|
VAGINAL VAULT SUSPENSION
|
Facility
|
OP
|
$3,935.00
|
|
| Hospital Charge Code |
2960490
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,145.87 |
| Max. Negotiated Rate |
$3,765.01 |
| Rate for Payer: Aetna Commercial |
$3,683.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,519.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,145.87
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,660.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,046.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,964.35
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,168.97
|
| Rate for Payer: Cash Price |
$1,180.50
|
| Rate for Payer: Cigna Commercial |
$3,765.01
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,290.17
|
| Rate for Payer: Health EOS Commercial |
$3,642.24
|
| Rate for Payer: HFN Commercial |
$3,765.01
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,069.30
|
| Rate for Payer: Multiplan Commercial |
$3,273.92
|
| Rate for Payer: NAPHCARE Commercial |
$2,455.44
|
| Rate for Payer: Preferred Network Access Commercial |
$3,765.01
|
| Rate for Payer: Quartz Beloit One Network |
$2,005.28
|
| Rate for Payer: Quartz Commercial |
$2,660.06
|
| Rate for Payer: Quartz Medicare Advantage |
$2,455.44
|
| Rate for Payer: The Alliance Commercial |
$2,046.20
|
| Rate for Payer: WEA Trust Commercial |
$2,250.82
|
| Rate for Payer: WPS Commercial |
$3,031.13
|
|
|
VAGOTOMY
|
Facility
|
OP
|
$4,460.00
|
|
| Hospital Charge Code |
2960489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$1,298.75 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Aetna Managed Medicare |
$1,298.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,014.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,319.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,226.43
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,595.72
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,478.80
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: NAPHCARE Commercial |
$2,783.04
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$3,014.96
|
| Rate for Payer: Quartz Medicare Advantage |
$2,783.04
|
| Rate for Payer: The Alliance Commercial |
$2,319.20
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
VAGOTOMY
|
Facility
|
IP
|
$4,460.00
|
|
| Hospital Charge Code |
2960489
|
|
Hospital Revenue Code
|
360
|
| Min. Negotiated Rate |
$2,272.82 |
| Max. Negotiated Rate |
$4,267.33 |
| Rate for Payer: Aetna Commercial |
$4,174.56
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,989.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,458.35
|
| Rate for Payer: Cash Price |
$1,338.00
|
| Rate for Payer: Cigna Commercial |
$4,267.33
|
| Rate for Payer: Health EOS Commercial |
$4,128.18
|
| Rate for Payer: HFN Commercial |
$4,267.33
|
| Rate for Payer: Multiplan Commercial |
$3,710.72
|
| Rate for Payer: Preferred Network Access Commercial |
$4,267.33
|
| Rate for Payer: Quartz Beloit One Network |
$2,272.82
|
| Rate for Payer: Quartz Commercial |
$2,783.04
|
| Rate for Payer: WEA Trust Commercial |
$2,551.12
|
| Rate for Payer: WPS Commercial |
$3,435.54
|
|
|
Valproic Acid, Free
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$401.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$244.44
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$388.75
|
| Rate for Payer: HFN Commercial |
$401.86
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$401.86
|
| Rate for Payer: Quartz Beloit One Network |
$214.03
|
| Rate for Payer: Quartz Commercial |
$283.92
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$56.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: United Healthcare PPO |
$327.60
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: Wellcare Medicare |
$14.08
|
| Rate for Payer: WPS Commercial |
$323.53
|
|
|
Valproic Acid, Free
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$214.03 |
| Max. Negotiated Rate |
$401.86 |
| Rate for Payer: Aetna Commercial |
$393.12
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$231.50
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$401.86
|
| Rate for Payer: Health EOS Commercial |
$388.75
|
| Rate for Payer: HFN Commercial |
$401.86
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: Preferred Network Access Commercial |
$401.86
|
| Rate for Payer: Quartz Beloit One Network |
$214.03
|
| Rate for Payer: Quartz Commercial |
$262.08
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$323.53
|
|
|
Valproic Acid, Free
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$414.96 |
| Rate for Payer: Aetna Commercial |
$414.96
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$375.65
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$414.96
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$218.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$397.49
