|
Valproic Acid, Free
|
Facility
|
OP
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$378.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Aetna Managed Medicare |
$13.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.48
|
| Rate for Payer: Anthem Medicaid |
$13.99
|
| Rate for Payer: Anthem Medicare Advantage |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.54
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$386.40
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$235.03
|
| Rate for Payer: Dean Health Medicaid |
$13.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.54
|
| Rate for Payer: Health EOS Commercial |
$373.80
|
| Rate for Payer: HFN Commercial |
$386.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.54
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: NAPHCARE Commercial |
$20.31
|
| Rate for Payer: Preferred Network Access Commercial |
$386.40
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.99
|
| Rate for Payer: Quartz Beloit One Network |
$205.80
|
| Rate for Payer: Quartz Commercial |
$273.00
|
| Rate for Payer: Quartz Medicare Advantage |
$13.54
|
| Rate for Payer: The Alliance Commercial |
$54.16
|
| Rate for Payer: United Healthcare Medicaid |
$13.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare PPO |
$315.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: Wellcare Medicare |
$13.54
|
| Rate for Payer: WMAP Medicaid |
$13.99
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Valproic Acid, Free
|
Professional
|
Both
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$399.00 |
| Rate for Payer: Aetna Commercial |
$399.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$399.00
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$210.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$252.00
|
| Rate for Payer: Health EOS Commercial |
$382.20
|
| Rate for Payer: HFN Commercial |
$399.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.80
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: Preferred Network Access Commercial |
$399.00
|
| Rate for Payer: Quartz Beloit One Network |
$184.80
|
| Rate for Payer: Quartz Commercial |
$239.40
|
| Rate for Payer: The Alliance Commercial |
$210.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Valproic Acid, Free
|
Facility
|
IP
|
$420.00
|
|
|
Service Code
|
CPT 80165
|
| Hospital Charge Code |
983432
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$205.80 |
| Max. Negotiated Rate |
$386.40 |
| Rate for Payer: Aetna Commercial |
$378.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$361.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$222.60
|
| Rate for Payer: Cash Price |
$126.00
|
| Rate for Payer: Cigna Commercial |
$386.40
|
| Rate for Payer: Health EOS Commercial |
$373.80
|
| Rate for Payer: HFN Commercial |
$386.40
|
| Rate for Payer: Multiplan Commercial |
$336.00
|
| Rate for Payer: NAPHCARE Commercial |
$252.00
|
| Rate for Payer: Preferred Network Access Commercial |
$386.40
|
| Rate for Payer: Quartz Beloit One Network |
$205.80
|
| Rate for Payer: Quartz Commercial |
$252.00
|
| Rate for Payer: WEA Trust Commercial |
$231.00
|
| Rate for Payer: WPS Commercial |
$311.09
|
|
|
Valproic Acid Level
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$136.71 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$167.40
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$167.40
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Valproic Acid Level
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$13.54 |
| Max. Negotiated Rate |
$256.68 |
| Rate for Payer: Aetna Commercial |
$251.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Aetna Managed Medicare |
$13.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$50.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$23.70
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$22.48
|
| Rate for Payer: Anthem Medicaid |
$13.99
|
| Rate for Payer: Anthem Medicare Advantage |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$147.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$13.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$13.54
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$256.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$13.54
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$13.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$156.13
|
| Rate for Payer: Dean Health Medicaid |
$13.99
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$13.54
|
| Rate for Payer: Health EOS Commercial |
$248.31
|
| Rate for Payer: HFN Commercial |
