|
MITRAL VALVE 25MM MOSAIC CINCH 310C25
|
Facility
|
OP
|
$38,439.00
|
|
| Hospital Charge Code |
2973958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,762.92 |
| Max. Negotiated Rate |
$153,756.00 |
| 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: 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 |
$153,756.00
|
| Rate for Payer: WEA Trust Commercial |
$21,141.45
|
| Rate for Payer: WPS Commercial |
$28,471.77
|
|
|
MITRAL VALVE 25MM STANDARD ATS #500DM25
|
Facility
|
OP
|
$42,231.00
|
|
| Hospital Charge Code |
2970327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,824.68 |
| Max. Negotiated Rate |
$168,924.00 |
| Rate for Payer: Aetna Commercial |
$38,007.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,318.66
|
| Rate for Payer: Aetna Managed Medicare |
$11,824.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,450.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,115.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,270.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,382.43
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$38,852.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,632.47
|
| Rate for Payer: Health EOS Commercial |
$37,585.59
|
| Rate for Payer: HFN Commercial |
$38,852.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,673.25
|
| Rate for Payer: Multiplan Commercial |
$33,784.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,338.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,852.52
|
| Rate for Payer: Quartz Beloit One Network |
$20,693.19
|
| Rate for Payer: Quartz Commercial |
$27,450.15
|
| Rate for Payer: Quartz Medicare Advantage |
$25,338.60
|
| Rate for Payer: The Alliance Commercial |
$168,924.00
|
| Rate for Payer: WEA Trust Commercial |
$23,227.05
|
| Rate for Payer: WPS Commercial |
$31,280.50
|
|
|
MITRAL VALVE 25MM STANDARD ATS #500DM25
|
Facility
|
IP
|
$42,231.00
|
|
| Hospital Charge Code |
2970327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,693.19 |
| Max. Negotiated Rate |
$38,852.52 |
| Rate for Payer: Aetna Commercial |
$38,007.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,318.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,382.43
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$38,852.52
|
| Rate for Payer: Health EOS Commercial |
$37,585.59
|
| Rate for Payer: HFN Commercial |
$38,852.52
|
| Rate for Payer: Multiplan Commercial |
$33,784.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,338.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,852.52
|
| Rate for Payer: Quartz Beloit One Network |
$20,693.19
|
| Rate for Payer: Quartz Commercial |
$25,338.60
|
| Rate for Payer: WEA Trust Commercial |
$23,227.05
|
| Rate for Payer: WPS Commercial |
$31,280.50
|
|
|
MITRAL VALVE 27MM MOSAIC CINCH 310C27
|
Facility
|
OP
|
$38,439.00
|
|
| Hospital Charge Code |
2969903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,762.92 |
| Max. Negotiated Rate |
$153,756.00 |
| 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: 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 |
$153,756.00
|
| Rate for Payer: WEA Trust Commercial |
$21,141.45
|
| Rate for Payer: WPS Commercial |
$28,471.77
|
|
|
MITRAL VALVE 27MM MOSAIC CINCH 310C27
|
Facility
|
IP
|
$38,439.00
|
|
| Hospital Charge Code |
2969903
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$33,057.54
|
| 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
|
|
|
MITRAL VALVE 27MM STANDARD ATS #500DM27
|
Facility
|
OP
|
$42,231.00
|
|
| Hospital Charge Code |
2970328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,824.68 |
| Max. Negotiated Rate |
$168,924.00 |
| Rate for Payer: Aetna Commercial |
$38,007.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,318.66
|
| Rate for Payer: Aetna Managed Medicare |
$11,824.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,450.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,115.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,270.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,382.43
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$38,852.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,632.47
|
| Rate for Payer: Health EOS Commercial |
$37,585.59
|
| Rate for Payer: HFN Commercial |
$38,852.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,673.25
|
| Rate for Payer: Multiplan Commercial |
$33,784.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,338.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,852.52
|
| Rate for Payer: Quartz Beloit One Network |
$20,693.19
|
| Rate for Payer: Quartz Commercial |
$27,450.15
|
| Rate for Payer: Quartz Medicare Advantage |
$25,338.60
|
| Rate for Payer: The Alliance Commercial |
$168,924.00
|
| Rate for Payer: WEA Trust Commercial |
$23,227.05
