|
AORTIC VALVE 19MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-19A
|
Facility
|
IP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,294.28 |
| Max. Negotiated Rate |
$26,838.24 |
| Rate for Payer: Aetna Commercial |
$26,254.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,087.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,461.16
|
| Rate for Payer: Cash Price |
$8,415.00
|
| Rate for Payer: Cigna Commercial |
$26,838.24
|
| Rate for Payer: Health EOS Commercial |
$25,963.08
|
| Rate for Payer: HFN Commercial |
$26,838.24
|
| Rate for Payer: Multiplan Commercial |
$23,337.60
|
| Rate for Payer: Preferred Network Access Commercial |
$26,838.24
|
| Rate for Payer: Quartz Beloit One Network |
$14,294.28
|
| Rate for Payer: Quartz Commercial |
$17,503.20
|
| Rate for Payer: WEA Trust Commercial |
$16,044.60
|
| Rate for Payer: WPS Commercial |
$21,606.92
|
|
|
AORTIC VALVE 19MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-19A
|
Facility
|
OP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074608
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,168.16 |
| Max. Negotiated Rate |
$26,838.24 |
| Rate for Payer: Aetna Commercial |
$26,254.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,087.92
|
| Rate for Payer: Aetna Managed Medicare |
$8,168.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,961.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,002.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,461.16
|
| Rate for Payer: Cash Price |
$8,415.00
|
| Rate for Payer: Cigna Commercial |
$26,838.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,325.10
|
| Rate for Payer: Health EOS Commercial |
$25,963.08
|
| Rate for Payer: HFN Commercial |
$26,838.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,879.00
|
| Rate for Payer: Multiplan Commercial |
$23,337.60
|
| Rate for Payer: NAPHCARE Commercial |
$17,503.20
|
| Rate for Payer: Preferred Network Access Commercial |
$26,838.24
|
| Rate for Payer: Quartz Beloit One Network |
$14,294.28
|
| Rate for Payer: Quartz Commercial |
$18,961.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17,503.20
|
| Rate for Payer: The Alliance Commercial |
$14,586.00
|
| Rate for Payer: WEA Trust Commercial |
$16,044.60
|
| Rate for Payer: WPS Commercial |
$21,606.92
|
|
|
AORTIC VALVE 20MM AP360 #505DA20
|
Facility
|
IP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,722.87 |
| Max. Negotiated Rate |
$33,275.59 |
| Rate for Payer: Aetna Commercial |
$32,552.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,169.63
|
| Rate for Payer: Cash Price |
$10,433.40
|
| Rate for Payer: Cigna Commercial |
$33,275.59
|
| Rate for Payer: Health EOS Commercial |
$32,190.52
|
| Rate for Payer: HFN Commercial |
$33,275.59
|
| Rate for Payer: Multiplan Commercial |
$28,935.30
|
| Rate for Payer: Preferred Network Access Commercial |
$33,275.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,722.87
|
| Rate for Payer: Quartz Commercial |
$21,701.47
|
| Rate for Payer: WEA Trust Commercial |
$19,893.02
|
| Rate for Payer: WPS Commercial |
$26,789.49
|
|
|
AORTIC VALVE 20MM AP360 #505DA20
|
Facility
|
OP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973949
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,127.35 |
| Max. Negotiated Rate |
$33,275.59 |
| Rate for Payer: Aetna Commercial |
$32,552.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,105.44
|
| Rate for Payer: Aetna Managed Medicare |
$10,127.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,509.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,084.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,361.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,169.63
|
| Rate for Payer: Cash Price |
$10,433.40
|
| Rate for Payer: Cigna Commercial |
$33,275.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,240.80
|
| Rate for Payer: Health EOS Commercial |
$32,190.52
|
| Rate for Payer: HFN Commercial |
$33,275.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,126.84
|
| Rate for Payer: Multiplan Commercial |
$28,935.30
|
| Rate for Payer: NAPHCARE Commercial |
$21,701.47
|
| Rate for Payer: Preferred Network Access Commercial |
