|
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: Aetna Gatekeeper/Not Gatekeeper |
$46,335.08
|
| 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 |
$15,085.84 |
| Max. Negotiated Rate |
$215,512.00 |
| 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: 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 |
$215,512.00
|
| 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: Aetna Gatekeeper/Not Gatekeeper |
$24,123.00
|
| 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 25MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-25A
|
Facility
|
OP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074611
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,854.00 |
| Max. Negotiated Rate |
$112,200.00 |
| 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: 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 |
$112,200.00
|
| Rate for Payer: WEA Trust Commercial |
$15,427.50
|
| Rate for Payer: WPS Commercial |
$20,776.64
|
|
|
AORTIC VALVE 26MM AP360 #505DA26
|
Facility
|
IP
|
$36,115.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,696.35 |
| Max. Negotiated Rate |
$33,225.80 |
| Rate for Payer: Aetna Commercial |
$32,503.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,058.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,140.95
|
| Rate for Payer: Cash Price |
$10,834.50
|
| Rate for Payer: Cigna Commercial |
$33,225.80
|
| Rate for Payer: Health EOS Commercial |
$32,142.35
|
| Rate for Payer: HFN Commercial |
$33,225.80
|
| Rate for Payer: Multiplan Commercial |
$28,892.00
|
| Rate for Payer: NAPHCARE Commercial |
$21,669.00
|
| Rate for Payer: Preferred Network Access Commercial |
$33,225.80
|
| Rate for Payer: Quartz Beloit One Network |
$17,696.35
|
| Rate for Payer: Quartz Commercial |
$21,669.00
|
| Rate for Payer: WEA Trust Commercial |
$19,863.25
|
| Rate for Payer: WPS Commercial |
$26,750.38
|
|
|
AORTIC VALVE 26MM AP360 #505DA26
|
Facility
|
OP
|
$36,115.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,112.20 |
| Max. Negotiated Rate |
$144,460.00 |
| Rate for Payer: Aetna Commercial |
$32,503.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,058.90
|
| Rate for Payer: Aetna Managed Medicare |
$10,112.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,474.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,057.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,335.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,140.95
|
| Rate for Payer: Cash Price |
$10,834.50
|
| Rate for Payer: Cigna Commercial |
$33,225.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,209.95
|
| Rate for Payer: Health EOS Commercial |
$32,142.35
|
| Rate for Payer: HFN Commercial |
$33,225.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,086.25
|
| Rate for Payer: Multiplan Commercial |
$28,892.00
|
| Rate for Payer: NAPHCARE Commercial |
$21,669.00
|
| Rate for Payer: Preferred Network Access Commercial |
$33,225.80
|
| Rate for Payer: Quartz Beloit One Network |
$17,696.35
|
| Rate for Payer: Quartz Commercial |
$23,474.75
|
| Rate for Payer: Quartz Medicare Advantage |
$21,669.00
|
| Rate for Payer: The Alliance Commercial |
$144,460.00
|
| Rate for Payer: WEA Trust Commercial |
$19,863.25
|
| Rate for Payer: WPS Commercial |
$26,750.38
|
|
|
AORTIC VALVE 27MM MOSAIC ULTRA 305U27
|
Facility
|
IP
|
$38,439.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973956
|
|
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
|
|
|
AORTIC VALVE 27MM MOSAIC ULTRA 305U27
|
Facility
|
OP
|
$38,439.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973956
|
|
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
|
|
|
AORTIC VALVE 27MM TRIFECTA TF-27A
|
Facility
|
OP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966069
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,085.84 |
| Max. Negotiated Rate |
$215,512.00 |
| 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: 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 |
$215,512.00
|
| Rate for Payer: WEA Trust Commercial |
$29,632.90
|
| Rate for Payer: WPS Commercial |
$39,907.43
|
|
|
AORTIC VALVE 27MM TRIFECTA TF-27A
|
Facility
|
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966069
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$46,335.08
|
| 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 27MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-27A
|
Facility
|
OP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074612
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,854.00 |
| Max. Negotiated Rate |
$112,200.00 |
| 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: 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 |
$112,200.00
|
| Rate for Payer: WEA Trust Commercial |
$15,427.50
|
| Rate for Payer: WPS Commercial |
$20,776.64
|
|
|
AORTIC VALVE 27MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-27A
|
Facility
|
IP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074612
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$24,123.00
|
| 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 29MM MOSAIC ULTRA 305U29
|
Facility
|
OP
|
$38,439.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973957
|
|
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
|
|
|
AORTIC VALVE 29MM MOSAIC ULTRA 305U29
|
Facility
|
IP
|
$38,439.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973957
|
|
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
|
|
|
AORTIC VALVE 29MM TRIFECTA TF-29A
|
Facility
|
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966070
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$46,335.08
|
| 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 29MM TRIFECTA TF-29A
|
Facility
|
OP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966070
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,085.84 |
| Max. Negotiated Rate |
$215,512.00 |
| 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: 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 |
$215,512.00
|
| Rate for Payer: WEA Trust Commercial |
$29,632.90
|
| Rate for Payer: WPS Commercial |
$39,907.43
|
|
|
AORTIC VALVE 29MM TRIFECTAWITH GLIDE TECHNOLOGY TFGT-29A
|
Facility
|
IP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074613
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$24,123.00