$256.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$50.37
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$13.54
|
| Rate for Payer: Independent Care Health Plan Medicaid |
$13.99
|
| Rate for Payer: Independent Care Health Plan Medicare |
$13.54
|
| Rate for Payer: Managed Health Services Medicaid |
$14.55
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$13.54
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$13.54
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: NAPHCARE Commercial |
$20.31
|
| Rate for Payer: Preferred Network Access Commercial |
$256.68
|
| Rate for Payer: Quartz Badgercare/Employee Trust Funds/QHP |
$13.99
|
| Rate for Payer: Quartz Beloit One Network |
$136.71
|
| Rate for Payer: Quartz Commercial |
$181.35
|
| Rate for Payer: Quartz Medicare Advantage |
$13.54
|
| Rate for Payer: The Alliance Commercial |
$54.16
|
| Rate for Payer: United Healthcare Medicaid |
$13.99
|
| Rate for Payer: United Healthcare Medicare Advantage |
$13.54
|
| Rate for Payer: United Healthcare PPO |
$209.25
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: Wellcare Medicare |
$13.54
|
| Rate for Payer: WMAP Medicaid |
$13.99
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
Valproic Acid Level
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 80164
|
| Hospital Charge Code |
633867
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$47.80 |
| Max. Negotiated Rate |
$265.05 |
| Rate for Payer: Aetna Commercial |
$265.05
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$239.94
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cash Price |
$83.70
|
| Rate for Payer: Cigna Commercial |
$265.05
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$139.50
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$167.40
|
| Rate for Payer: Health EOS Commercial |
$253.89
|
| Rate for Payer: HFN Commercial |
$265.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$47.80
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$47.80
|
| Rate for Payer: Multiplan Commercial |
$223.20
|
| Rate for Payer: Preferred Network Access Commercial |
$265.05
|
| Rate for Payer: Quartz Beloit One Network |
$122.76
|
| Rate for Payer: Quartz Commercial |
$159.03
|
| Rate for Payer: The Alliance Commercial |
$139.50
|
| Rate for Payer: WEA Trust Commercial |
$153.45
|
| Rate for Payer: WPS Commercial |
$206.66
|
|
|
VALVE ANTI-REFLUX SALEM SUMP
|
Facility
|
IP
|
$121.00
|
|
| Hospital Charge Code |
2963636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$59.29 |
| Max. Negotiated Rate |
$111.32 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$72.60
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
VALVE ANTI-REFLUX SALEM SUMP
|
Facility
|
OP
|
$121.00
|
|
| Hospital Charge Code |
2963636
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$33.88 |
| Max. Negotiated Rate |
$484.00 |
| Rate for Payer: Aetna Commercial |
$108.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$104.06
|
| Rate for Payer: Aetna Managed Medicare |
$33.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$78.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$60.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$58.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$64.13
|
| Rate for Payer: Cash Price |
$36.30
|
| Rate for Payer: Cigna Commercial |
$111.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$67.71
|
| Rate for Payer: Health EOS Commercial |
$107.69
|
| Rate for Payer: HFN Commercial |
$111.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$90.75
|
| Rate for Payer: Multiplan Commercial |
$96.80
|
| Rate for Payer: NAPHCARE Commercial |
$72.60
|
| Rate for Payer: Preferred Network Access Commercial |
$111.32
|
| Rate for Payer: Quartz Beloit One Network |
$59.29
|
| Rate for Payer: Quartz Commercial |
$78.65
|
| Rate for Payer: Quartz Medicare Advantage |
$72.60
|
| Rate for Payer: The Alliance Commercial |
$484.00
|
| Rate for Payer: WEA Trust Commercial |
$66.55
|
| Rate for Payer: WPS Commercial |
$89.62
|
|
|
VALVE CO PT BLEEDBACK #1003331
|
Facility
|
OP
|
$1,005.00
|
|
| Hospital Charge Code |
2971810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$281.40 |
| Max. Negotiated Rate |
$4,020.00 |
| Rate for Payer: Aetna Commercial |
$904.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.30
|
| Rate for Payer: Aetna Managed Medicare |
$281.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$653.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$502.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$482.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$532.65