$33,275.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,722.87
|
| Rate for Payer: Quartz Commercial |
$23,509.93
|
| Rate for Payer: Quartz Medicare Advantage |
$21,701.47
|
| Rate for Payer: The Alliance Commercial |
$18,084.56
|
| Rate for Payer: WEA Trust Commercial |
$19,893.02
|
| Rate for Payer: WPS Commercial |
$26,789.49
|
|
|
AORTIC VALVE 21MM MOSAIC ULTRA 305U221
|
Facility
|
OP
|
$39,917.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,623.83 |
| Max. Negotiated Rate |
$38,192.59 |
| Rate for Payer: Aetna Commercial |
$37,362.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,701.76
|
| Rate for Payer: Aetna Managed Medicare |
$11,623.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,983.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,756.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,926.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,002.25
|
| Rate for Payer: Cash Price |
$11,975.10
|
| Rate for Payer: Cigna Commercial |
$38,192.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,231.69
|
| Rate for Payer: Health EOS Commercial |
$36,947.18
|
| Rate for Payer: HFN Commercial |
$38,192.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,135.26
|
| Rate for Payer: Multiplan Commercial |
$33,210.94
|
| Rate for Payer: NAPHCARE Commercial |
$24,908.21
|
| Rate for Payer: Preferred Network Access Commercial |
$38,192.59
|
| Rate for Payer: Quartz Beloit One Network |
$20,341.70
|
| Rate for Payer: Quartz Commercial |
$26,983.89
|
| Rate for Payer: Quartz Medicare Advantage |
$24,908.21
|
| Rate for Payer: The Alliance Commercial |
$20,756.84
|
| Rate for Payer: WEA Trust Commercial |
$22,832.52
|
| Rate for Payer: WPS Commercial |
$30,748.07
|
|
|
AORTIC VALVE 21MM MOSAIC ULTRA 305U221
|
Facility
|
IP
|
$39,917.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973955
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,341.70 |
| Max. Negotiated Rate |
$38,192.59 |
| Rate for Payer: Aetna Commercial |
$37,362.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,701.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,002.25
|
| Rate for Payer: Cash Price |
$11,975.10
|
| Rate for Payer: Cigna Commercial |
$38,192.59
|
| Rate for Payer: Health EOS Commercial |
$36,947.18
|
| Rate for Payer: HFN Commercial |
$38,192.59
|
| Rate for Payer: Multiplan Commercial |
$33,210.94
|
| Rate for Payer: Preferred Network Access Commercial |
$38,192.59
|
| Rate for Payer: Quartz Beloit One Network |
$20,341.70
|
| Rate for Payer: Quartz Commercial |
$24,908.21
|
| Rate for Payer: WEA Trust Commercial |
$22,832.52
|
| Rate for Payer: WPS Commercial |
$30,748.07
|
|
|
AORTIC VALVE 21MM ON-X CONFORM-X SEWING RING ONXACE-21
|
Facility
|
IP
|
$23,935.00
|
|
| Hospital Charge Code |
5591282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,197.28 |
| Max. Negotiated Rate |
$22,901.01 |
| Rate for Payer: Aetna Commercial |
$22,403.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,407.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,192.97
|
| Rate for Payer: Cash Price |
$7,180.50
|
| Rate for Payer: Cigna Commercial |
$22,901.01
|
| Rate for Payer: Health EOS Commercial |
$22,154.24
|
| Rate for Payer: HFN Commercial |
$22,901.01
|
| Rate for Payer: Multiplan Commercial |
$19,913.92
|
| Rate for Payer: Preferred Network Access Commercial |
$22,901.01
|
| Rate for Payer: Quartz Beloit One Network |
$12,197.28
|
| Rate for Payer: Quartz Commercial |
$14,935.44
|
| Rate for Payer: WEA Trust Commercial |
$13,690.82
|
| Rate for Payer: WPS Commercial |
$18,437.13
|
|
|
AORTIC VALVE 21MM ON-X CONFORM-X SEWING RING ONXACE-21
|
Facility
|
OP
|
$23,935.00
|
|
| Hospital Charge Code |
5591282
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,969.87 |
| Max. Negotiated Rate |
$22,901.01 |
| Rate for Payer: Aetna Commercial |
$22,403.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,407.46
|
| Rate for Payer: Aetna Managed Medicare |
$6,969.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,180.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,446.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,948.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,192.97
