|
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
|
|
|
AORTIC VALVE 25MM ON-X CONFORM-X SEWING RING ONXACE-25
|
Facility
|
OP
|
$23,783.00
|
|
| Hospital Charge Code |
5617672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,925.61 |
| Max. Negotiated Rate |
$22,755.57 |
| Rate for Payer: Aetna Commercial |
$22,260.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,271.52
|
| Rate for Payer: Aetna Managed Medicare |
$6,925.61
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,077.31
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$12,367.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$11,872.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,109.19
|
| Rate for Payer: Cash Price |
$7,134.90
|
| Rate for Payer: Cigna Commercial |
$22,755.57
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$13,841.71
|
| Rate for Payer: Health EOS Commercial |
$22,013.54
|
| Rate for Payer: HFN Commercial |
$22,755.57
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$18,550.74
|
| Rate for Payer: Multiplan Commercial |
$19,787.46
|
| Rate for Payer: NAPHCARE Commercial |
$14,840.59
|
| Rate for Payer: Preferred Network Access Commercial |
$22,755.57
|
| Rate for Payer: Quartz Beloit One Network |
$12,119.82
|
| Rate for Payer: Quartz Commercial |
$16,077.31
|
| Rate for Payer: Quartz Medicare Advantage |
$14,840.59
|
| Rate for Payer: The Alliance Commercial |
$12,367.16
|
| Rate for Payer: WEA Trust Commercial |
$13,603.88
|
| Rate for Payer: WPS Commercial |
$18,320.04
|
|
|
AORTIC VALVE 25MM ON-X CONFORM-X SEWING RING ONXACE-25
|
Facility
|
IP
|
$23,783.00
|
|
| Hospital Charge Code |
5617672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$12,119.82 |
| Max. Negotiated Rate |
$22,755.57 |
| Rate for Payer: Aetna Commercial |
$22,260.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$21,271.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$13,109.19
|
| Rate for Payer: Cash Price |
$7,134.90
|
| Rate for Payer: Cigna Commercial |
$22,755.57
|
| Rate for Payer: Health EOS Commercial |
$22,013.54
|
| Rate for Payer: HFN Commercial |
$22,755.57
|
| Rate for Payer: Multiplan Commercial |
$19,787.46
|
| Rate for Payer: Preferred Network Access Commercial |
$22,755.57
|
| Rate for Payer: Quartz Beloit One Network |
$12,119.82
|
| Rate for Payer: Quartz Commercial |
$14,840.59
|
| Rate for Payer: WEA Trust Commercial |
$13,603.88
|
| Rate for Payer: WPS Commercial |
$18,320.04
|
|
|
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 |
$15,689.27 |
| 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 25MM TRIFECTA TF-25A
|
Facility
|
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966068
|
|
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 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 |
$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 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 |
$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 26MM AP360 #505DA26
|
Facility
|
IP
|
$36,115.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973952
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$18,404.20 |
| Max. Negotiated Rate |
$34,554.83 |
| Rate for Payer: Aetna Commercial |
$33,803.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32,301.26
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,906.59
|
| Rate for Payer: Cash Price |
$10,834.50
|
| Rate for Payer: Cigna Commercial |
$34,554.83
|
| Rate for Payer: Health EOS Commercial |
$33,428.04
|
| Rate for Payer: HFN Commercial |
$34,554.83
|
| Rate for Payer: Multiplan Commercial |
$30,047.68
|
| Rate for Payer: Preferred Network Access Commercial |
$34,554.83
|
| Rate for Payer: Quartz Beloit One Network |
$18,404.20
|
| Rate for Payer: Quartz Commercial |
$22,535.76
|
| Rate for Payer: WEA Trust Commercial |
$20,657.78
|
| Rate for Payer: WPS Commercial |
$27,819.38
|
|
|
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 |
$10,516.69 |
| Max. Negotiated Rate |
$34,554.83 |
| Rate for Payer: Aetna Commercial |
$33,803.64
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$32,301.26
|
| Rate for Payer: Aetna Managed Medicare |
$10,516.69
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$24,413.74
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,779.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,028.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$19,906.59
|
| Rate for Payer: Cash Price |
$10,834.50
|
| Rate for Payer: Cigna Commercial |
$34,554.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$21,018.93
|
| Rate for Payer: Health EOS Commercial |
$33,428.04
|
| Rate for Payer: HFN Commercial |
$34,554.83
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$28,169.70
|