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$924.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$562.40
|
| Rate for Payer: Health EOS Commercial |
$894.45
|
| Rate for Payer: HFN Commercial |
$924.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$753.75
|
| Rate for Payer: Multiplan Commercial |
$804.00
|
| Rate for Payer: NAPHCARE Commercial |
$603.00
|
| Rate for Payer: Preferred Network Access Commercial |
$924.60
|
| Rate for Payer: Quartz Beloit One Network |
$492.45
|
| Rate for Payer: Quartz Commercial |
$653.25
|
| Rate for Payer: Quartz Medicare Advantage |
$603.00
|
| Rate for Payer: The Alliance Commercial |
$4,020.00
|
| Rate for Payer: WEA Trust Commercial |
$552.75
|
| Rate for Payer: WPS Commercial |
$744.40
|
|
|
VALVE CO PT BLEEDBACK #1003331
|
Facility
|
IP
|
$1,005.00
|
|
| Hospital Charge Code |
2971810
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$492.45 |
| Max. Negotiated Rate |
$924.60 |
| Rate for Payer: Aetna Commercial |
$904.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$864.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$532.65
|
| Rate for Payer: Cash Price |
$301.50
|
| Rate for Payer: Cigna Commercial |
$924.60
|
| Rate for Payer: Health EOS Commercial |
$894.45
|
| Rate for Payer: HFN Commercial |
$924.60
|
| Rate for Payer: Multiplan Commercial |
$804.00
|
| Rate for Payer: NAPHCARE Commercial |
$603.00
|
| Rate for Payer: Preferred Network Access Commercial |
$924.60
|
| Rate for Payer: Quartz Beloit One Network |
$492.45
|
| Rate for Payer: Quartz Commercial |
$603.00
|
| Rate for Payer: WEA Trust Commercial |
$552.75
|
| Rate for Payer: WPS Commercial |
$744.40
|
|
|
VALVE CUTTER 2MM CH8686-1
|
Facility
|
IP
|
$339.00
|
|
| Hospital Charge Code |
2964853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$166.11 |
| Max. Negotiated Rate |
$311.88 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$203.40
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
VALVE CUTTER 2MM CH8686-1
|
Facility
|
OP
|
$339.00
|
|
| Hospital Charge Code |
2964853
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$94.92 |
| Max. Negotiated Rate |
$1,356.00 |
| Rate for Payer: Aetna Commercial |
$305.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$291.54
|
| Rate for Payer: Aetna Managed Medicare |
$94.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$220.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$169.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$162.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$179.67
|
| Rate for Payer: Cash Price |
$101.70
|
| Rate for Payer: Cigna Commercial |
$311.88
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$189.70
|
| Rate for Payer: Health EOS Commercial |
$301.71
|
| Rate for Payer: HFN Commercial |
$311.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$254.25
|
| Rate for Payer: Multiplan Commercial |
$271.20
|
| Rate for Payer: NAPHCARE Commercial |
$203.40
|
| Rate for Payer: Preferred Network Access Commercial |
$311.88
|
| Rate for Payer: Quartz Beloit One Network |
$166.11
|
| Rate for Payer: Quartz Commercial |
$220.35
|
| Rate for Payer: Quartz Medicare Advantage |
$203.40
|
| Rate for Payer: The Alliance Commercial |
$1,356.00
|
| Rate for Payer: WEA Trust Commercial |
$186.45
|
| Rate for Payer: WPS Commercial |
$251.10
|
|
|
VALVE CUTTER 3MM CH8686
|
Facility
|
OP
|
$1,358.00
|
|
| Hospital Charge Code |
2964854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$380.24 |
| Max. Negotiated Rate |
$5,432.00 |
| Rate for Payer: Aetna Commercial |
$1,222.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.88
|
| Rate for Payer: Aetna Managed Medicare |
$380.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$882.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$679.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$651.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.74
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$1,249.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$759.94
|
| Rate for Payer: Health EOS Commercial |
$1,208.62
|
| Rate for Payer: HFN Commercial |
$1,249.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,018.50
|
| Rate for Payer: Multiplan Commercial |
$1,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$814.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,249.36
|
| Rate for Payer: Quartz Beloit One Network |
$665.42
|
| Rate for Payer: Quartz Commercial |
$882.70
|
| Rate for Payer: Quartz Medicare Advantage |
$814.80
|
| Rate for Payer: The Alliance Commercial |
$5,432.00