|
| Rate for Payer: Cash Price |
$7,180.50
|
| Rate for Payer: Cigna Commercial |
$22,901.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,930.17
|
| Rate for Payer: Health EOS Commercial |
$22,154.24
|
| Rate for Payer: HFN Commercial |
$22,901.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,669.30
|
| Rate for Payer: Multiplan Commercial |
$19,913.92
|
| Rate for Payer: NAPHCARE Commercial |
$14,935.44
|
| Rate for Payer: Preferred Network Access Commercial |
$22,901.01
|
| Rate for Payer: Quartz Beloit One Network |
$12,197.28
|
| Rate for Payer: Quartz Commercial |
$16,180.06
|
| Rate for Payer: Quartz Medicare Advantage |
$14,935.44
|
| Rate for Payer: The Alliance Commercial |
$12,446.20
|
| Rate for Payer: WEA Trust Commercial |
$13,690.82
|
| Rate for Payer: WPS Commercial |
$18,437.13
|
|
|
AORTIC VALVE 21MM TRIFECTA TF-21A
|
Facility
|
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,456.23 |
| Max. Negotiated Rate |
$51,550.47 |
| Rate for Payer: Aetna Commercial |
$50,429.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48,188.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,697.55
|
| Rate for Payer: Cash Price |
$16,163.40
|
| Rate for Payer: Cigna Commercial |
$51,550.47
|
| Rate for Payer: Health EOS Commercial |
$49,869.48
|
| Rate for Payer: HFN Commercial |
$51,550.47
|
| Rate for Payer: Multiplan Commercial |
$44,826.50
|
| Rate for Payer: Preferred Network Access Commercial |
$51,550.47
|
| Rate for Payer: Quartz Beloit One Network |
$27,456.23
|
| Rate for Payer: Quartz Commercial |
$33,619.87
|
| Rate for Payer: WEA Trust Commercial |
$30,818.22
|
| Rate for Payer: WPS Commercial |
$41,502.22
|
|
|
AORTIC VALVE 21MM TRIFECTA TF-21A
|
Facility
|
OP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966067
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,689.27 |
| Max. Negotiated Rate |
$51,550.47 |
| Rate for Payer: Aetna Commercial |
$50,429.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48,188.48
|
| Rate for Payer: Aetna Managed Medicare |
$15,689.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,421.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,016.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,895.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,697.55
|
| Rate for Payer: Cash Price |
$16,163.40
|
| Rate for Payer: Cigna Commercial |
$51,550.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,357.00
|
| Rate for Payer: Health EOS Commercial |
$49,869.48
|
| Rate for Payer: HFN Commercial |
$51,550.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,024.84
|
| Rate for Payer: Multiplan Commercial |
$44,826.50
|
| Rate for Payer: NAPHCARE Commercial |
$33,619.87
|
| Rate for Payer: Preferred Network Access Commercial |
$51,550.47
|
| Rate for Payer: Quartz Beloit One Network |
$27,456.23
|
| Rate for Payer: Quartz Commercial |
$36,421.53
|
| Rate for Payer: Quartz Medicare Advantage |
$33,619.87
|
| Rate for Payer: The Alliance Commercial |
$28,016.56
|
| Rate for Payer: WEA Trust Commercial |
$30,818.22
|
| Rate for Payer: WPS Commercial |
$41,502.22
|
|
|
AORTIC VALVE 21MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-21A
|
Facility
|
IP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,294.28 |
| Max. Negotiated Rate |
$26,838.24 |
| Rate for Payer: Aetna Commercial |
$26,254.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,087.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,461.16
|
| Rate for Payer: Cash Price |
$8,415.00
|
| Rate for Payer: Cigna Commercial |
$26,838.24
|
| Rate for Payer: Health EOS Commercial |
$25,963.08
|
| Rate for Payer: HFN Commercial |
$26,838.24
|
| Rate for Payer: Multiplan Commercial |
$23,337.60
|
| Rate for Payer: Preferred Network Access Commercial |
$26,838.24
|
| Rate for Payer: Quartz Beloit One Network |
$14,294.28
|
| Rate for Payer: Quartz Commercial |
$17,503.20
|
| Rate for Payer: WEA Trust Commercial |
$16,044.60
|
| Rate for Payer: WPS Commercial |
$21,606.92
|
|
|
AORTIC VALVE 21MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-21A
|
Facility
|
