|
MITRAL VALVE 25MM MOSAIC CINCH 310C25
|
Facility
|
OP
|
$38,439.00
|
|
| Hospital Charge Code |
2973958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,193.44 |
| Max. Negotiated Rate |
$36,778.44 |
| Rate for Payer: Aetna Commercial |
$35,978.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,379.84
|
| Rate for Payer: Aetna Managed Medicare |
$11,193.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,984.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,988.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,188.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,187.58
|
| Rate for Payer: Cash Price |
$11,531.70
|
| Rate for Payer: Cigna Commercial |
$36,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,371.50
|
| Rate for Payer: Health EOS Commercial |
$35,579.14
|
| Rate for Payer: HFN Commercial |
$36,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,982.42
|
| Rate for Payer: Multiplan Commercial |
$31,981.25
|
| Rate for Payer: NAPHCARE Commercial |
$23,985.94
|
| Rate for Payer: Preferred Network Access Commercial |
$36,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$19,588.51
|
| Rate for Payer: Quartz Commercial |
$25,984.76
|
| Rate for Payer: Quartz Medicare Advantage |
$23,985.94
|
| Rate for Payer: The Alliance Commercial |
$19,988.28
|
| Rate for Payer: WEA Trust Commercial |
$21,987.11
|
| Rate for Payer: WPS Commercial |
$29,609.56
|
|
|
MITRAL VALVE 25MM MOSAIC CINCH 310C25
|
Facility
|
IP
|
$38,439.00
|
|
| Hospital Charge Code |
2973958
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19,588.51 |
| Max. Negotiated Rate |
$36,778.44 |
| Rate for Payer: Aetna Commercial |
$35,978.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,379.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,187.58
|
| Rate for Payer: Cash Price |
$11,531.70
|
| Rate for Payer: Cigna Commercial |
$36,778.44
|
| Rate for Payer: Health EOS Commercial |
$35,579.14
|
| Rate for Payer: HFN Commercial |
$36,778.44
|
| Rate for Payer: Multiplan Commercial |
$31,981.25
|
| Rate for Payer: Preferred Network Access Commercial |
$36,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$19,588.51
|
| Rate for Payer: Quartz Commercial |
$23,985.94
|
| Rate for Payer: WEA Trust Commercial |
$21,987.11
|
| Rate for Payer: WPS Commercial |
$29,609.56
|
|
|
MITRAL VALVE 25MM STANDARD ATS #500DM25
|
Facility
|
IP
|
$42,231.00
|
|
| Hospital Charge Code |
2970327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,520.92 |
| Max. Negotiated Rate |
$40,406.62 |
| Rate for Payer: Aetna Commercial |
$39,528.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,771.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,277.73
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$40,406.62
|
| Rate for Payer: Health EOS Commercial |
$39,089.01
|
| Rate for Payer: HFN Commercial |
$40,406.62
|
| Rate for Payer: Multiplan Commercial |
$35,136.19
|
| Rate for Payer: Preferred Network Access Commercial |
$40,406.62
|
| Rate for Payer: Quartz Beloit One Network |
$21,520.92
|
| Rate for Payer: Quartz Commercial |
$26,352.14
|
| Rate for Payer: WEA Trust Commercial |
$24,156.13
|
| Rate for Payer: WPS Commercial |
$32,530.54
|
|
|
MITRAL VALVE 25MM STANDARD ATS #500DM25
|
Facility
|
OP
|
$42,231.00
|
|
| Hospital Charge Code |
2970327
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,297.67 |
| Max. Negotiated Rate |
$40,406.62 |
| Rate for Payer: Aetna Commercial |
$39,528.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,771.41
|
| Rate for Payer: Aetna Managed Medicare |
$12,297.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,548.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,960.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,081.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,277.73
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$40,406.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,578.44
|
| Rate for Payer: Health EOS Commercial |
$39,089.01
|
| Rate for Payer: HFN Commercial |
$40,406.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,940.18
|
| Rate for Payer: Multiplan Commercial |
$35,136.19
|
| Rate for Payer: NAPHCARE Commercial |
$26,352.14
|
| Rate for Payer: Preferred Network Access Commercial |
