|
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 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 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 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 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 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 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
|
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
|
|
|
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
|
|
|
Valvuloplasty-Percutaneous Aortic Valve
|
Facility
|
OP
|
$11,496.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
5280751
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,858.36 |
| Max. Negotiated Rate |
$23,958.98 |
| Rate for Payer: Aetna Commercial |
$10,760.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,282.02
|
| Rate for Payer: Aetna Managed Medicare |
$5,989.74
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$16,970.72
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$14,336.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$13,619.84
|
| Rate for Payer: Anthem Medicare Advantage |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,336.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$5,989.74
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$5,989.74
|
| 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 |
$10,999.37
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$5,989.74
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,690.67
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$5,989.74
|
| Rate for Payer: Health EOS Commercial |
$10,640.70
|
| Rate for Payer: HFN Commercial |
$10,999.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$22,281.85
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$5,989.74
|
| Rate for Payer: Independent Care Health Plan Medicare |
$5,989.74
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$5,989.74
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$5,989.74
|
| Rate for Payer: Multiplan Commercial |
$9,564.67
|
| Rate for Payer: NAPHCARE Commercial |
$8,984.62
|
| Rate for Payer: Preferred Network Access Commercial |
$10,999.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,858.36
|
| Rate for Payer: Quartz Commercial |
$7,771.30
|
| Rate for Payer: Quartz Medicare Advantage |
$5,989.74
|
| Rate for Payer: The Alliance Commercial |
$23,958.98
|
| Rate for Payer: United Healthcare Medicare Advantage |
$5,989.74
|
| Rate for Payer: United Healthcare PPO |
$6,400.16
|
| Rate for Payer: WEA Trust Commercial |
$6,575.71
|
| Rate for Payer: Wellcare Medicare |
$5,989.74
|
| Rate for Payer: WPS Commercial |
$8,855.37
|
|
|
Valvuloplasty-Percutaneous Aortic Valve
|
Facility
|
IP
|
$11,496.00
|
|
|
Service Code
|
CPT 92986
|
| Hospital Charge Code |
5280751
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,858.36 |
| Max. Negotiated Rate |
$10,999.37 |
| Rate for Payer: Aetna Commercial |
$10,760.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,282.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,336.60
|
| Rate for Payer: Cash Price |
$3,448.80
|
| Rate for Payer: Cigna Commercial |
$10,999.37
|
| Rate for Payer: Health EOS Commercial |
$10,640.70
|
| Rate for Payer: HFN Commercial |
$10,999.37
|
| Rate for Payer: Multiplan Commercial |
$9,564.67
|
| Rate for Payer: Preferred Network Access Commercial |
$10,999.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,858.36
|
| Rate for Payer: Quartz Commercial |
$7,173.50
|
| Rate for Payer: WEA Trust Commercial |
$6,575.71
|
| Rate for Payer: WPS Commercial |
$8,855.37
|
|
|
VALVULOTOME TRU-INCISE TIVK2030
|
Facility
|
OP
|
$4,805.00
|
|
| Hospital Charge Code |
2973635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,399.22 |
| Max. Negotiated Rate |
$4,597.42 |
| Rate for Payer: Aetna Commercial |
$4,497.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,297.59
|
| Rate for Payer: Aetna Managed Medicare |
$1,399.22
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,248.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,498.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,398.66
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,648.52
|
| Rate for Payer: Cash Price |
$1,441.50
|
| Rate for Payer: Cigna Commercial |
$4,597.42
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,796.51
|
| Rate for Payer: Health EOS Commercial |
$4,447.51
|
| Rate for Payer: HFN Commercial |
$4,597.42
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,747.90
|
| Rate for Payer: Multiplan Commercial |
$3,997.76
|
| Rate for Payer: NAPHCARE Commercial |
$2,998.32
|
| Rate for Payer: Preferred Network Access Commercial |
$4,597.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,448.63
|
| Rate for Payer: Quartz Commercial |
$3,248.18
|
| Rate for Payer: Quartz Medicare Advantage |
$2,998.32
|
| Rate for Payer: The Alliance Commercial |
$2,498.60
|
| Rate for Payer: WEA Trust Commercial |
$2,748.46
|
| Rate for Payer: WPS Commercial |
$3,701.29
|
|
|
VALVULOTOME TRU-INCISE TIVK2030
|
Facility
|
IP
|
$4,805.00
|
|
| Hospital Charge Code |
2973635
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,448.63 |
| Max. Negotiated Rate |
$4,597.42 |
| Rate for Payer: Aetna Commercial |
$4,497.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,297.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,648.52
|