|
| Rate for Payer: HFN Commercial |
$414.96
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$349.44
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$414.96
|
| Rate for Payer: Quartz Beloit One Network |
$192.19
|
| Rate for Payer: Quartz Commercial |
$248.98
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$55.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: WEA Trust Commercial |
$240.24
|
| Rate for Payer: WPS Commercial |
$61.96
|
|
|
Valproic Acid Level
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$275.65 |
| Rate for Payer: Aetna Commercial |
$275.65
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$275.65
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$145.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$264.05
|
| Rate for Payer: HFN Commercial |
$275.65
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.71
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$49.71
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$275.65
|
| Rate for Payer: Quartz Beloit One Network |
$127.67
|
| Rate for Payer: Quartz Commercial |
$165.39
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$55.62
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$61.96
|
|
|
Valproic Acid Level
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$142.18 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$174.10
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
Valproic Acid Level
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$266.95 |
| Rate for Payer: Aetna Commercial |
$261.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$249.54
|
| Rate for Payer: Aetna Managed Medicare |
$14.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$52.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$24.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$23.38
|
| Rate for Payer: Anthem Medicare Advantage |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$153.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$14.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$14.08
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$266.95
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$162.38
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$258.24
|
| Rate for Payer: HFN Commercial |
$266.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$52.38
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$14.08
|
| Rate for Payer: Independent Care Health Plan Medicare |
$14.08
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$14.08
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$14.08
|
| Rate for Payer: Multiplan Commercial |
$232.13
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$266.95
|
| Rate for Payer: Quartz Beloit One Network |
$142.18
|
| Rate for Payer: Quartz Commercial |
$188.60
|
| Rate for Payer: Quartz Medicare Advantage |
$14.08
|
| Rate for Payer: The Alliance Commercial |
$56.33
|
| Rate for Payer: United Healthcare Medicare Advantage |
$14.08
|
| Rate for Payer: United Healthcare PPO |
$217.62
|
| Rate for Payer: WEA Trust Commercial |
$159.59
|
| Rate for Payer: Wellcare Medicare |
$14.08
|
| Rate for Payer: WPS Commercial |
$214.91
|
|
|
VALVE ANTI-REFLUX SALEM SUMP
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2963636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$61.66 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$75.50
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
VALVE ANTI-REFLUX SALEM SUMP
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2963636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$35.24 |
| Max. Negotiated Rate |
$115.77 |
| Rate for Payer: Aetna Commercial |
$113.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$108.22
|
| Rate for Payer: Aetna Managed Medicare |
$35.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$81.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$62.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$60.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$66.70
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$115.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$70.42
|
| Rate for Payer: Health EOS Commercial |
$112.00
|
| Rate for Payer: HFN Commercial |
$115.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$94.38
|
| Rate for Payer: Multiplan Commercial |
$100.67
|
| Rate for Payer: NAPHCARE Commercial |
$75.50
|
| Rate for Payer: Preferred Network Access Commercial |
$115.77
|
| Rate for Payer: Quartz Beloit One Network |
$61.66
|
| Rate for Payer: Quartz Commercial |
$81.80
|
| Rate for Payer: Quartz Medicare Advantage |
$75.50
|
| Rate for Payer: The Alliance Commercial |
$62.92
|
| Rate for Payer: WEA Trust Commercial |
$69.21
|
| Rate for Payer: WPS Commercial |
$93.21
|
|
|
VALVE CO PT BLEEDBACK #1003331
|