$40,406.62
|
| Rate for Payer: Quartz Beloit One Network |
$21,520.92
|
| Rate for Payer: Quartz Commercial |
$28,548.16
|
| Rate for Payer: Quartz Medicare Advantage |
$26,352.14
|
| Rate for Payer: The Alliance Commercial |
$21,960.12
|
| Rate for Payer: WEA Trust Commercial |
$24,156.13
|
| Rate for Payer: WPS Commercial |
$32,530.54
|
|
|
MITRAL VALVE 27MM MOSAIC CINCH 310C27
|
Facility
|
OP
|
$38,439.00
|
|
| Hospital Charge Code |
2969903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,193.44 |
| Max. Negotiated Rate |
$36,778.44 |
| Rate for Payer: Aetna Commercial |
$35,978.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,379.84
|
| Rate for Payer: Aetna Managed Medicare |
$11,193.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,984.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,988.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,188.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,187.58
|
| Rate for Payer: Cash Price |
$11,531.70
|
| Rate for Payer: Cigna Commercial |
$36,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,371.50
|
| Rate for Payer: Health EOS Commercial |
$35,579.14
|
| Rate for Payer: HFN Commercial |
$36,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,982.42
|
| Rate for Payer: Multiplan Commercial |
$31,981.25
|
| Rate for Payer: NAPHCARE Commercial |
$23,985.94
|
| Rate for Payer: Preferred Network Access Commercial |
$36,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$19,588.51
|
| Rate for Payer: Quartz Commercial |
$25,984.76
|
| Rate for Payer: Quartz Medicare Advantage |
$23,985.94
|
| Rate for Payer: The Alliance Commercial |
$19,988.28
|
| Rate for Payer: WEA Trust Commercial |
$21,987.11
|
| Rate for Payer: WPS Commercial |
$29,609.56
|
|
|
MITRAL VALVE 27MM MOSAIC CINCH 310C27
|
Facility
|
IP
|
$38,439.00
|
|
| Hospital Charge Code |
2969903
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19,588.51 |
| Max. Negotiated Rate |
$36,778.44 |
| Rate for Payer: Aetna Commercial |
$35,978.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,379.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,187.58
|
| Rate for Payer: Cash Price |
$11,531.70
|
| Rate for Payer: Cigna Commercial |
$36,778.44
|
| Rate for Payer: Health EOS Commercial |
$35,579.14
|
| Rate for Payer: HFN Commercial |
$36,778.44
|
| Rate for Payer: Multiplan Commercial |
$31,981.25
|
| Rate for Payer: Preferred Network Access Commercial |
$36,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$19,588.51
|
| Rate for Payer: Quartz Commercial |
$23,985.94
|
| Rate for Payer: WEA Trust Commercial |
$21,987.11
|
| Rate for Payer: WPS Commercial |
$29,609.56
|
|
|
MITRAL VALVE 27MM STANDARD ATS #500DM27
|
Facility
|
OP
|
$42,231.00
|
|
| Hospital Charge Code |
2970328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,297.67 |
| Max. Negotiated Rate |
$40,406.62 |
| Rate for Payer: Aetna Commercial |
$39,528.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,771.41
|
| Rate for Payer: Aetna Managed Medicare |
$12,297.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,548.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,960.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,081.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,277.73
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$40,406.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,578.44
|
| Rate for Payer: Health EOS Commercial |
$39,089.01
|
| Rate for Payer: HFN Commercial |
$40,406.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,940.18
|
| Rate for Payer: Multiplan Commercial |
$35,136.19
|
| Rate for Payer: NAPHCARE Commercial |
$26,352.14
|
| Rate for Payer: Preferred Network Access Commercial |
$40,406.62
|
| Rate for Payer: Quartz Beloit One Network |
$21,520.92
|
| Rate for Payer: Quartz Commercial |
$28,548.16
|
| Rate for Payer: Quartz Medicare Advantage |
$26,352.14
|
| Rate for Payer: The Alliance Commercial |
$21,960.12
|
| Rate for Payer: WEA Trust Commercial |
$24,156.13
|
| Rate for Payer: WPS Commercial |
$32,530.54
|
|
|
MITRAL VALVE 27MM STANDARD ATS #500DM27
|
Facility
|
IP
|
$42,231.00
|
|
| Hospital Charge Code |
2970328
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,520.92 |