OP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074609
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,168.16 |
| Max. Negotiated Rate |
$26,838.24 |
| Rate for Payer: Aetna Commercial |
$26,254.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,087.92
|
| Rate for Payer: Aetna Managed Medicare |
$8,168.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,961.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,002.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,461.16
|
| Rate for Payer: Cash Price |
$8,415.00
|
| Rate for Payer: Cigna Commercial |
$26,838.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,325.10
|
| Rate for Payer: Health EOS Commercial |
$25,963.08
|
| Rate for Payer: HFN Commercial |
$26,838.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,879.00
|
| Rate for Payer: Multiplan Commercial |
$23,337.60
|
| Rate for Payer: NAPHCARE Commercial |
$17,503.20
|
| Rate for Payer: Preferred Network Access Commercial |
$26,838.24
|
| Rate for Payer: Quartz Beloit One Network |
$14,294.28
|
| Rate for Payer: Quartz Commercial |
$18,961.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17,503.20
|
| Rate for Payer: The Alliance Commercial |
$14,586.00
|
| Rate for Payer: WEA Trust Commercial |
$16,044.60
|
| Rate for Payer: WPS Commercial |
$21,606.92
|
|
|
AORTIC VALVE 22MM AP360 #505DA22
|
Facility
|
OP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,127.35 |
| Max. Negotiated Rate |
$33,275.59 |
| Rate for Payer: Aetna Commercial |
$32,552.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,105.44
|
| Rate for Payer: Aetna Managed Medicare |
$10,127.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,509.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,084.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,361.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,169.63
|
| Rate for Payer: Cash Price |
$10,433.40
|
| Rate for Payer: Cigna Commercial |
$33,275.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,240.80
|
| Rate for Payer: Health EOS Commercial |
$32,190.52
|
| Rate for Payer: HFN Commercial |
$33,275.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,126.84
|
| Rate for Payer: Multiplan Commercial |
$28,935.30
|
| Rate for Payer: NAPHCARE Commercial |
$21,701.47
|
| Rate for Payer: Preferred Network Access Commercial |
$33,275.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,722.87
|
| Rate for Payer: Quartz Commercial |
$23,509.93
|
| Rate for Payer: Quartz Medicare Advantage |
$21,701.47
|
| Rate for Payer: The Alliance Commercial |
$18,084.56
|
| Rate for Payer: WEA Trust Commercial |
$19,893.02
|
| Rate for Payer: WPS Commercial |
$26,789.49
|
|
|
AORTIC VALVE 22MM AP360 #505DA22
|
Facility
|
IP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973950
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,722.87 |
| Max. Negotiated Rate |
$33,275.59 |
| Rate for Payer: Aetna Commercial |
$32,552.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,169.63
|
| Rate for Payer: Cash Price |
$10,433.40
|
| Rate for Payer: Cigna Commercial |
$33,275.59
|
| Rate for Payer: Health EOS Commercial |
$32,190.52
|
| Rate for Payer: HFN Commercial |
$33,275.59
|
| Rate for Payer: Multiplan Commercial |
$28,935.30
|
| Rate for Payer: Preferred Network Access Commercial |
$33,275.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,722.87
|
| Rate for Payer: Quartz Commercial |
$21,701.47
|
| Rate for Payer: WEA Trust Commercial |
$19,893.02
|
| Rate for Payer: WPS Commercial |
$26,789.49
|
|
|
AORTIC VALVE 23MM MOSAIC ULTRA 305U23
|
Facility
|
IP
|
$39,917.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$20,341.70 |
| Max. Negotiated Rate |
$38,192.59 |
| Rate for Payer: Aetna Commercial |
$37,362.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,701.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,002.25
|
| Rate for Payer: Cash Price |
$11,975.10
|
| Rate for Payer: Cigna Commercial |
$38,192.59
|
| Rate for Payer: Health EOS Commercial |
$36,947.18
|
| Rate for Payer: HFN Commercial |
$38,192.59
|
| Rate for Payer: Multiplan Commercial |
$33,210.94
|
| Rate for Payer: Preferred Network Access Commercial |