Facility
|
IP
|
$1,005.00
|
|
| Hospital Charge Code |
2971810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$512.15 |
| Max. Negotiated Rate |
$961.58 |
| Rate for Payer: Aetna Commercial |
$940.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$898.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.96
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: Health EOS Commercial |
$930.23
|
| Rate for Payer: HFN Commercial |
$961.58
|
| Rate for Payer: Multiplan Commercial |
$836.16
|
| Rate for Payer: Preferred Network Access Commercial |
$961.58
|
| Rate for Payer: Quartz Beloit One Network |
$512.15
|
| Rate for Payer: Quartz Commercial |
$627.12
|
| Rate for Payer: WEA Trust Commercial |
$574.86
|
| Rate for Payer: WPS Commercial |
$774.15
|
|
|
VALVE CO PT BLEEDBACK #1003331
|
Facility
|
OP
|
$1,005.00
|
|
| Hospital Charge Code |
2971810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$292.66 |
| Max. Negotiated Rate |
$961.58 |
| Rate for Payer: Aetna Commercial |
$940.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$898.87
|
| Rate for Payer: Aetna Managed Medicare |
$292.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$679.38
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$522.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$501.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$553.96
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$961.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$584.91
|
| Rate for Payer: Health EOS Commercial |
$930.23
|
| Rate for Payer: HFN Commercial |
$961.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$783.90
|
| Rate for Payer: Multiplan Commercial |
$836.16
|
| Rate for Payer: NAPHCARE Commercial |
$627.12
|
| Rate for Payer: Preferred Network Access Commercial |
$961.58
|
| Rate for Payer: Quartz Beloit One Network |
$512.15
|
| Rate for Payer: Quartz Commercial |
$679.38
|
| Rate for Payer: Quartz Medicare Advantage |
$627.12
|
| Rate for Payer: The Alliance Commercial |
$522.60
|
| Rate for Payer: WEA Trust Commercial |
$574.86
|
| Rate for Payer: WPS Commercial |
$774.15
|
|
|
VALVE CUTTER 2MM CH8686-1
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
2964853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$98.72 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Aetna Managed Medicare |
$98.72
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$229.16
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$176.28
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$169.23
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$197.30
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$264.42
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: NAPHCARE Commercial |
$211.54
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$229.16
|
| Rate for Payer: Quartz Medicare Advantage |
$211.54
|
| Rate for Payer: The Alliance Commercial |
$176.28
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
VALVE CUTTER 2MM CH8686-1
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
2964853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$172.75 |
| Max. Negotiated Rate |
$324.36 |
| Rate for Payer: Aetna Commercial |
$317.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$303.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$186.86
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$324.36
|
| Rate for Payer: Health EOS Commercial |
$313.78
|
| Rate for Payer: HFN Commercial |
$324.36
|
| Rate for Payer: Multiplan Commercial |
$282.05
|
| Rate for Payer: Preferred Network Access Commercial |
$324.36
|
| Rate for Payer: Quartz Beloit One Network |
$172.75
|
| Rate for Payer: Quartz Commercial |
$211.54
|
| Rate for Payer: WEA Trust Commercial |
$193.91
|
| Rate for Payer: WPS Commercial |
$261.13
|
|
|
VALVE CUTTER 3MM CH8686
|
Facility
|
OP
|
$1,358.00
|
|
| Hospital Charge Code |
2964854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$395.45 |
| Max. Negotiated Rate |
$1,299.33 |
| Rate for Payer: Aetna Commercial |
$1,271.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.60
|
| Rate for Payer: Aetna Managed Medicare |
$395.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$918.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$706.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$677.91
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.53
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$1,299.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$790.36
|
| Rate for Payer: Health EOS Commercial |
$1,256.96
|
| Rate for Payer: HFN Commercial |
$1,299.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,059.24
|
| Rate for Payer: Multiplan Commercial |
$1,129.86
|
| Rate for Payer: NAPHCARE Commercial |
$847.39
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.33
|