| Max. Negotiated Rate |
$40,406.62 |
| Rate for Payer: Aetna Commercial |
$39,528.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,771.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,277.73
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$40,406.62
|
| Rate for Payer: Health EOS Commercial |
$39,089.01
|
| Rate for Payer: HFN Commercial |
$40,406.62
|
| Rate for Payer: Multiplan Commercial |
$35,136.19
|
| Rate for Payer: Preferred Network Access Commercial |
$40,406.62
|
| Rate for Payer: Quartz Beloit One Network |
$21,520.92
|
| Rate for Payer: Quartz Commercial |
$26,352.14
|
| Rate for Payer: WEA Trust Commercial |
$24,156.13
|
| Rate for Payer: WPS Commercial |
$32,530.54
|
|
|
MITRAL VALVE 29MM MOSAIC CINCH 310C29
|
Facility
|
OP
|
$49,421.00
|
|
| Hospital Charge Code |
2973964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,391.40 |
| Max. Negotiated Rate |
$47,286.01 |
| Rate for Payer: Aetna Commercial |
$46,258.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44,202.14
|
| Rate for Payer: Aetna Managed Medicare |
$14,391.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$33,408.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$25,698.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$24,670.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27,240.86
|
| Rate for Payer: Cash Price |
$14,826.30
|
| Rate for Payer: Cigna Commercial |
$47,286.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$28,763.02
|
| Rate for Payer: Health EOS Commercial |
$45,744.08
|
| Rate for Payer: HFN Commercial |
$47,286.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$38,548.38
|
| Rate for Payer: Multiplan Commercial |
$41,118.27
|
| Rate for Payer: NAPHCARE Commercial |
$30,838.70
|
| Rate for Payer: Preferred Network Access Commercial |
$47,286.01
|
| Rate for Payer: Quartz Beloit One Network |
$25,184.94
|
| Rate for Payer: Quartz Commercial |
$33,408.60
|
| Rate for Payer: Quartz Medicare Advantage |
$30,838.70
|
| Rate for Payer: The Alliance Commercial |
$25,698.92
|
| Rate for Payer: WEA Trust Commercial |
$28,268.81
|
| Rate for Payer: WPS Commercial |
$38,069.00
|
|
|
MITRAL VALVE 29MM MOSAIC CINCH 310C29
|
Facility
|
IP
|
$49,421.00
|
|
| Hospital Charge Code |
2973964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$25,184.94 |
| Max. Negotiated Rate |
$47,286.01 |
| Rate for Payer: Aetna Commercial |
$46,258.06
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$44,202.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27,240.86
|
| Rate for Payer: Cash Price |
$14,826.30
|
| Rate for Payer: Cigna Commercial |
$47,286.01
|
| Rate for Payer: Health EOS Commercial |
$45,744.08
|
| Rate for Payer: HFN Commercial |
$47,286.01
|
| Rate for Payer: Multiplan Commercial |
$41,118.27
|
| Rate for Payer: Preferred Network Access Commercial |
$47,286.01
|
| Rate for Payer: Quartz Beloit One Network |
$25,184.94
|
| Rate for Payer: Quartz Commercial |
$30,838.70
|
| Rate for Payer: WEA Trust Commercial |
$28,268.81
|
| Rate for Payer: WPS Commercial |
$38,069.00
|
|
|
MITRAL VALVE 29MM STANDARD ATS 500DM29
|
Facility
|
IP
|
$42,231.00
|
|
| Hospital Charge Code |
2970329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,520.92 |
| Max. Negotiated Rate |
$40,406.62 |
| Rate for Payer: Aetna Commercial |
$39,528.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,771.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,277.73
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$40,406.62
|
| Rate for Payer: Health EOS Commercial |
$39,089.01
|
| Rate for Payer: HFN Commercial |
$40,406.62
|
| Rate for Payer: Multiplan Commercial |
$35,136.19
|
| Rate for Payer: Preferred Network Access Commercial |
$40,406.62
|
| Rate for Payer: Quartz Beloit One Network |
$21,520.92
|
| Rate for Payer: Quartz Commercial |
$26,352.14
|
| Rate for Payer: WEA Trust Commercial |
$24,156.13
|
| Rate for Payer: WPS Commercial |
$32,530.54
|
|
|
MITRAL VALVE 29MM STANDARD ATS 500DM29
|
Facility
|
OP
|
$42,231.00
|
|
| Hospital Charge Code |
2970329
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,297.67 |
| Max. Negotiated Rate |
$40,406.62 |
| Rate for Payer: Aetna Commercial |