|
| Rate for Payer: WPS Commercial |
$31,280.50
|
|
|
MITRAL VALVE 27MM STANDARD ATS #500DM27
|
Facility
|
IP
|
$42,231.00
|
|
| Hospital Charge Code |
2970328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,693.19 |
| Max. Negotiated Rate |
$38,852.52 |
| Rate for Payer: Aetna Commercial |
$38,007.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,318.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,382.43
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$38,852.52
|
| Rate for Payer: Health EOS Commercial |
$37,585.59
|
| Rate for Payer: HFN Commercial |
$38,852.52
|
| Rate for Payer: Multiplan Commercial |
$33,784.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,338.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,852.52
|
| Rate for Payer: Quartz Beloit One Network |
$20,693.19
|
| Rate for Payer: Quartz Commercial |
$25,338.60
|
| Rate for Payer: WEA Trust Commercial |
$23,227.05
|
| Rate for Payer: WPS Commercial |
$31,280.50
|
|
|
MITRAL VALVE 29MM MOSAIC CINCH 310C29
|
Facility
|
IP
|
$49,421.00
|
|
| Hospital Charge Code |
2973964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,216.29 |
| Max. Negotiated Rate |
$45,467.32 |
| Rate for Payer: Aetna Commercial |
$44,478.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42,502.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26,193.13
|
| Rate for Payer: Cash Price |
$14,826.30
|
| Rate for Payer: Cigna Commercial |
$45,467.32
|
| Rate for Payer: Health EOS Commercial |
$43,984.69
|
| Rate for Payer: HFN Commercial |
$45,467.32
|
| Rate for Payer: Multiplan Commercial |
$39,536.80
|
| Rate for Payer: NAPHCARE Commercial |
$29,652.60
|
| Rate for Payer: Preferred Network Access Commercial |
$45,467.32
|
| Rate for Payer: Quartz Beloit One Network |
$24,216.29
|
| Rate for Payer: Quartz Commercial |
$29,652.60
|
| Rate for Payer: WEA Trust Commercial |
$27,181.55
|
| Rate for Payer: WPS Commercial |
$36,606.13
|
|
|
MITRAL VALVE 29MM MOSAIC CINCH 310C29
|
Facility
|
OP
|
$49,421.00
|
|
| Hospital Charge Code |
2973964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,837.88 |
| Max. Negotiated Rate |
$197,684.00 |
| Rate for Payer: Aetna Commercial |
$44,478.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$42,502.06
|
| Rate for Payer: Aetna Managed Medicare |
$13,837.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,123.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24,710.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23,722.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26,193.13
|
| Rate for Payer: Cash Price |
$14,826.30
|
| Rate for Payer: Cigna Commercial |
$45,467.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$27,655.99
|
| Rate for Payer: Health EOS Commercial |
$43,984.69
|
| Rate for Payer: HFN Commercial |
$45,467.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$37,065.75
|
| Rate for Payer: Multiplan Commercial |
$39,536.80
|
| Rate for Payer: NAPHCARE Commercial |
$29,652.60
|
| Rate for Payer: Preferred Network Access Commercial |
$45,467.32
|
| Rate for Payer: Quartz Beloit One Network |
$24,216.29
|
| Rate for Payer: Quartz Commercial |
$32,123.65
|
| Rate for Payer: Quartz Medicare Advantage |
$29,652.60
|
| Rate for Payer: The Alliance Commercial |
$197,684.00
|
| Rate for Payer: WEA Trust Commercial |
$27,181.55
|
| Rate for Payer: WPS Commercial |
$36,606.13
|
|
|
MITRAL VALVE 29MM STANDARD ATS 500DM29
|
Facility
|
IP
|
$42,231.00
|
|
| Hospital Charge Code |
2970329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,693.19 |
| Max. Negotiated Rate |
$38,852.52 |
| Rate for Payer: Aetna Commercial |
$38,007.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,318.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,382.43
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$38,852.52
|
| Rate for Payer: Health EOS Commercial |
$37,585.59
|
| Rate for Payer: HFN Commercial |
$38,852.52
|
| Rate for Payer: Multiplan Commercial |
$33,784.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,338.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,852.52
|
| Rate for Payer: Quartz Beloit One Network |
$20,693.19
|
| Rate for Payer: Quartz Commercial |
$25,338.60
|
| Rate for Payer: WEA Trust Commercial |
$23,227.05
|
| Rate for Payer: WPS Commercial |
$31,280.50
|
|
|
MITRAL VALVE 29MM STANDARD ATS 500DM29
|
Facility
|
OP
|
$42,231.00
|
|
| Hospital Charge Code |
2970329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,824.68 |
| Max. Negotiated Rate |
$168,924.00 |
| Rate for Payer: Aetna Commercial |
$38,007.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,318.66
|
| Rate for Payer: Aetna Managed Medicare |