| Rate for Payer: Quartz Beloit One Network |
$692.04
|
| Rate for Payer: Quartz Commercial |
$918.01
|
| Rate for Payer: Quartz Medicare Advantage |
$847.39
|
| Rate for Payer: The Alliance Commercial |
$706.16
|
| Rate for Payer: WEA Trust Commercial |
$776.78
|
| Rate for Payer: WPS Commercial |
$1,046.07
|
|
|
VALVE CUTTER 3MM CH8686
|
Facility
|
IP
|
$1,358.00
|
|
| Hospital Charge Code |
2964854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$692.04 |
| Max. Negotiated Rate |
$1,299.33 |
| Rate for Payer: Aetna Commercial |
$1,271.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,214.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$748.53
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$1,299.33
|
| Rate for Payer: Health EOS Commercial |
$1,256.96
|
| Rate for Payer: HFN Commercial |
$1,299.33
|
| Rate for Payer: Multiplan Commercial |
$1,129.86
|
| Rate for Payer: Preferred Network Access Commercial |
$1,299.33
|
| Rate for Payer: Quartz Beloit One Network |
$692.04
|
| Rate for Payer: Quartz Commercial |
$847.39
|
| Rate for Payer: WEA Trust Commercial |
$776.78
|
| Rate for Payer: WPS Commercial |
$1,046.07
|
|
|
VALVE HEART AROTIC 23MM
|
Facility
|
OP
|
$54,883.00
|
|
| Hospital Charge Code |
2965106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,981.93 |
| Max. Negotiated Rate |
$52,512.05 |
| Rate for Payer: Aetna Commercial |
$51,370.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49,087.36
|
| Rate for Payer: Aetna Managed Medicare |
$15,981.93
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$37,100.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$28,539.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$27,397.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30,251.51
|
| Rate for Payer: Cash Price |
$16,464.90
|
| Rate for Payer: Cigna Commercial |
$52,512.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$31,941.91
|
| Rate for Payer: Health EOS Commercial |
$50,799.70
|
| Rate for Payer: HFN Commercial |
$52,512.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$42,808.74
|
| Rate for Payer: Multiplan Commercial |
$45,662.66
|
| Rate for Payer: NAPHCARE Commercial |
$34,246.99
|
| Rate for Payer: Preferred Network Access Commercial |
$52,512.05
|
| Rate for Payer: Quartz Beloit One Network |
$27,968.38
|
| Rate for Payer: Quartz Commercial |
$37,100.91
|
| Rate for Payer: Quartz Medicare Advantage |
$34,246.99
|
| Rate for Payer: The Alliance Commercial |
$28,539.16
|
| Rate for Payer: WEA Trust Commercial |
$31,393.08
|
| Rate for Payer: WPS Commercial |
$42,276.37
|
|
|
VALVE HEART AROTIC 23MM
|
Facility
|
IP
|
$54,883.00
|
|
| Hospital Charge Code |
2965106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$27,968.38 |
| Max. Negotiated Rate |
$52,512.05 |
| Rate for Payer: Aetna Commercial |
$51,370.49
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$49,087.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$30,251.51
|
| Rate for Payer: Cash Price |
$16,464.90
|
| Rate for Payer: Cigna Commercial |
$52,512.05
|
| Rate for Payer: Health EOS Commercial |
$50,799.70
|
| Rate for Payer: HFN Commercial |
$52,512.05
|
| Rate for Payer: Multiplan Commercial |
$45,662.66
|
| Rate for Payer: Preferred Network Access Commercial |
$52,512.05
|
| Rate for Payer: Quartz Beloit One Network |
$27,968.38
|
| Rate for Payer: Quartz Commercial |
$34,246.99
|
| Rate for Payer: WEA Trust Commercial |
$31,393.08
|
| Rate for Payer: WPS Commercial |
$42,276.37
|
|
|
VALVE LOPEZ ENTERAL
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
2972586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.63 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$41.18
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
VALVE LOPEZ ENTERAL
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
2972586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$19.22 |
| Max. Negotiated Rate |
$63.15 |
| Rate for Payer: Aetna Commercial |
$61.78
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$59.03
|
| Rate for Payer: Aetna Managed Medicare |
$19.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$44.62
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$34.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$32.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$36.38
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$63.15
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$38.41
|
| Rate for Payer: Health EOS Commercial |
$61.09
|
| Rate for Payer: HFN Commercial |
$63.15
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$51.48
|
| Rate for Payer: Multiplan Commercial |
$54.91
|
| Rate for Payer: NAPHCARE Commercial |
$41.18
|
| Rate for Payer: Preferred Network Access Commercial |
$63.15
|
| Rate for Payer: Quartz Beloit One Network |
$33.63
|
| Rate for Payer: Quartz Commercial |