$39,528.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,771.41
|
| Rate for Payer: Aetna Managed Medicare |
$12,297.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,548.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,960.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,081.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,277.73
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$40,406.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,578.44
|
| Rate for Payer: Health EOS Commercial |
$39,089.01
|
| Rate for Payer: HFN Commercial |
$40,406.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,940.18
|
| Rate for Payer: Multiplan Commercial |
$35,136.19
|
| Rate for Payer: NAPHCARE Commercial |
$26,352.14
|
| Rate for Payer: Preferred Network Access Commercial |
$40,406.62
|
| Rate for Payer: Quartz Beloit One Network |
$21,520.92
|
| Rate for Payer: Quartz Commercial |
$28,548.16
|
| Rate for Payer: Quartz Medicare Advantage |
$26,352.14
|
| Rate for Payer: The Alliance Commercial |
$21,960.12
|
| Rate for Payer: WEA Trust Commercial |
$24,156.13
|
| Rate for Payer: WPS Commercial |
$32,530.54
|
|
|
MITRAL VALVE 31MM MOSAIC CINCH 310C31
|
Facility
|
OP
|
$38,439.00
|
|
| Hospital Charge Code |
2970326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,193.44 |
| Max. Negotiated Rate |
$36,778.44 |
| Rate for Payer: Aetna Commercial |
$35,978.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,379.84
|
| Rate for Payer: Aetna Managed Medicare |
$11,193.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,984.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,988.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,188.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,187.58
|
| Rate for Payer: Cash Price |
$11,531.70
|
| Rate for Payer: Cigna Commercial |
$36,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,371.50
|
| Rate for Payer: Health EOS Commercial |
$35,579.14
|
| Rate for Payer: HFN Commercial |
$36,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,982.42
|
| Rate for Payer: Multiplan Commercial |
$31,981.25
|
| Rate for Payer: NAPHCARE Commercial |
$23,985.94
|
| Rate for Payer: Preferred Network Access Commercial |
$36,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$19,588.51
|
| Rate for Payer: Quartz Commercial |
$25,984.76
|
| Rate for Payer: Quartz Medicare Advantage |
$23,985.94
|
| Rate for Payer: The Alliance Commercial |
$19,988.28
|
| Rate for Payer: WEA Trust Commercial |
$21,987.11
|
| Rate for Payer: WPS Commercial |
$29,609.56
|
|
|
MITRAL VALVE 31MM MOSAIC CINCH 310C31
|
Facility
|
IP
|
$38,439.00
|
|
| Hospital Charge Code |
2970326
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19,588.51 |
| Max. Negotiated Rate |
$36,778.44 |
| Rate for Payer: Aetna Commercial |
$35,978.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,379.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,187.58
|
| Rate for Payer: Cash Price |
$11,531.70
|
| Rate for Payer: Cigna Commercial |
$36,778.44
|
| Rate for Payer: Health EOS Commercial |
$35,579.14
|
| Rate for Payer: HFN Commercial |
$36,778.44
|
| Rate for Payer: Multiplan Commercial |
$31,981.25
|
| Rate for Payer: Preferred Network Access Commercial |
$36,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$19,588.51
|
| Rate for Payer: Quartz Commercial |
$23,985.94
|
| Rate for Payer: WEA Trust Commercial |
$21,987.11
|
| Rate for Payer: WPS Commercial |
$29,609.56
|
|
|
MITRAL VALVE 31MM STANDARD ATS #500DM31
|
Facility
|
IP
|
$42,231.00
|
|
| Hospital Charge Code |
2970330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,520.92 |
| Max. Negotiated Rate |
$40,406.62 |
| Rate for Payer: Aetna Commercial |
$39,528.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,771.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,277.73
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$40,406.62
|
| Rate for Payer: Health EOS Commercial |
$39,089.01
|
| Rate for Payer: HFN Commercial |
$40,406.62
|
| Rate for Payer: Multiplan Commercial |
$35,136.19
|
| Rate for Payer: Preferred Network Access Commercial |
$40,406.62
|
| Rate for Payer: Quartz Beloit One Network |
$21,520.92
|
| Rate for Payer: Quartz Commercial |
$26,352.14
|
| Rate for Payer: WEA Trust Commercial |