$38,192.59
|
| Rate for Payer: Quartz Beloit One Network |
$20,341.70
|
| Rate for Payer: Quartz Commercial |
$24,908.21
|
| Rate for Payer: WEA Trust Commercial |
$22,832.52
|
| Rate for Payer: WPS Commercial |
$30,748.07
|
|
|
AORTIC VALVE 23MM MOSAIC ULTRA 305U23
|
Facility
|
OP
|
$39,917.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,623.83 |
| Max. Negotiated Rate |
$38,192.59 |
| Rate for Payer: Aetna Commercial |
$37,362.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,701.76
|
| Rate for Payer: Aetna Managed Medicare |
$11,623.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,983.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,756.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,926.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,002.25
|
| Rate for Payer: Cash Price |
$11,975.10
|
| Rate for Payer: Cigna Commercial |
$38,192.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,231.69
|
| Rate for Payer: Health EOS Commercial |
$36,947.18
|
| Rate for Payer: HFN Commercial |
$38,192.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,135.26
|
| Rate for Payer: Multiplan Commercial |
$33,210.94
|
| Rate for Payer: NAPHCARE Commercial |
$24,908.21
|
| Rate for Payer: Preferred Network Access Commercial |
$38,192.59
|
| Rate for Payer: Quartz Beloit One Network |
$20,341.70
|
| Rate for Payer: Quartz Commercial |
$26,983.89
|
| Rate for Payer: Quartz Medicare Advantage |
$24,908.21
|
| Rate for Payer: The Alliance Commercial |
$20,756.84
|
| Rate for Payer: WEA Trust Commercial |
$22,832.52
|
| Rate for Payer: WPS Commercial |
$30,748.07
|
|
|
AORTIC VALVE 23MM ON-X CONFORM-X SEWING RING ONXACE-23
|
Facility
|
IP
|
$23,935.00
|
|
| Hospital Charge Code |
5591402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,197.28 |
| Max. Negotiated Rate |
$22,901.01 |
| Rate for Payer: Aetna Commercial |
$22,403.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,407.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,192.97
|
| Rate for Payer: Cash Price |
$7,180.50
|
| Rate for Payer: Cigna Commercial |
$22,901.01
|
| Rate for Payer: Health EOS Commercial |
$22,154.24
|
| Rate for Payer: HFN Commercial |
$22,901.01
|
| Rate for Payer: Multiplan Commercial |
$19,913.92
|
| Rate for Payer: Preferred Network Access Commercial |
$22,901.01
|
| Rate for Payer: Quartz Beloit One Network |
$12,197.28
|
| Rate for Payer: Quartz Commercial |
$14,935.44
|
| Rate for Payer: WEA Trust Commercial |
$13,690.82
|
| Rate for Payer: WPS Commercial |
$18,437.13
|
|
|
AORTIC VALVE 23MM ON-X CONFORM-X SEWING RING ONXACE-23
|
Facility
|
OP
|
$23,935.00
|
|
| Hospital Charge Code |
5591402
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,969.87 |
| Max. Negotiated Rate |
$22,901.01 |
| Rate for Payer: Aetna Commercial |
$22,403.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,407.46
|
| Rate for Payer: Aetna Managed Medicare |
$6,969.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,180.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,446.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,948.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,192.97
|
| Rate for Payer: Cash Price |
$7,180.50
|
| Rate for Payer: Cigna Commercial |
$22,901.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,930.17
|
| Rate for Payer: Health EOS Commercial |
$22,154.24
|
| Rate for Payer: HFN Commercial |
$22,901.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,669.30
|
| Rate for Payer: Multiplan Commercial |
$19,913.92
|
| Rate for Payer: NAPHCARE Commercial |
$14,935.44
|
| Rate for Payer: Preferred Network Access Commercial |
$22,901.01
|
| Rate for Payer: Quartz Beloit One Network |
$12,197.28
|
| Rate for Payer: Quartz Commercial |
$16,180.06
|
| Rate for Payer: Quartz Medicare Advantage |
$14,935.44
|
| Rate for Payer: The Alliance Commercial |
$12,446.20
|
| Rate for Payer: WEA Trust Commercial |
$13,690.82
|
| Rate for Payer: WPS Commercial |
$18,437.13
|
|
|
AORTIC VALVE 23MM TRIFECTA TF-23A
|
Facility
|
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2974039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,456.23 |
| Max. Negotiated Rate |