$11,824.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,450.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,115.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,270.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,382.43
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$38,852.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,632.47
|
| Rate for Payer: Health EOS Commercial |
$37,585.59
|
| Rate for Payer: HFN Commercial |
$38,852.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,673.25
|
| Rate for Payer: Multiplan Commercial |
$33,784.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,338.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,852.52
|
| Rate for Payer: Quartz Beloit One Network |
$20,693.19
|
| Rate for Payer: Quartz Commercial |
$27,450.15
|
| Rate for Payer: Quartz Medicare Advantage |
$25,338.60
|
| Rate for Payer: The Alliance Commercial |
$168,924.00
|
| Rate for Payer: WEA Trust Commercial |
$23,227.05
|
| Rate for Payer: WPS Commercial |
$31,280.50
|
|
|
MITRAL VALVE 31MM MOSAIC CINCH 310C31
|
Facility
|
IP
|
$38,439.00
|
|
| Hospital Charge Code |
2970326
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$33,057.54
|
| 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
|
|
|
MITRAL VALVE 31MM MOSAIC CINCH 310C31
|
Facility
|
OP
|
$38,439.00
|
|
| Hospital Charge Code |
2970326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,762.92 |
| Max. Negotiated Rate |
$153,756.00 |
| 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: 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 |
$153,756.00
|
| Rate for Payer: WEA Trust Commercial |
$21,141.45
|
| Rate for Payer: WPS Commercial |
$28,471.77
|
|
|
MITRAL VALVE 31MM STANDARD ATS #500DM31
|
Facility
|
OP
|
$42,231.00
|
|
| Hospital Charge Code |
2970330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,824.68 |
| Max. Negotiated Rate |
$168,924.00 |
| Rate for Payer: Aetna Commercial |
$38,007.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,318.66
|
| Rate for Payer: Aetna Managed Medicare |
$11,824.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,450.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,115.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,270.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,382.43
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$38,852.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,632.47
|
| Rate for Payer: Health EOS Commercial |
$37,585.59
|
| Rate for Payer: HFN Commercial |
$38,852.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,673.25
|
| Rate for Payer: Multiplan Commercial |
$33,784.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,338.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,852.52
|
| Rate for Payer: Quartz Beloit One Network |
$20,693.19
|
| Rate for Payer: Quartz Commercial |
$27,450.15
|
| Rate for Payer: Quartz Medicare Advantage |
$25,338.60
|
| Rate for Payer: The Alliance Commercial |
$168,924.00
|
| Rate for Payer: WEA Trust Commercial |
$23,227.05
|
| Rate for Payer: WPS Commercial |
$31,280.50
|
|
|
MITRAL VALVE 31MM STANDARD ATS #500DM31
|
Facility
|
IP
|
$42,231.00
|
|
| Hospital Charge Code |
2970330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,693.19 |
| Max. Negotiated Rate |
$38,852.52 |
| Rate for Payer: Aetna Commercial |
$38,007.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,318.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,382.43
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$38,852.52
|
| Rate for Payer: Health EOS Commercial |
$37,585.59
|
| Rate for Payer: HFN Commercial |
$38,852.52
|
| Rate for Payer: Multiplan Commercial |
$33,784.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,338.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,852.52
|
| Rate for Payer: Quartz Beloit One Network |
$20,693.19
|
| Rate for Payer: Quartz Commercial |
$25,338.60
|
| Rate for Payer: WEA Trust Commercial |
$23,227.05
|
| Rate for Payer: WPS Commercial |
$31,280.50
|
|
|
MITRAL VALVE 33MM MOSAIC CINCH 310C33
|
Facility
|
OP
|
$38,439.00
|
|
| Hospital Charge Code |
2973959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,762.92 |
| Max. Negotiated Rate |
$153,756.00 |
| 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: 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 |
$153,756.00
|
| Rate for Payer: WEA Trust Commercial |
$21,141.45
|
| Rate for Payer: WPS Commercial |
$28,471.77
|
|
|
MITRAL VALVE 33MM MOSAIC CINCH 310C33
|
Facility
|
IP
|
$38,439.00
|
|
| Hospital Charge Code |
2973959
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$33,057.54
|
| 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
|
|
|
MITRAL VALVE 35MM STANDARD ATS #500DM35
|
Facility
|
OP
|
$42,231.00
|
|
| Hospital Charge Code |
2970331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,824.68 |