$24,156.13
|
| Rate for Payer: WPS Commercial |
$32,530.54
|
|
|
MITRAL VALVE 31MM STANDARD ATS #500DM31
|
Facility
|
OP
|
$42,231.00
|
|
| Hospital Charge Code |
2970330
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,297.67 |
| Max. Negotiated Rate |
$40,406.62 |
| Rate for Payer: Aetna Commercial |
$39,528.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,771.41
|
| Rate for Payer: Aetna Managed Medicare |
$12,297.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,548.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,960.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,081.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,277.73
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$40,406.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,578.44
|
| Rate for Payer: Health EOS Commercial |
$39,089.01
|
| Rate for Payer: HFN Commercial |
$40,406.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,940.18
|
| Rate for Payer: Multiplan Commercial |
$35,136.19
|
| Rate for Payer: NAPHCARE Commercial |
$26,352.14
|
| Rate for Payer: Preferred Network Access Commercial |
$40,406.62
|
| Rate for Payer: Quartz Beloit One Network |
$21,520.92
|
| Rate for Payer: Quartz Commercial |
$28,548.16
|
| Rate for Payer: Quartz Medicare Advantage |
$26,352.14
|
| Rate for Payer: The Alliance Commercial |
$21,960.12
|
| Rate for Payer: WEA Trust Commercial |
$24,156.13
|
| Rate for Payer: WPS Commercial |
$32,530.54
|
|
|
MITRAL VALVE 33MM MOSAIC CINCH 310C33
|
Facility
|
IP
|
$38,439.00
|
|
| Hospital Charge Code |
2973959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$19,588.51 |
| Max. Negotiated Rate |
$36,778.44 |
| Rate for Payer: Aetna Commercial |
$35,978.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,379.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,187.58
|
| Rate for Payer: Cash Price |
$11,531.70
|
| Rate for Payer: Cigna Commercial |
$36,778.44
|
| Rate for Payer: Health EOS Commercial |
$35,579.14
|
| Rate for Payer: HFN Commercial |
$36,778.44
|
| Rate for Payer: Multiplan Commercial |
$31,981.25
|
| Rate for Payer: Preferred Network Access Commercial |
$36,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$19,588.51
|
| Rate for Payer: Quartz Commercial |
$23,985.94
|
| Rate for Payer: WEA Trust Commercial |
$21,987.11
|
| Rate for Payer: WPS Commercial |
$29,609.56
|
|
|
MITRAL VALVE 33MM MOSAIC CINCH 310C33
|
Facility
|
OP
|
$38,439.00
|
|
| Hospital Charge Code |
2973959
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,193.44 |
| Max. Negotiated Rate |
$36,778.44 |
| Rate for Payer: Aetna Commercial |
$35,978.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$34,379.84
|
| Rate for Payer: Aetna Managed Medicare |
$11,193.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$25,984.76
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,988.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,188.75
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$21,187.58
|
| Rate for Payer: Cash Price |
$11,531.70
|
| Rate for Payer: Cigna Commercial |
$36,778.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$22,371.50
|
| Rate for Payer: Health EOS Commercial |
$35,579.14
|
| Rate for Payer: HFN Commercial |
$36,778.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$29,982.42
|
| Rate for Payer: Multiplan Commercial |
$31,981.25
|
| Rate for Payer: NAPHCARE Commercial |
$23,985.94
|
| Rate for Payer: Preferred Network Access Commercial |
$36,778.44
|
| Rate for Payer: Quartz Beloit One Network |
$19,588.51
|
| Rate for Payer: Quartz Commercial |
$25,984.76
|
| Rate for Payer: Quartz Medicare Advantage |
$23,985.94
|
| Rate for Payer: The Alliance Commercial |
$19,988.28
|
| Rate for Payer: WEA Trust Commercial |
$21,987.11
|
| Rate for Payer: WPS Commercial |
$29,609.56
|
|
|
MITRAL VALVE 35MM STANDARD ATS #500DM35
|
Facility
|
OP
|
$42,231.00
|
|
| Hospital Charge Code |
2970331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,297.67 |
| Max. Negotiated Rate |
$40,406.62 |
| Rate for Payer: Aetna Commercial |
$39,528.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,771.41
|
| Rate for Payer: Aetna Managed Medicare |