|
| Rate for Payer: WEA Trust Commercial |
$746.90
|
| Rate for Payer: WPS Commercial |
$1,005.87
|
|
|
VALVE CUTTER 3MM CH8686
|
Facility
|
IP
|
$1,358.00
|
|
| Hospital Charge Code |
2964854
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$665.42 |
| Max. Negotiated Rate |
$1,249.36 |
| Rate for Payer: Aetna Commercial |
$1,222.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,167.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$719.74
|
| Rate for Payer: Cash Price |
$407.40
|
| Rate for Payer: Cigna Commercial |
$1,249.36
|
| Rate for Payer: Health EOS Commercial |
$1,208.62
|
| Rate for Payer: HFN Commercial |
$1,249.36
|
| Rate for Payer: Multiplan Commercial |
$1,086.40
|
| Rate for Payer: NAPHCARE Commercial |
$814.80
|
| Rate for Payer: Preferred Network Access Commercial |
$1,249.36
|
| Rate for Payer: Quartz Beloit One Network |
$665.42
|
| Rate for Payer: Quartz Commercial |
$814.80
|
| Rate for Payer: WEA Trust Commercial |
$746.90
|
| Rate for Payer: WPS Commercial |
$1,005.87
|
|
|
VALVE HEART AROTIC 23MM
|
Facility
|
OP
|
$54,883.00
|
|
| Hospital Charge Code |
2965106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$15,367.24 |
| Max. Negotiated Rate |
$219,532.00 |
| Rate for Payer: Aetna Commercial |
$49,394.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47,199.38
|
| Rate for Payer: Aetna Managed Medicare |
$15,367.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$35,673.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$27,441.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$26,343.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,087.99
|
| Rate for Payer: Cash Price |
$16,464.90
|
| Rate for Payer: Cigna Commercial |
$50,492.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$30,712.53
|
| Rate for Payer: Health EOS Commercial |
$48,845.87
|
| Rate for Payer: HFN Commercial |
$50,492.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$41,162.25
|
| Rate for Payer: Multiplan Commercial |
$43,906.40
|
| Rate for Payer: NAPHCARE Commercial |
$32,929.80
|
| Rate for Payer: Preferred Network Access Commercial |
$50,492.36
|
| Rate for Payer: Quartz Beloit One Network |
$26,892.67
|
| Rate for Payer: Quartz Commercial |
$35,673.95
|
| Rate for Payer: Quartz Medicare Advantage |
$32,929.80
|
| Rate for Payer: The Alliance Commercial |
$219,532.00
|
| Rate for Payer: WEA Trust Commercial |
$30,185.65
|
| Rate for Payer: WPS Commercial |
$40,651.84
|
|
|
VALVE HEART AROTIC 23MM
|
Facility
|
IP
|
$54,883.00
|
|
| Hospital Charge Code |
2965106
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$26,892.67 |
| Max. Negotiated Rate |
$50,492.36 |
| Rate for Payer: Aetna Commercial |
$49,394.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$47,199.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$29,087.99
|
| Rate for Payer: Cash Price |
$16,464.90
|
| Rate for Payer: Cigna Commercial |
$50,492.36
|
| Rate for Payer: Health EOS Commercial |
$48,845.87
|
| Rate for Payer: HFN Commercial |
$50,492.36
|
| Rate for Payer: Multiplan Commercial |
$43,906.40
|
| Rate for Payer: NAPHCARE Commercial |
$32,929.80
|
| Rate for Payer: Preferred Network Access Commercial |
$50,492.36
|
| Rate for Payer: Quartz Beloit One Network |
$26,892.67
|
| Rate for Payer: Quartz Commercial |
$32,929.80
|
| Rate for Payer: WEA Trust Commercial |
$30,185.65
|
| Rate for Payer: WPS Commercial |
$40,651.84
|
|
|
VALVE LOPEZ ENTERAL
|
Facility
|
IP
|
$66.00
|
|
| Hospital Charge Code |
2972586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$32.34 |
| Max. Negotiated Rate |
$60.72 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$39.60
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
VALVE LOPEZ ENTERAL
|
Facility
|
OP
|
$66.00
|
|
| Hospital Charge Code |
2972586
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$18.48 |
| Max. Negotiated Rate |
$264.00 |
| Rate for Payer: Aetna Commercial |
$59.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$56.76
|
| Rate for Payer: Aetna Managed Medicare |
$18.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$42.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$33.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$31.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$34.98
|
| Rate for Payer: Cash Price |
$19.80
|
| Rate for Payer: Cigna Commercial |
$60.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$36.93
|
| Rate for Payer: Health EOS Commercial |
$58.74
|
| Rate for Payer: HFN Commercial |
$60.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$49.50
|
| Rate for Payer: Multiplan Commercial |