| Max. Negotiated Rate |
$168,924.00 |
| Rate for Payer: Aetna Commercial |
$38,007.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,318.66
|
| Rate for Payer: Aetna Managed Medicare |
$11,824.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$27,450.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,115.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$20,270.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,382.43
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$38,852.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,632.47
|
| Rate for Payer: Health EOS Commercial |
$37,585.59
|
| Rate for Payer: HFN Commercial |
$38,852.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,673.25
|
| Rate for Payer: Multiplan Commercial |
$33,784.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,338.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,852.52
|
| Rate for Payer: Quartz Beloit One Network |
$20,693.19
|
| Rate for Payer: Quartz Commercial |
$27,450.15
|
| Rate for Payer: Quartz Medicare Advantage |
$25,338.60
|
| Rate for Payer: The Alliance Commercial |
$168,924.00
|
| Rate for Payer: WEA Trust Commercial |
$23,227.05
|
| Rate for Payer: WPS Commercial |
$31,280.50
|
|
|
MITRAL VALVE 35MM STANDARD ATS #500DM35
|
Facility
|
IP
|
$42,231.00
|
|
| Hospital Charge Code |
2970331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,693.19 |
| Max. Negotiated Rate |
$38,852.52 |
| Rate for Payer: Aetna Commercial |
$38,007.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$36,318.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,382.43
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$38,852.52
|
| Rate for Payer: Health EOS Commercial |
$37,585.59
|
| Rate for Payer: HFN Commercial |
$38,852.52
|
| Rate for Payer: Multiplan Commercial |
$33,784.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,338.60
|
| Rate for Payer: Preferred Network Access Commercial |
$38,852.52
|
| Rate for Payer: Quartz Beloit One Network |
$20,693.19
|
| Rate for Payer: Quartz Commercial |
$25,338.60
|
| Rate for Payer: WEA Trust Commercial |
$23,227.05
|
| Rate for Payer: WPS Commercial |
$31,280.50
|
|
|
MITRAL VALVE EPIC 31MM ST JUDE E100-31M-00
|
Facility
|
OP
|
$50,706.00
|
|
| Hospital Charge Code |
4080598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,197.68 |
| Max. Negotiated Rate |
$202,824.00 |
| Rate for Payer: Aetna Commercial |
$45,635.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43,607.16
|
| Rate for Payer: Aetna Managed Medicare |
$14,197.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$32,958.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,353.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,338.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26,874.18
|
| Rate for Payer: Cash Price |
$15,211.80
|
| Rate for Payer: Cigna Commercial |
$46,649.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,375.08
|
| Rate for Payer: Health EOS Commercial |
$45,128.34
|
| Rate for Payer: HFN Commercial |
$46,649.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,029.50
|
| Rate for Payer: Multiplan Commercial |
$40,564.80
|
| Rate for Payer: NAPHCARE Commercial |
$30,423.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46,649.52
|
| Rate for Payer: Quartz Beloit One Network |
$24,845.94
|
| Rate for Payer: Quartz Commercial |
$32,958.90
|
| Rate for Payer: Quartz Medicare Advantage |
$30,423.60
|
| Rate for Payer: The Alliance Commercial |
$202,824.00
|
| Rate for Payer: WEA Trust Commercial |
$27,888.30
|
| Rate for Payer: WPS Commercial |
$37,557.93
|
|
|
MITRAL VALVE EPIC 31MM ST JUDE E100-31M-00
|
Facility
|
IP
|
$50,706.00
|
|
| Hospital Charge Code |
4080598
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$24,845.94 |
| Max. Negotiated Rate |
$46,649.52 |
| Rate for Payer: Aetna Commercial |
$45,635.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$43,607.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$26,874.18
|
| Rate for Payer: Cash Price |
$15,211.80
|
| Rate for Payer: Cigna Commercial |
$46,649.52
|
| Rate for Payer: Health EOS Commercial |
$45,128.34
|
| Rate for Payer: HFN Commercial |
$46,649.52
|
| Rate for Payer: Multiplan Commercial |
$40,564.80
|
| Rate for Payer: NAPHCARE Commercial |
$30,423.60
|
| Rate for Payer: Preferred Network Access Commercial |
$46,649.52
|
| Rate for Payer: Quartz Beloit One Network |
$24,845.94
|
| Rate for Payer: Quartz Commercial |
$30,423.60
|
| Rate for Payer: WEA Trust Commercial |
$27,888.30
|
| Rate for Payer: WPS Commercial |
$37,557.93
|
|
|
MITRAL VALVE REPLACEMENT
|
Facility
|
OP
|
$17,117.00
|
|
| Hospital Charge Code |
2960493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,792.76 |
| Max. Negotiated Rate |