$12,297.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$28,548.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$21,960.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$21,081.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,277.73
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$40,406.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$24,578.44
|
| Rate for Payer: Health EOS Commercial |
$39,089.01
|
| Rate for Payer: HFN Commercial |
$40,406.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$32,940.18
|
| Rate for Payer: Multiplan Commercial |
$35,136.19
|
| Rate for Payer: NAPHCARE Commercial |
$26,352.14
|
| Rate for Payer: Preferred Network Access Commercial |
$40,406.62
|
| Rate for Payer: Quartz Beloit One Network |
$21,520.92
|
| Rate for Payer: Quartz Commercial |
$28,548.16
|
| Rate for Payer: Quartz Medicare Advantage |
$26,352.14
|
| Rate for Payer: The Alliance Commercial |
$21,960.12
|
| Rate for Payer: WEA Trust Commercial |
$24,156.13
|
| Rate for Payer: WPS Commercial |
$32,530.54
|
|
|
MITRAL VALVE 35MM STANDARD ATS #500DM35
|
Facility
|
IP
|
$42,231.00
|
|
| Hospital Charge Code |
2970331
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$21,520.92 |
| Max. Negotiated Rate |
$40,406.62 |
| Rate for Payer: Aetna Commercial |
$39,528.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$37,771.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$23,277.73
|
| Rate for Payer: Cash Price |
$12,669.30
|
| Rate for Payer: Cigna Commercial |
$40,406.62
|
| Rate for Payer: Health EOS Commercial |
$39,089.01
|
| Rate for Payer: HFN Commercial |
$40,406.62
|
| Rate for Payer: Multiplan Commercial |
$35,136.19
|
| Rate for Payer: Preferred Network Access Commercial |
$40,406.62
|
| Rate for Payer: Quartz Beloit One Network |
$21,520.92
|
| Rate for Payer: Quartz Commercial |
$26,352.14
|
| Rate for Payer: WEA Trust Commercial |
$24,156.13
|
| Rate for Payer: WPS Commercial |
$32,530.54
|
|
|
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 |
$14,765.59 |
| Max. Negotiated Rate |
$48,515.50 |
| Rate for Payer: Aetna Commercial |
$47,460.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45,351.45
|
| Rate for Payer: Aetna Managed Medicare |
$14,765.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$34,277.26
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$26,367.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$25,312.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27,949.15
|
| Rate for Payer: Cash Price |
$15,211.80
|
| Rate for Payer: Cigna Commercial |
$48,515.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$29,510.89
|
| Rate for Payer: Health EOS Commercial |
$46,933.47
|
| Rate for Payer: HFN Commercial |
$48,515.50
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$39,550.68
|
| Rate for Payer: Multiplan Commercial |
$42,187.39
|
| Rate for Payer: NAPHCARE Commercial |
$31,640.54
|
| Rate for Payer: Preferred Network Access Commercial |
$48,515.50
|
| Rate for Payer: Quartz Beloit One Network |
$25,839.78
|
| Rate for Payer: Quartz Commercial |
$34,277.26
|
| Rate for Payer: Quartz Medicare Advantage |
$31,640.54
|
| Rate for Payer: The Alliance Commercial |
$26,367.12
|
| Rate for Payer: WEA Trust Commercial |
$29,003.83
|
| Rate for Payer: WPS Commercial |
$39,058.83
|
|
|
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 |
$25,839.78 |
| Max. Negotiated Rate |
$48,515.50 |
| Rate for Payer: Aetna Commercial |
$47,460.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$45,351.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$27,949.15
|
| Rate for Payer: Cash Price |
$15,211.80
|
| Rate for Payer: Cigna Commercial |
$48,515.50
|
| Rate for Payer: Health EOS Commercial |
$46,933.47
|
| Rate for Payer: HFN Commercial |
$48,515.50
|
| Rate for Payer: Multiplan Commercial |
$42,187.39
|
| Rate for Payer: Preferred Network Access Commercial |
$48,515.50
|
| Rate for Payer: Quartz Beloit One Network |
$25,839.78
|
| Rate for Payer: Quartz Commercial |
$31,640.54
|
| Rate for Payer: WEA Trust Commercial |
$29,003.83
|
| Rate for Payer: WPS Commercial |
$39,058.83
|
|
|
MITRAL VALVE REPLACEMENT
|
Facility
|
IP
|
$17,117.00
|
|
| Hospital Charge Code |
2960493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$8,722.82 |
