|
ANNULOPLASTY BAND 31MM DURAN 620BG31
|
Facility
|
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,553.22 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,553.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,248.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,345.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,091.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,101.56
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,517.56
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,614.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$8,248.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,614.05
|
| Rate for Payer: The Alliance Commercial |
$6,345.04
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY BAND 31MM DURAN 620BG31
|
Facility
|
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973895
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.14 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$7,614.05
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY BAND 33MM DURAN 620BG33
|
Facility
|
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.14 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$7,614.05
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY BAND 33MM DURAN 620BG33
|
Facility
|
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973896
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,553.22 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,553.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,248.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,345.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,091.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,101.56
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,517.56
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,614.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$8,248.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,614.05
|
| Rate for Payer: The Alliance Commercial |
$6,345.04
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 23MM DURAN #620RG23
|
Facility
|
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.14 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$7,614.05
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 23MM DURAN #620RG23
|
Facility
|
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,553.22 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,553.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,248.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,345.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,091.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,101.56
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,517.56
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,614.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$8,248.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,614.05
|
| Rate for Payer: The Alliance Commercial |
$6,345.04
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 25MM DURAN #620RG25
|
Facility
|
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,553.22 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,553.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,248.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,345.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,091.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,101.56
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,517.56
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,614.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$8,248.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,614.05
|
| Rate for Payer: The Alliance Commercial |
$6,345.04
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 25MM DURAN #620RG25
|
Facility
|
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973885
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.14 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$7,614.05
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 27MM DURAN #620RG27
|
Facility
|
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,553.22 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,553.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,248.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,345.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,091.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,101.56
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,517.56
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,614.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$8,248.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,614.05
|
| Rate for Payer: The Alliance Commercial |
$6,345.04
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 27MM DURAN #620RG27
|
Facility
|
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.14 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$7,614.05
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 29MM DURAN #620RG29
|
Facility
|
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.14 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$7,614.05
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 29MM DURAN #620RG29
|
Facility
|
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,553.22 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,553.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,248.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,345.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,091.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,101.56
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,517.56
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,614.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$8,248.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,614.05
|
| Rate for Payer: The Alliance Commercial |
$6,345.04
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 31MM DURAN #620RG31
|
Facility
|
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.14 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$7,614.05
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 31MM DURAN #620RG31
|
Facility
|
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,553.22 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,553.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,248.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,345.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,091.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,101.56
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,517.56
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,614.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$8,248.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,614.05
|
| Rate for Payer: The Alliance Commercial |
$6,345.04
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 33MM DURAN #620RG33
|
Facility
|
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.14 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$7,614.05
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 33MM DURAN #620RG33
|
Facility
|
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,553.22 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,553.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,248.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,345.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,091.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,101.56
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,517.56
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,614.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$8,248.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,614.05
|
| Rate for Payer: The Alliance Commercial |
$6,345.04
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 35MM DURAN 620BG35
|
Facility
|
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2970332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,553.22 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,553.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,248.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,345.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,091.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,101.56
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,517.56
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,614.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$8,248.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,614.05
|