| Rate for Payer: Cash Price |
$1,441.50
|
| Rate for Payer: Cigna Commercial |
$4,597.42
|
| Rate for Payer: Health EOS Commercial |
$4,447.51
|
| Rate for Payer: HFN Commercial |
$4,597.42
|
| Rate for Payer: Multiplan Commercial |
$3,997.76
|
| Rate for Payer: Preferred Network Access Commercial |
$4,597.42
|
| Rate for Payer: Quartz Beloit One Network |
$2,448.63
|
| Rate for Payer: Quartz Commercial |
$2,998.32
|
| Rate for Payer: WEA Trust Commercial |
$2,748.46
|
| Rate for Payer: WPS Commercial |
$3,701.29
|
|
|
Vancomycin
|
Facility
|
IP
|
$32.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4075402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$16.31 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$19.97
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$24.65
|
|
|
Vancomycin
|
Facility
|
OP
|
$32.00
|
|
|
Service Code
|
HCPCS J3370
|
| Hospital Charge Code |
4075402
|
|
Hospital Revenue Code
|
636
|
| Min. Negotiated Rate |
$3.55 |
| Max. Negotiated Rate |
$30.62 |
| Rate for Payer: Aetna Commercial |
$29.95
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$28.62
|
| Rate for Payer: Aetna Managed Medicare |
$9.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$21.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$16.64
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$15.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$17.64
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cash Price |
$9.60
|
| Rate for Payer: Cigna Commercial |
$30.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3.55
|
| Rate for Payer: Health EOS Commercial |
$29.62
|
| Rate for Payer: HFN Commercial |
$30.62
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$24.96
|
| Rate for Payer: Multiplan Commercial |
$26.62
|
| Rate for Payer: NAPHCARE Commercial |
$19.97
|
| Rate for Payer: Preferred Network Access Commercial |
$30.62
|
| Rate for Payer: Quartz Beloit One Network |
$16.31
|
| Rate for Payer: Quartz Commercial |
$21.63
|
| Rate for Payer: Quartz Medicare Advantage |
$19.97
|
| Rate for Payer: The Alliance Commercial |
$16.64
|
| Rate for Payer: WEA Trust Commercial |
$18.30
|
| Rate for Payer: WPS Commercial |
$6.70
|
|
|
Vancomycin, Kinetics
|
Professional
|
Both
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
979882
|
|
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
|
|
|
Vancomycin, Kinetics
|
Facility
|
OP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
979882
|
|
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
|
|
|
Vancomycin, Kinetics
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
979882
|
|
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
|
|
|
Vancomycin Level Peak
|
Facility
|
IP
|
$262.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$133.52 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$144.41
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| Rate for Payer: Multiplan Commercial |
$217.98
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$163.49
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
Vancomycin Level Peak
|
Facility
|
OP
|
$262.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$250.68 |
| Rate for Payer: Aetna Commercial |
$245.23
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| 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 |
$144.41
|
| 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 |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$250.68
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$14.08
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$152.48
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$242.51
|
| Rate for Payer: HFN Commercial |
$250.68
|
| 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 |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$250.68
|
| Rate for Payer: Quartz Beloit One Network |
$133.52
|
| Rate for Payer: Quartz Commercial |
$177.11
|
| 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 |
$204.36
|
| Rate for Payer: WEA Trust Commercial |
$149.86
|
| Rate for Payer: Wellcare Medicare |
$14.08
|
| Rate for Payer: WPS Commercial |
$201.82
|
|
|
Vancomycin Level Peak
|
Professional
|
Both
|
$262.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633869
|
|
Hospital Revenue Code
|
300
|
| Min. Negotiated Rate |
$14.08 |
| Max. Negotiated Rate |
$258.86 |
| Rate for Payer: Aetna Commercial |
$258.86
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$234.33
|
| 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 |
$78.60
|
| Rate for Payer: Cash Price |
$78.60
|
| Rate for Payer: Cigna Commercial |
$258.86
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$136.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$14.08
|
| Rate for Payer: Health EOS Commercial |
$247.96
|
| Rate for Payer: HFN Commercial |
$258.86
|
| 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 |
$217.98
|
| Rate for Payer: NAPHCARE Commercial |
$21.12
|
| Rate for Payer: Preferred Network Access Commercial |
$258.86
|
| Rate for Payer: Quartz Beloit One Network |
$119.89
|
| Rate for Payer: Quartz Commercial |
$155.31
|
| 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 |
$149.86
|
| Rate for Payer: WPS Commercial |
$61.96
|
|
|
Vancomycin Level Trough
|
Facility
|
IP
|
$279.00
|
|
|
Service Code
|
CPT 80202
|
| Hospital Charge Code |
633870
|
|
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
|
|