$52.80
|
| Rate for Payer: NAPHCARE Commercial |
$39.60
|
| Rate for Payer: Preferred Network Access Commercial |
$60.72
|
| Rate for Payer: Quartz Beloit One Network |
$32.34
|
| Rate for Payer: Quartz Commercial |
$42.90
|
| Rate for Payer: Quartz Medicare Advantage |
$39.60
|
| Rate for Payer: The Alliance Commercial |
$264.00
|
| Rate for Payer: WEA Trust Commercial |
$36.30
|
| Rate for Payer: WPS Commercial |
$48.89
|
|
|
VALVE PASSY-MUIR ORIGINAL #PMV005
|
Facility
|
IP
|
$1,159.00
|
|
| Hospital Charge Code |
2972077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$567.91 |
| Max. Negotiated Rate |
$1,066.28 |
| Rate for Payer: Aetna Commercial |
$1,043.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$996.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.27
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cigna Commercial |
$1,066.28
|
| Rate for Payer: Health EOS Commercial |
$1,031.51
|
| Rate for Payer: HFN Commercial |
$1,066.28
|
| Rate for Payer: Multiplan Commercial |
$927.20
|
| Rate for Payer: NAPHCARE Commercial |
$695.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,066.28
|
| Rate for Payer: Quartz Beloit One Network |
$567.91
|
| Rate for Payer: Quartz Commercial |
$695.40
|
| Rate for Payer: WEA Trust Commercial |
$637.45
|
| Rate for Payer: WPS Commercial |
$858.47
|
|
|
VALVE PASSY-MUIR ORIGINAL #PMV005
|
Facility
|
OP
|
$1,159.00
|
|
| Hospital Charge Code |
2972077
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$324.52 |
| Max. Negotiated Rate |
$4,636.00 |
| Rate for Payer: Aetna Commercial |
$1,043.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$996.74
|
| Rate for Payer: Aetna Managed Medicare |
$324.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$753.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$579.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$556.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$614.27
|
| Rate for Payer: Cash Price |
$347.70
|
| Rate for Payer: Cigna Commercial |
$1,066.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$648.58
|
| Rate for Payer: Health EOS Commercial |
$1,031.51
|
| Rate for Payer: HFN Commercial |
$1,066.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$869.25
|
| Rate for Payer: Multiplan Commercial |
$927.20
|
| Rate for Payer: NAPHCARE Commercial |
$695.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,066.28
|
| Rate for Payer: Quartz Beloit One Network |
$567.91
|
| Rate for Payer: Quartz Commercial |
$753.35
|
| Rate for Payer: Quartz Medicare Advantage |
$695.40
|
| Rate for Payer: The Alliance Commercial |
$4,636.00
|
| Rate for Payer: WEA Trust Commercial |
$637.45
|
| Rate for Payer: WPS Commercial |
$858.47
|
|
|
VALVE PERICARDIAL TISSUE HRT
|
Facility
|
IP
|
$60,404.00
|
|
| Hospital Charge Code |
2965107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$29,597.96 |
| Max. Negotiated Rate |
$55,571.68 |
| Rate for Payer: Aetna Commercial |
$54,363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51,947.44
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32,014.12
|
| Rate for Payer: Cash Price |
$18,121.20
|
| Rate for Payer: Cigna Commercial |
$55,571.68
|
| Rate for Payer: Health EOS Commercial |
$53,759.56
|
| Rate for Payer: HFN Commercial |
$55,571.68
|
| Rate for Payer: Multiplan Commercial |
$48,323.20
|
| Rate for Payer: NAPHCARE Commercial |
$36,242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$55,571.68
|
| Rate for Payer: Quartz Beloit One Network |
$29,597.96
|
| Rate for Payer: Quartz Commercial |
$36,242.40
|
| Rate for Payer: WEA Trust Commercial |
$33,222.20
|
| Rate for Payer: WPS Commercial |
$44,741.24
|
|
|
VALVE PERICARDIAL TISSUE HRT
|
Facility
|
OP
|
$60,404.00
|
|
| Hospital Charge Code |
2965107
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$16,913.12 |
| Max. Negotiated Rate |
$241,616.00 |
| Rate for Payer: Aetna Commercial |
$54,363.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$51,947.44
|
| Rate for Payer: Aetna Managed Medicare |
$16,913.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$39,262.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$30,202.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$28,993.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$32,014.12
|
| Rate for Payer: Cash Price |
$18,121.20
|
| Rate for Payer: Cigna Commercial |
$55,571.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$33,802.08
|
| Rate for Payer: Health EOS Commercial |
$53,759.56
|
| Rate for Payer: HFN Commercial |
$55,571.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,303.00