| Rate for Payer: The Alliance Commercial |
$6,345.04
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 35MM DURAN 620BG35
|
Facility
|
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2970332
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.14 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$7,614.05
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 35MM DURAN #620RG35
|
Facility
|
OP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,553.22 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Aetna Managed Medicare |
$3,553.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$8,248.55
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,345.04
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$6,091.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$7,101.56
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,517.56
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: NAPHCARE Commercial |
$7,614.05
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$8,248.55
|
| Rate for Payer: Quartz Medicare Advantage |
$7,614.05
|
| Rate for Payer: The Alliance Commercial |
$6,345.04
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANNULOPLASTY RING 35MM DURAN #620RG35
|
Facility
|
IP
|
$12,202.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,218.14 |
| Max. Negotiated Rate |
$11,674.87 |
| Rate for Payer: Aetna Commercial |
$11,421.07
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,913.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,725.74
|
| Rate for Payer: Cash Price |
$3,660.60
|
| Rate for Payer: Cigna Commercial |
$11,674.87
|
| Rate for Payer: Health EOS Commercial |
$11,294.17
|
| Rate for Payer: HFN Commercial |
$11,674.87
|
| Rate for Payer: Multiplan Commercial |
$10,152.06
|
| Rate for Payer: Preferred Network Access Commercial |
$11,674.87
|
| Rate for Payer: Quartz Beloit One Network |
$6,218.14
|
| Rate for Payer: Quartz Commercial |
$7,614.05
|
| Rate for Payer: WEA Trust Commercial |
$6,979.54
|
| Rate for Payer: WPS Commercial |
$9,399.20
|
|
|
ANORECTAL EXAM, SURGICAL, REQUIRING ANESTHESIA (GENERAL, SPINAL, OR EPIDURAL), DIAGNOSTIC
|
Facility
|
OP
|
$11,684.32
|
|
|
Service Code
|
CPT 45990
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,835.04 |
| Max. Negotiated Rate |
$11,684.32 |
| Rate for Payer: Aetna Managed Medicare |
$2,921.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,635.84
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,985.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,835.04
|
| Rate for Payer: Anthem Medicare Advantage |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$2,921.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$2,921.08
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$2,921.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,386.95
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$2,921.08
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$10,866.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$2,921.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$2,921.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$2,921.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$2,921.08
|
| Rate for Payer: NAPHCARE Commercial |
$4,381.62
|
| Rate for Payer: Quartz Medicare Advantage |
$2,921.08
|
| Rate for Payer: The Alliance Commercial |
$11,684.32
|
| Rate for Payer: United Healthcare Medicare Advantage |
$2,921.08
|
| Rate for Payer: United Healthcare PPO |
$3,726.32
|
| Rate for Payer: Wellcare Medicare |
$2,921.08
|
|
|
Anorectal Manometry
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
CPT 91122
|
| Hospital Charge Code |
1190818
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$420.99 |
| Max. Negotiated Rate |
$968.21 |
| Rate for Payer: Aetna Commercial |
$908.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$822.85
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$478.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$574.08
|
| Rate for Payer: Health EOS Commercial |
$870.69
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$968.21
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$968.21
|
| Rate for Payer: Multiplan Commercial |
$765.44
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$420.99
|
| Rate for Payer: Quartz Commercial |
$545.38
|
| Rate for Payer: The Alliance Commercial |
$478.40
|
| Rate for Payer: WEA Trust Commercial |
$526.24
|
| Rate for Payer: WPS Commercial |
$708.68
|
|
|
Anorectal Manometry 9112226
|
Professional
|
Both
|
$920.00
|
|
|
Service Code
|
CPT 91122 26
|
| Hospital Charge Code |
3128860
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$314.62 |
| Max. Negotiated Rate |
$908.96 |
| Rate for Payer: Aetna Commercial |
$908.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$822.85
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cash Price |
$276.00
|
| Rate for Payer: Cigna Commercial |
$908.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$478.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$574.08
|
| Rate for Payer: Health EOS Commercial |
$870.69
|
| Rate for Payer: HFN Commercial |
$908.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$314.62
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$314.62
|
| Rate for Payer: Multiplan Commercial |
$765.44
|
| Rate for Payer: Preferred Network Access Commercial |
$908.96
|
| Rate for Payer: Quartz Beloit One Network |
$420.99
|
| Rate for Payer: Quartz Commercial |
$545.38
|
| Rate for Payer: The Alliance Commercial |
$478.40
|
| Rate for Payer: WEA Trust Commercial |
$526.24
|
| Rate for Payer: WPS Commercial |
$708.68
|
|
|
Anorectal Sensation 9112026
|
Professional
|
Both
|
$490.00
|
|
|
Service Code
|
CPT 91120 26
|
| Hospital Charge Code |
3128872
|
|
Hospital Revenue Code
|
920
|
| Min. Negotiated Rate |
$174.42 |
| Max. Negotiated Rate |
$484.12 |
| Rate for Payer: Aetna Commercial |
$484.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$438.26
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cash Price |
$147.00
|
| Rate for Payer: Cigna Commercial |
$484.12
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$254.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$305.76
|
| Rate for Payer: Health EOS Commercial |
$463.74
|
| Rate for Payer: HFN Commercial |
$484.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$174.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$174.42
|
| Rate for Payer: Multiplan Commercial |
$407.68
|
| Rate for Payer: Preferred Network Access Commercial |
$484.12
|
| Rate for Payer: Quartz Beloit One Network |
$224.22
|
| Rate for Payer: Quartz Commercial |
$290.47
|
| Rate for Payer: The Alliance Commercial |
$254.80
|
| Rate for Payer: WEA Trust Commercial |
$280.28
|
| Rate for Payer: WPS Commercial |
$377.45
|
|
|
ANOSCOPY 46615
|
Professional
|
Both
|
$1,592.00
|
|
|
Service Code
|
CPT 46615
|
| Hospital Charge Code |
3014844
|
|
Hospital Revenue Code
|
510
|
| Min. Negotiated Rate |
$80.91 |
| Max. Negotiated Rate |
$1,572.90 |
| Rate for Payer: Aetna Commercial |
$1,572.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,423.88
|
| Rate for Payer: Aetna Managed Medicare |
$80.91
|
| Rate for Payer: Anthem Medicare Advantage |
$80.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$80.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$80.91
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cash Price |
$477.60
|
| Rate for Payer: Cigna Commercial |
$1,572.90
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$216.14
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$80.91
|
| Rate for Payer: Health EOS Commercial |
$1,506.67
|
| Rate for Payer: HFN Commercial |
$1,572.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$316.42
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$316.42
|
| Rate for Payer: Independent Care Health Plan Medicare |
$80.91
|
| Rate for Payer: Multiplan Commercial |
$1,324.54
|
| Rate for Payer: NAPHCARE Commercial |
$121.37
|
| Rate for Payer: Preferred Network Access Commercial |
$1,572.90
|
| Rate for Payer: Quartz Beloit One Network |
$728.50
|
| Rate for Payer: Quartz Commercial |
$943.74
|
| Rate for Payer: Quartz Medicare Advantage |
$80.91
|
| Rate for Payer: The Alliance Commercial |
$343.88
|
| Rate for Payer: United Healthcare Medicaid |
$216.14
|
| Rate for Payer: United Healthcare Medicare Advantage |
$80.91
|
| Rate for Payer: WEA Trust Commercial |
$910.62
|
| Rate for Payer: WPS Commercial |
$364.10
|
|