| Rate for Payer: Multiplan Commercial |
$30,047.68
|
| Rate for Payer: NAPHCARE Commercial |
$22,535.76
|
| Rate for Payer: Preferred Network Access Commercial |
$34,554.83
|
| Rate for Payer: Quartz Beloit One Network |
$18,404.20
|
| Rate for Payer: Quartz Commercial |
$24,413.74
|
| Rate for Payer: Quartz Medicare Advantage |
$22,535.76
|
| Rate for Payer: The Alliance Commercial |
$18,779.80
|
| Rate for Payer: WEA Trust Commercial |
$20,657.78
|
| Rate for Payer: WPS Commercial |
$27,819.38
|
|
|
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 |
$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
|
|
|
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 |
$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
|
|
|
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 |
$15,689.27 |
| 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 27MM TRIFECTA TF-27A
|
Facility
|
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966069
|
|
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 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 |
$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 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 |
$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 29MM MOSAIC ULTRA 305U29
|
Facility
|
IP
|
$38,439.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2973957
|
|
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
|
|
|
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 |
$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
|
|
|
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 |
$15,689.27 |
| 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 29MM TRIFECTA TF-29A
|
Facility
|
IP
|
$53,878.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2966070
|
|
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 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 |
$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 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 |
$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 ATS 21MM
|
Facility
|
IP
|
$45,638.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2965348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$23,257.12 |
| Max. Negotiated Rate |
$43,666.44 |
| Rate for Payer: Aetna Commercial |
$42,717.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40,818.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25,155.67
|
| Rate for Payer: Cash Price |
$13,691.40
|
| Rate for Payer: Cigna Commercial |
$43,666.44
|
| Rate for Payer: Health EOS Commercial |
$42,242.53
|
| Rate for Payer: HFN Commercial |
$43,666.44
|
| Rate for Payer: Multiplan Commercial |
$37,970.82
|
| Rate for Payer: Preferred Network Access Commercial |
$43,666.44
|
| Rate for Payer: Quartz Beloit One Network |
$23,257.12
|
| Rate for Payer: Quartz Commercial |
$28,478.11
|
| Rate for Payer: WEA Trust Commercial |
$26,104.94
|
| Rate for Payer: WPS Commercial |
$35,154.95
|
|
|
AORTIC VALVE ATS 21MM
|
Facility
|
OP
|
$45,638.00
|
|
|
Service Code
|
HCPCS L8699
|
| Hospital Charge Code |
2965348
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$13,289.79 |
| Max. Negotiated Rate |
$43,666.44 |
| Rate for Payer: Aetna Commercial |
$42,717.17
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$40,818.63
|
| Rate for Payer: Aetna Managed Medicare |
$13,289.79
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$30,851.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23,731.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22,782.49
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$25,155.67
|
| Rate for Payer: Cash Price |
$13,691.40
|
| Rate for Payer: Cigna Commercial |
$43,666.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$26,561.32
|
| Rate for Payer: Health EOS Commercial |
$42,242.53
|
| Rate for Payer: HFN Commercial |
$43,666.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$35,597.64
|
| Rate for Payer: Multiplan Commercial |
$37,970.82
|
| Rate for Payer: NAPHCARE Commercial |
$28,478.11
|
| Rate for Payer: Preferred Network Access Commercial |
$43,666.44
|
| Rate for Payer: Quartz Beloit One Network |
$23,257.12
|
| Rate for Payer: Quartz Commercial |
$30,851.29
|
| Rate for Payer: Quartz Medicare Advantage |
$28,478.11
|
| Rate for Payer: The Alliance Commercial |
$23,731.76
|
| Rate for Payer: WEA Trust Commercial |
$26,104.94
|
| Rate for Payer: WPS Commercial |
$35,154.95
|
|
|
AORTIC VALVE REPLACEMENT
|
Facility
|
OP
|
$17,117.00
|
|
| Hospital Charge Code |
2960491
|
|
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
|
|
|
AORTIC VALVE REPLACEMENT
|
Facility
|
IP
|
$17,117.00
|
|
| Hospital Charge Code |
2960491
|
|
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
|
|