|
| Rate for Payer: Multiplan Commercial |
$48,323.20
|
| Rate for Payer: NAPHCARE Commercial |
$36,242.40
|
| Rate for Payer: Preferred Network Access Commercial |
$55,571.68
|
| Rate for Payer: Quartz Beloit One Network |
$29,597.96
|
| Rate for Payer: Quartz Commercial |
$39,262.60
|
| Rate for Payer: Quartz Medicare Advantage |
$36,242.40
|
| Rate for Payer: The Alliance Commercial |
$241,616.00
|
| Rate for Payer: WEA Trust Commercial |
$33,222.20
|
| Rate for Payer: WPS Commercial |
$44,741.24
|
|
|
Valvuloplasty-Percutaneous Aortic Valve
|
Facility
|
OP
|
$11,496.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
5280751
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,633.04 |
| Max. Negotiated Rate |
$22,597.64 |
| Rate for Payer: Aetna Commercial |
$10,346.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,886.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,649.41
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,318.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$13,785.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,096.00
|
| Rate for Payer: Anthem Medicare Advantage |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,092.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,649.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,649.41
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cigna Commercial |
$10,576.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,649.41
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,433.16
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,649.41
|
| Rate for Payer: Health EOS Commercial |
$10,231.44
|
| Rate for Payer: HFN Commercial |
$10,576.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$21,015.81
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,649.41
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,649.41
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,649.41
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,649.41
|
| Rate for Payer: Multiplan Commercial |
$9,196.80
|
| Rate for Payer: NAPHCARE Commercial |
$8,474.12
|
| Rate for Payer: Preferred Network Access Commercial |
$10,576.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,633.04
|
| Rate for Payer: Quartz Commercial |
$7,472.40
|
| Rate for Payer: Quartz Medicare Advantage |
$5,649.41
|
| Rate for Payer: The Alliance Commercial |
$22,597.64
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,649.41
|
| Rate for Payer: United Healthcare PPO |
$6,154.00
|
| Rate for Payer: WEA Trust Commercial |
$6,322.80
|
| Rate for Payer: Wellcare Medicare |
$5,649.41
|
| Rate for Payer: WPS Commercial |
$8,515.09
|
|
|
Valvuloplasty-Percutaneous Aortic Valve
|
Facility
|
IP
|
$11,496.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
5280751
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,633.04 |
| Max. Negotiated Rate |
$10,576.32 |
| Rate for Payer: Aetna Commercial |
$10,346.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,886.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,092.88
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cigna Commercial |
$10,576.32
|
| Rate for Payer: Health EOS Commercial |
$10,231.44
|
| Rate for Payer: HFN Commercial |
$10,576.32
|
| Rate for Payer: Multiplan Commercial |
$9,196.80
|
| Rate for Payer: NAPHCARE Commercial |
$6,897.60
|
| Rate for Payer: Preferred Network Access Commercial |
$10,576.32
|
| Rate for Payer: Quartz Beloit One Network |
$5,633.04
|
| Rate for Payer: Quartz Commercial |
$6,897.60
|
| Rate for Payer: WEA Trust Commercial |
$6,322.80
|
| Rate for Payer: WPS Commercial |
$8,515.09
|
|
|
VALVULOTOME TRU-INCISE TIVK2030
|
Facility
|
IP
|
$4,805.00
|
|
| Hospital Charge Code |
2973635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,354.45 |
| Max. Negotiated Rate |
$4,420.60 |
| Rate for Payer: Aetna Commercial |
$4,324.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,132.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,546.65
|
| Rate for Payer: Cash Price |
$1,441.50
|
| Rate for Payer: Cigna Commercial |
$4,420.60
|
| Rate for Payer: Health EOS Commercial |
$4,276.45
|
| Rate for Payer: HFN Commercial |
$4,420.60
|
| Rate for Payer: Multiplan Commercial |
$3,844.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,883.00
|
| Rate for Payer: Preferred Network Access Commercial |
$4,420.60
|
| Rate for Payer: Quartz Beloit One Network |
$2,354.45
|
| Rate for Payer: Quartz Commercial |
$2,883.00
|
| Rate for Payer: WEA Trust Commercial |
$2,642.75
|
| Rate for Payer: WPS Commercial |
$3,559.06
|
|
