WPS Commercial |
$17,728.65
|
|
|
AORTIC VALVE 23MM ON-X CONFORM-X SEWING RING ONXACE-23
|
Facility
OP
|
$23,935.00
|
|
| Hospital Charge Code |
5591402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,701.80 |
| Max. Negotiated Rate |
$95,740.00 |
| Rate for Payer: Aetna Commercial |
$21,541.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,584.10
|
| Rate for Payer: Aetna Managed Medicare |
$6,701.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,557.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,967.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,488.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,685.55
|
| Rate for Payer: Cash Price |
$7,180.50
|
| Rate for Payer: Cigna Commercial |
$22,020.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,394.03
|
| Rate for Payer: Health EOS Commercial |
$21,302.15
|
| Rate for Payer: HFN Commercial |
$22,020.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,951.25
|
| Rate for Payer: Multiplan Commercial |
$19,148.00
|
| Rate for Payer: NAPHCARE Commercial |
$14,361.00
|
| Rate for Payer: Preferred Network Access Commercial |
$22,020.20
|
| Rate for Payer: Quartz Beloit One Network |
$11,728.15
|
| Rate for Payer: Quartz Commercial |
$15,557.75
|
| Rate for Payer: Quartz Medicare Advantage |
$14,361.00
|
| Rate for Payer: The Alliance Commercial |
$95,740.00
|
| Rate for Payer: WEA Trust Commercial |
$13,164.25
|
| Rate for Payer: WPS Commercial |
$17,728.65
|
|
|
AORTIC VALVE 23MM TRIFECTA TF-23A
|
Facility
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2974039
|
|
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 23MM TRIFECTA TF-23A
|
Facility
OP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2974039
|
|
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 23MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-23A
|
Facility
OP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074610
|
|
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 23MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-23A
|
Facility
IP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074610
|
|
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 24MM AP360 #505DA24
|
Facility
OP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973951
|
|
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 24MM AP360 #505DA24
|
Facility
IP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973951
|
|
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 25MM MOSAIC ULTRA 305U225
|
Facility
IP
|
$39,917.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2969900
|
|
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 25MM MOSAIC ULTRA 305U225
|
Facility
OP
|
$39,917.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2969900
|
|
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
|
|
|
AORTIC VALVE 25MM ON-X CONFORM-X SEWING RING ONXACE-25
|
Facility
OP
|
$23,783.00
|
|
| Hospital Charge Code |
5617672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,659.24 |
| Max. Negotiated Rate |
$95,132.00 |
| Rate for Payer: Aetna Commercial |
$21,404.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$20,453.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,659.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$15,458.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$11,891.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,415.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,604.99
|
| Rate for Payer: Cash Price |
$7,134.90
|
| Rate for Payer: Cigna Commercial |
$21,880.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,308.97
|
| Rate for Payer: Health EOS Commercial |
$21,166.87
|
| Rate for Payer: HFN Commercial |
$21,880.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$17,837.25
|
| Rate for Payer: Multiplan Commercial |
$19,026.40
|
| Rate for Payer: NAPHCARE Commercial |
$14,269.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21,880.36
|
| Rate for Payer: Quartz Beloit One Network |
$11,653.67
|
| Rate for Payer: Quartz Commercial |
$15,458.95
|
| Rate for Payer: Quartz Medicare Advantage |
$14,269.80
|
| Rate for Payer: The Alliance Commercial |
$95,132.00
|
| Rate for Payer: WEA Trust Commercial |
$13,080.65
|
| Rate for Payer: WPS Commercial |
$17,616.07
|
|
|
AORTIC VALVE 25MM ON-X CONFORM-X SEWING RING ONXACE-25
|
Facility
IP
|
$23,783.00
|
|
| Hospital Charge Code |
5617672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,653.67 |
| Max. Negotiated Rate |
$21,880.36 |
| Rate for Payer: Aetna Commercial |
$21,404.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$12,604.99
|
| Rate for Payer: Cash Price |
$7,134.90
|
| Rate for Payer: Cigna Commercial |
$21,880.36
|
| Rate for Payer: Health EOS Commercial |
$21,166.87
|
| Rate for Payer: HFN Commercial |
$21,880.36
|
| Rate for Payer: Multiplan Commercial |
$19,026.40
|
| Rate for Payer: NAPHCARE Commercial |
$14,269.80
|
| Rate for Payer: Preferred Network Access Commercial |
$21,880.36
|
| Rate for Payer: Quartz Beloit One Network |
$11,653.67
|
| Rate for Payer: Quartz Commercial |
$14,269.80
|
| Rate for Payer: WEA Trust Commercial |
$13,080.65
|
| Rate for Payer: WPS Commercial |
$17,616.07
|
|
|
AORTIC VALVE 25MM TRIFECTA TF-25A
|
Facility
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966068
|
|
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 25MM TRIFECTA TF-25A
|
Facility
OP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966068
|
|
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 25MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-25A
|
Facility
IP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074611
|
|
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
|
|