$44.62
|
| Rate for Payer: Quartz Medicare Advantage |
$41.18
|
| Rate for Payer: The Alliance Commercial |
$34.32
|
| Rate for Payer: WEA Trust Commercial |
$37.75
|
| Rate for Payer: WPS Commercial |
$50.84
|
|
|
VALVE PASSY-MUIR ORIGINAL #PMV005
|
Facility
|
IP
|
$1,159.00
|
|
| Hospital Charge Code |
2972077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$590.63 |
| Max. Negotiated Rate |
$1,108.93 |
| Rate for Payer: Aetna Commercial |
$1,084.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,036.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.84
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cigna Commercial |
$1,108.93
|
| Rate for Payer: Health EOS Commercial |
$1,072.77
|
| Rate for Payer: HFN Commercial |
$1,108.93
|
| Rate for Payer: Multiplan Commercial |
$964.29
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.93
|
| Rate for Payer: Quartz Beloit One Network |
$590.63
|
| Rate for Payer: Quartz Commercial |
$723.22
|
| Rate for Payer: WEA Trust Commercial |
$662.95
|
| Rate for Payer: WPS Commercial |
$892.78
|
|
|
VALVE PASSY-MUIR ORIGINAL #PMV005
|
Facility
|
OP
|
$1,159.00
|
|
| Hospital Charge Code |
2972077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$337.50 |
| Max. Negotiated Rate |
$1,108.93 |
| Rate for Payer: Aetna Commercial |
$1,084.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,036.61
|
| Rate for Payer: Aetna Managed Medicare |
$337.50
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$783.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$602.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$578.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$638.84
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cigna Commercial |
$1,108.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$674.54
|
| Rate for Payer: Health EOS Commercial |
$1,072.77
|
| Rate for Payer: HFN Commercial |
$1,108.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$904.02
|
| Rate for Payer: Multiplan Commercial |
$964.29
|
| Rate for Payer: NAPHCARE Commercial |
$723.22
|
| Rate for Payer: Preferred Network Access Commercial |
$1,108.93
|
| Rate for Payer: Quartz Beloit One Network |
$590.63
|
| Rate for Payer: Quartz Commercial |
$783.48
|
| Rate for Payer: Quartz Medicare Advantage |
$723.22
|
| Rate for Payer: The Alliance Commercial |
$602.68
|
| Rate for Payer: WEA Trust Commercial |
$662.95
|
| Rate for Payer: WPS Commercial |
$892.78
|
|
|
VALVE PERICARDIAL TISSUE HRT
|
Facility
|
IP
|
$60,404.00
|
|
| Hospital Charge Code |
2965107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$30,781.88 |
| Max. Negotiated Rate |
$57,794.55 |
| Rate for Payer: Aetna Commercial |
$56,538.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54,025.34
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33,294.68
|
| Rate for Payer: Cash Price |
$18,121.20
|
| Rate for Payer: Cigna Commercial |
$57,794.55
|
| Rate for Payer: Health EOS Commercial |
$55,909.94
|
| Rate for Payer: HFN Commercial |
$57,794.55
|
| Rate for Payer: Multiplan Commercial |
$50,256.13
|
| Rate for Payer: Preferred Network Access Commercial |
$57,794.55
|
| Rate for Payer: Quartz Beloit One Network |
$30,781.88
|
| Rate for Payer: Quartz Commercial |
$37,692.10
|
| Rate for Payer: WEA Trust Commercial |
$34,551.09
|
| Rate for Payer: WPS Commercial |
$46,529.20
|
|
|
VALVE PERICARDIAL TISSUE HRT
|
Facility
|
OP
|
$60,404.00
|
|
| Hospital Charge Code |
2965107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$17,589.64 |
| Max. Negotiated Rate |
$57,794.55 |
| Rate for Payer: Aetna Commercial |
$56,538.14
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$54,025.34
|
| Rate for Payer: Aetna Managed Medicare |
$17,589.64
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$40,833.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$31,410.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$30,153.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$33,294.68
|
| Rate for Payer: Cash Price |
$18,121.20
|
| Rate for Payer: Cigna Commercial |
$57,794.55
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$35,155.13
|
| Rate for Payer: Health EOS Commercial |
$55,909.94
|
| Rate for Payer: HFN Commercial |
$57,794.55
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47,115.12
|
| Rate for Payer: Multiplan Commercial |
$50,256.13
|
| Rate for Payer: NAPHCARE Commercial |
$37,692.10
|
| Rate for Payer: Preferred Network Access Commercial |
$57,794.55
|
| Rate for Payer: Quartz Beloit One Network |
$30,781.88
|
| Rate for Payer: Quartz Commercial |
$40,833.10
|
| Rate for Payer: Quartz Medicare Advantage |
$37,692.10
|
| Rate for Payer: The Alliance Commercial |
$31,410.08
|
| Rate for Payer: WEA Trust Commercial |
$34,551.09
|
| Rate for Payer: WPS Commercial |
$46,529.20
|
|