|
| 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 29MM TRIFECTAWITH GLIDE TECHNOLOGY TFGT-29A
|
Facility
|
OP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074613
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,854.00 |
| Max. Negotiated Rate |
$112,200.00 |
| 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: 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 |
$112,200.00
|
| Rate for Payer: WEA Trust Commercial |
$15,427.50
|
| Rate for Payer: WPS Commercial |
$20,776.64
|
|
|
AORTIC VALVE ATS 21MM
|
Facility
|
OP
|
$45,638.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2965348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,778.64 |
| Max. Negotiated Rate |
$182,552.00 |
| Rate for Payer: Aetna Commercial |
$41,074.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39,248.68
|
| Rate for Payer: Aetna Managed Medicare |
$12,778.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$29,664.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$22,819.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,906.24
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24,188.14
|
| Rate for Payer: Cash Price |
$13,691.40
|
| Rate for Payer: Cigna Commercial |
$41,986.96
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$25,539.02
|
| Rate for Payer: Health EOS Commercial |
$40,617.82
|
| Rate for Payer: HFN Commercial |
$41,986.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$34,228.50
|
| Rate for Payer: Multiplan Commercial |
$36,510.40
|
| Rate for Payer: NAPHCARE Commercial |
$27,382.80
|
| Rate for Payer: Preferred Network Access Commercial |
$41,986.96
|
| Rate for Payer: Quartz Beloit One Network |
$22,362.62
|
| Rate for Payer: Quartz Commercial |
$29,664.70
|
| Rate for Payer: Quartz Medicare Advantage |
$27,382.80
|
| Rate for Payer: The Alliance Commercial |
$182,552.00
|
| Rate for Payer: WEA Trust Commercial |
$25,100.90
|
| Rate for Payer: WPS Commercial |
$33,804.07
|
|
|
AORTIC VALVE ATS 21MM
|
Facility
|
IP
|
$45,638.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2965348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$22,362.62 |
| Max. Negotiated Rate |
$41,986.96 |
| Rate for Payer: Aetna Commercial |
$41,074.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$39,248.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$24,188.14
|
| Rate for Payer: Cash Price |
$13,691.40
|
| Rate for Payer: Cigna Commercial |
$41,986.96
|
| Rate for Payer: Health EOS Commercial |
$40,617.82
|
| Rate for Payer: HFN Commercial |
$41,986.96
|
| Rate for Payer: Multiplan Commercial |
$36,510.40
|
| Rate for Payer: NAPHCARE Commercial |
$27,382.80
|
| Rate for Payer: Preferred Network Access Commercial |
$41,986.96
|
| Rate for Payer: Quartz Beloit One Network |
$22,362.62
|
| Rate for Payer: Quartz Commercial |
$27,382.80
|
| Rate for Payer: WEA Trust Commercial |
$25,100.90
|
| Rate for Payer: WPS Commercial |
$33,804.07
|
|
|
AORTIC VALVE REPLACEMENT
|
Facility
|
IP
|
$17,117.00
|
|
| Hospital Charge Code |
2960491
|
|
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
|
|
|
AORTIC VALVE REPLACEMENT
|
Facility
|
OP
|
$17,117.00
|
|
| Hospital Charge Code |
2960491
|
|
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
|
|
|
AORTOFEMORAL BYPASS GRAFT
|
Facility
|
OP
|
$16,069.00
|
|
| Hospital Charge Code |
2959809
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,499.32 |
| Max. Negotiated Rate |
$64,276.00 |
| Rate for Payer: Aetna Commercial |
$14,462.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,819.34
|
| Rate for Payer: Aetna Managed Medicare |
$4,499.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,444.85
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,034.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,713.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,516.57
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$14,783.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,992.21
|
| Rate for Payer: Health EOS Commercial |
$14,301.41
|
| Rate for Payer: HFN Commercial |
$14,783.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,051.75
|
| Rate for Payer: Multiplan Commercial |
$12,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,873.81
|
| Rate for Payer: Quartz Commercial |
$10,444.85
|
| Rate for Payer: Quartz Medicare Advantage |
$9,641.40
|
| Rate for Payer: The Alliance Commercial |
$64,276.00
|
| Rate for Payer: WEA Trust Commercial |
$8,837.95
|
| Rate for Payer: WPS Commercial |
$11,902.31
|
|
|
AORTOFEMORAL BYPASS GRAFT
|
Facility
|
IP
|
$16,069.00
|
|
| Hospital Charge Code |
2959809
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,873.81 |
| Max. Negotiated Rate |
$14,783.48 |
| Rate for Payer: Aetna Commercial |
$14,462.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,819.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,516.57
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$14,783.48
|
| Rate for Payer: Health EOS Commercial |
$14,301.41
|
| Rate for Payer: HFN Commercial |
$14,783.48
|
| Rate for Payer: Multiplan Commercial |
$12,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,873.81
|
| Rate for Payer: Quartz Commercial |
$9,641.40
|
| Rate for Payer: WEA Trust Commercial |
$8,837.95
|
| Rate for Payer: WPS Commercial |
$11,902.31
|
|
|
AORTORENAL BYPASS GRAFT
|
Facility
|
IP
|
$16,069.00
|
|
| Hospital Charge Code |
2959810
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$7,873.81 |
| Max. Negotiated Rate |
$14,783.48 |
| Rate for Payer: Aetna Commercial |
$14,462.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,819.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,516.57
|
| Rate for Payer: Cash Price |
$4,820.70
|
| Rate for Payer: Cigna Commercial |
$14,783.48
|
| Rate for Payer: Health EOS Commercial |
$14,301.41
|
| Rate for Payer: HFN Commercial |
$14,783.48
|
| Rate for Payer: Multiplan Commercial |
$12,855.20
|
| Rate for Payer: NAPHCARE Commercial |
$9,641.40
|
| Rate for Payer: Preferred Network Access Commercial |
$14,783.48
|
| Rate for Payer: Quartz Beloit One Network |
$7,873.81
|
| Rate for Payer: Quartz Commercial |
$9,641.40
|
| Rate for Payer: WEA Trust Commercial |
$8,837.95
|
| Rate for Payer: WPS Commercial |
$11,902.31
|
|