| Max. Negotiated Rate |
$16,377.55 |
| Rate for Payer: Aetna Commercial |
$16,021.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,309.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,434.89
|
| Rate for Payer: Cash Price |
$5,135.10
|
| Rate for Payer: Cigna Commercial |
$16,377.55
|
| Rate for Payer: Health EOS Commercial |
$15,843.50
|
| Rate for Payer: HFN Commercial |
$16,377.55
|
| Rate for Payer: Multiplan Commercial |
$14,241.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,377.55
|
| Rate for Payer: Quartz Beloit One Network |
$8,722.82
|
| Rate for Payer: Quartz Commercial |
$10,681.01
|
| Rate for Payer: WEA Trust Commercial |
$9,790.92
|
| Rate for Payer: WPS Commercial |
$13,185.23
|
|
|
MITRAL VALVE REPLACEMENT
|
Facility
|
OP
|
$17,117.00
|
|
| Hospital Charge Code |
2960493
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$4,984.47 |
| Max. Negotiated Rate |
$16,377.55 |
| Rate for Payer: Aetna Commercial |
$16,021.51
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,309.44
|
| Rate for Payer: Aetna Managed Medicare |
$4,984.47
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,571.09
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,900.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,544.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,434.89
|
| Rate for Payer: Cash Price |
$5,135.10
|
| Rate for Payer: Cigna Commercial |
$16,377.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,962.09
|
| Rate for Payer: Health EOS Commercial |
$15,843.50
|
| Rate for Payer: HFN Commercial |
$16,377.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,351.26
|
| Rate for Payer: Multiplan Commercial |
$14,241.34
|
| Rate for Payer: NAPHCARE Commercial |
$10,681.01
|
| Rate for Payer: Preferred Network Access Commercial |
$16,377.55
|
| Rate for Payer: Quartz Beloit One Network |
$8,722.82
|
| Rate for Payer: Quartz Commercial |
$11,571.09
|
| Rate for Payer: Quartz Medicare Advantage |
$10,681.01
|
| Rate for Payer: The Alliance Commercial |
$8,900.84
|
| Rate for Payer: WEA Trust Commercial |
$9,790.92
|
| Rate for Payer: WPS Commercial |
$13,185.23
|
|
|
Mix PT 1 Hour
|
Facility
|
OP
|
$107.00
|
|
|
Service Code
|
CPT 85610
|
| Hospital Charge Code |
1050811
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$4.46 |
| Max. Negotiated Rate |
$102.38 |
| Rate for Payer: Aetna Commercial |
$100.15
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$95.70
|
| Rate for Payer: Aetna Managed Medicare |
$4.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16.73
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7.81
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7.41
|
| Rate for Payer: Anthem Medicare Advantage |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$58.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$4.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$4.46
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cash Price |
$32.10
|
| Rate for Payer: Cigna Commercial |
$102.38
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$4.46
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$62.27
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$4.46
|
| Rate for Payer: Health EOS Commercial |
$99.04
|
| Rate for Payer: HFN Commercial |
$102.38
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16.60
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$4.46
|
| Rate for Payer: Independent Care Health Plan Medicare |
$4.46
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$4.46
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$4.46
|
| Rate for Payer: Multiplan Commercial |
$89.02
|
| Rate for Payer: NAPHCARE Commercial |
$6.69
|
| Rate for Payer: Preferred Network Access Commercial |
$102.38
|
| Rate for Payer: Quartz Beloit One Network |
$54.53
|
| Rate for Payer: Quartz Commercial |
$72.33
|
| Rate for Payer: Quartz Medicare Advantage |
$4.46
|
| Rate for Payer: The Alliance Commercial |
$17.85
|
| Rate for Payer: United Healthcare Medicare Advantage |
$4.46
|
| Rate for Payer: United Healthcare PPO |
$83.46
|
| Rate for Payer: WEA Trust Commercial |
$61.20
|
| Rate for Payer: Wellcare Medicare |
$4.46
|
| Rate for Payer: WPS Commercial |
$82.42
|
|