$51,550.47 |
| Rate for Payer: Aetna Commercial |
$50,429.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48,188.48
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,697.55
|
| Rate for Payer: Cash Price |
$16,163.40
|
| Rate for Payer: Cigna Commercial |
$51,550.47
|
| Rate for Payer: Health EOS Commercial |
$49,869.48
|
| Rate for Payer: HFN Commercial |
$51,550.47
|
| Rate for Payer: Multiplan Commercial |
$44,826.50
|
| Rate for Payer: Preferred Network Access Commercial |
$51,550.47
|
| Rate for Payer: Quartz Beloit One Network |
$27,456.23
|
| Rate for Payer: Quartz Commercial |
$33,619.87
|
| Rate for Payer: WEA Trust Commercial |
$30,818.22
|
| Rate for Payer: WPS Commercial |
$41,502.22
|
|
|
AORTIC VALVE 23MM TRIFECTA TF-23A
|
Facility
|
OP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2974039
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,689.27 |
| Max. Negotiated Rate |
$51,550.47 |
| Rate for Payer: Aetna Commercial |
$50,429.81
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$48,188.48
|
| Rate for Payer: Aetna Managed Medicare |
$15,689.27
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$36,421.53
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,016.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,895.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,697.55
|
| Rate for Payer: Cash Price |
$16,163.40
|
| Rate for Payer: Cigna Commercial |
$51,550.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,357.00
|
| Rate for Payer: Health EOS Commercial |
$49,869.48
|
| Rate for Payer: HFN Commercial |
$51,550.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,024.84
|
| Rate for Payer: Multiplan Commercial |
$44,826.50
|
| Rate for Payer: NAPHCARE Commercial |
$33,619.87
|
| Rate for Payer: Preferred Network Access Commercial |
$51,550.47
|
| Rate for Payer: Quartz Beloit One Network |
$27,456.23
|
| Rate for Payer: Quartz Commercial |
$36,421.53
|
| Rate for Payer: Quartz Medicare Advantage |
$33,619.87
|
| Rate for Payer: The Alliance Commercial |
$28,016.56
|
| Rate for Payer: WEA Trust Commercial |
$30,818.22
|
| Rate for Payer: WPS Commercial |
$41,502.22
|
|
|
AORTIC VALVE 23MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-23A
|
Facility
|
OP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,168.16 |
| Max. Negotiated Rate |
$26,838.24 |
| Rate for Payer: Aetna Commercial |
$26,254.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,087.92
|
| Rate for Payer: Aetna Managed Medicare |
$8,168.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,961.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,586.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$14,002.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,461.16
|
| Rate for Payer: Cash Price |
$8,415.00
|
| Rate for Payer: Cigna Commercial |
$26,838.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$16,325.10
|
| Rate for Payer: Health EOS Commercial |
$25,963.08
|
| Rate for Payer: HFN Commercial |
$26,838.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,879.00
|
| Rate for Payer: Multiplan Commercial |
$23,337.60
|
| Rate for Payer: NAPHCARE Commercial |
$17,503.20
|
| Rate for Payer: Preferred Network Access Commercial |
$26,838.24
|
| Rate for Payer: Quartz Beloit One Network |
$14,294.28
|
| Rate for Payer: Quartz Commercial |
$18,961.80
|
| Rate for Payer: Quartz Medicare Advantage |
$17,503.20
|
| Rate for Payer: The Alliance Commercial |
$14,586.00
|
| Rate for Payer: WEA Trust Commercial |
$16,044.60
|
| Rate for Payer: WPS Commercial |
$21,606.92
|
|
|
AORTIC VALVE 23MM TRIFECTA WITH GLIDE TECHNOLOGY TFGT-23A
|
Facility
|
IP
|
$28,050.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
5074610
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$14,294.28 |
| Max. Negotiated Rate |
$26,838.24 |
| Rate for Payer: Aetna Commercial |
$26,254.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$25,087.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$15,461.16
|
| Rate for Payer: Cash Price |
$8,415.00
|
| Rate for Payer: Cigna Commercial |
$26,838.24
|
| Rate for Payer: Health EOS Commercial |
$25,963.08
|