$68,468.00 |
| Rate for Payer: Aetna Commercial |
$15,405.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,720.62
|
| Rate for Payer: Aetna Managed Medicare |
$4,792.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,126.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,558.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,216.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,072.01
|
| Rate for Payer: Cash Price |
$5,135.10
|
| Rate for Payer: Cigna Commercial |
$15,747.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,578.67
|
| Rate for Payer: Health EOS Commercial |
$15,234.13
|
| Rate for Payer: HFN Commercial |
$15,747.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,837.75
|
| Rate for Payer: Multiplan Commercial |
$13,693.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,270.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,747.64
|
| Rate for Payer: Quartz Beloit One Network |
$8,387.33
|
| Rate for Payer: Quartz Commercial |
$11,126.05
|
| Rate for Payer: Quartz Medicare Advantage |
$10,270.20
|
| Rate for Payer: The Alliance Commercial |
$68,468.00
|
| Rate for Payer: WEA Trust Commercial |
$9,414.35
|
| Rate for Payer: WPS Commercial |
$12,678.56
|
|
|
MITRAL VALVE REPLACEMENT
|
Facility
|
IP
|
$17,117.00
|
|
| Hospital Charge Code |
2960493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,387.33 |
| Max. Negotiated Rate |
$15,747.64 |
| Rate for Payer: Aetna Commercial |
$15,405.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,720.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,072.01
|
| Rate for Payer: Cash Price |
$5,135.10
|
| Rate for Payer: Cigna Commercial |
$15,747.64
|
| Rate for Payer: Health EOS Commercial |
$15,234.13
|
| Rate for Payer: HFN Commercial |
$15,747.64
|
| Rate for Payer: Multiplan Commercial |
$13,693.60
|
| Rate for Payer: NAPHCARE Commercial |
$10,270.20
|
| Rate for Payer: Preferred Network Access Commercial |
$15,747.64
|
| Rate for Payer: Quartz Beloit One Network |
$8,387.33
|
| Rate for Payer: Quartz Commercial |
$10,270.20
|
| Rate for Payer: WEA Trust Commercial |
$9,414.35
|
| Rate for Payer: WPS Commercial |
$12,678.56
|
|
|
Mix PT 1 Hour
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1050811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.29 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Aetna Managed Medicare |
$4.29
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.51
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.12
|
| Rate for Payer: Anthem Medicaid |
$4.43
|
| Rate for Payer: Anthem Medicare Advantage |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.29
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$4.43
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$59.88
|
| Rate for Payer: Dean Health Medicaid |
$4.43
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.29
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15.96
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.29
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$4.43
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.29
|
| Rate for Payer: Managed Health Services Medicaid |
$4.61
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.29
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.29
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$6.44
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$4.43
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$69.55
|
| Rate for Payer: Quartz Medicare Advantage |
$4.29
|
| Rate for Payer: The Alliance Commercial |
$17.16
|
| Rate for Payer: United Healthcare Medicaid |
$4.43
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.29
|
| Rate for Payer: United Healthcare PPO |
$80.25
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: Wellcare Medicare |
$4.29
|
| Rate for Payer: WMAP Medicaid |
$4.43
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
|
Mix PT 1 Hour
|
Facility
|
IP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1050811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$52.43 |
| Max. Negotiated Rate |
$98.44 |
| Rate for Payer: Aetna Commercial |
$96.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$92.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$56.71
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$98.44
|
| Rate for Payer: Health EOS Commercial |
$95.23
|
| Rate for Payer: HFN Commercial |
$98.44
|
| Rate for Payer: Multiplan Commercial |
$85.60
|
| Rate for Payer: NAPHCARE Commercial |
$64.20
|
| Rate for Payer: Preferred Network Access Commercial |
$98.44
|
| Rate for Payer: Quartz Beloit One Network |
$52.43
|
| Rate for Payer: Quartz Commercial |
$64.20
|
| Rate for Payer: WEA Trust Commercial |
$58.85
|
| Rate for Payer: WPS Commercial |
$79.25
|
|