| Rate for Payer: HFN Commercial |
$26,838.24
|
| Rate for Payer: Multiplan Commercial |
$23,337.60
|
| Rate for Payer: Preferred Network Access Commercial |
$26,838.24
|
| Rate for Payer: Quartz Beloit One Network |
$14,294.28
|
| Rate for Payer: Quartz Commercial |
$17,503.20
|
| Rate for Payer: WEA Trust Commercial |
$16,044.60
|
| Rate for Payer: WPS Commercial |
$21,606.92
|
|
|
AORTIC VALVE 24MM AP360 #505DA24
|
Facility
|
OP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,127.35 |
| Max. Negotiated Rate |
$33,275.59 |
| Rate for Payer: Aetna Commercial |
$32,552.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,105.44
|
| Rate for Payer: Aetna Managed Medicare |
$10,127.35
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$23,509.93
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,084.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,361.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,169.63
|
| Rate for Payer: Cash Price |
$10,433.40
|
| Rate for Payer: Cigna Commercial |
$33,275.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$20,240.80
|
| Rate for Payer: Health EOS Commercial |
$32,190.52
|
| Rate for Payer: HFN Commercial |
$33,275.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$27,126.84
|
| Rate for Payer: Multiplan Commercial |
$28,935.30
|
| Rate for Payer: NAPHCARE Commercial |
$21,701.47
|
| Rate for Payer: Preferred Network Access Commercial |
$33,275.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,722.87
|
| Rate for Payer: Quartz Commercial |
$23,509.93
|
| Rate for Payer: Quartz Medicare Advantage |
$21,701.47
|
| Rate for Payer: The Alliance Commercial |
$18,084.56
|
| Rate for Payer: WEA Trust Commercial |
$19,893.02
|
| Rate for Payer: WPS Commercial |
$26,789.49
|
|
|
AORTIC VALVE 24MM AP360 #505DA24
|
Facility
|
IP
|
$34,778.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973951
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,722.87 |
| Max. Negotiated Rate |
$33,275.59 |
| Rate for Payer: Aetna Commercial |
$32,552.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$31,105.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,169.63
|
| Rate for Payer: Cash Price |
$10,433.40
|
| Rate for Payer: Cigna Commercial |
$33,275.59
|
| Rate for Payer: Health EOS Commercial |
$32,190.52
|
| Rate for Payer: HFN Commercial |
$33,275.59
|
| Rate for Payer: Multiplan Commercial |
$28,935.30
|
| Rate for Payer: Preferred Network Access Commercial |
$33,275.59
|
| Rate for Payer: Quartz Beloit One Network |
$17,722.87
|
| Rate for Payer: Quartz Commercial |
$21,701.47
|
| Rate for Payer: WEA Trust Commercial |
$19,893.02
|
| Rate for Payer: WPS Commercial |
$26,789.49
|
|
|
AORTIC VALVE 25MM MOSAIC ULTRA 305U225
|
Facility
|
OP
|
$39,917.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2969900
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$11,623.83 |
| Max. Negotiated Rate |
$38,192.59 |
| Rate for Payer: Aetna Commercial |
$37,362.31
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$35,701.76
|
| Rate for Payer: Aetna Managed Medicare |
$11,623.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$26,983.89
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$20,756.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$19,926.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$22,002.25
|
| Rate for Payer: Cash Price |
$11,975.10
|
| Rate for Payer: Cigna Commercial |
$38,192.59
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$23,231.69
|
| Rate for Payer: Health EOS Commercial |
$36,947.18
|
| Rate for Payer: HFN Commercial |
$38,192.59
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$31,135.26
|
| Rate for Payer: Multiplan Commercial |
$33,210.94
|
| Rate for Payer: NAPHCARE Commercial |
$24,908.21
|
| Rate for Payer: Preferred Network Access Commercial |
$38,192.59
|
| Rate for Payer: Quartz Beloit One Network |
$20,341.70
|
| Rate for Payer: Quartz Commercial |
$26,983.89
|
| Rate for Payer: Quartz Medicare Advantage |
$24,908.21
|
| Rate for Payer: The Alliance Commercial |
$20,756.84
|
| Rate for Payer: WEA Trust Commercial |
$22,832.52
|
| Rate for Payer: WPS Commercial |
$30,748.07
|
|
