|
STENT 8 X 22 BLACK SILICONE LOOP G15127
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2965886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.40 |
| Max. Negotiated Rate |
$7,220.00 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Aetna Managed Medicare |
$505.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$902.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.08
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,353.75
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,173.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.00
|
| Rate for Payer: The Alliance Commercial |
$7,220.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
STENT 8 X 22 BLACK SILICONE LOOP G15127
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2965886
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.45 |
| Max. Negotiated Rate |
$1,660.60 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,083.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
STENT 8 X 24 BLACK SILICONE LOOP G15128
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2965887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.45 |
| Max. Negotiated Rate |
$1,660.60 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,083.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
STENT 8 X 24 BLACK SILICONE LOOP G15128
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2965887
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.40 |
| Max. Negotiated Rate |
$7,220.00 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Aetna Managed Medicare |
$505.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$902.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.08
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,353.75
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,173.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.00
|
| Rate for Payer: The Alliance Commercial |
$7,220.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
STENT 8 X 26 BLACK SILICONE LOOP G15130
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2965888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.45 |
| Max. Negotiated Rate |
$1,660.60 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,083.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
STENT 8 X 26 BLACK SILICONE LOOP G15130
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2965888
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.40 |
| Max. Negotiated Rate |
$7,220.00 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Aetna Managed Medicare |
$505.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$902.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.08
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,353.75
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,173.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.00
|
| Rate for Payer: The Alliance Commercial |
$7,220.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
STENT 8 X 28 BLACK SILICONE LOOP G15129
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2965889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.40 |
| Max. Negotiated Rate |
$7,220.00 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Aetna Managed Medicare |
$505.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$902.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.08
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,353.75
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,173.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.00
|
| Rate for Payer: The Alliance Commercial |
$7,220.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
STENT 8 X 28 BLACK SILICONE LOOP G15129
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2965889
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.45 |
| Max. Negotiated Rate |
$1,660.60 |
| Rate for Payer: Aetna Commercial |
$1,624.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.65
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,660.60
|
| Rate for Payer: Health EOS Commercial |
$1,606.45
|
| Rate for Payer: HFN Commercial |
$1,660.60
|
| Rate for Payer: Multiplan Commercial |
$1,444.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,660.60
|
| Rate for Payer: Quartz Beloit One Network |
$884.45
|
| Rate for Payer: Quartz Commercial |
$1,083.00
|
| Rate for Payer: WEA Trust Commercial |
$992.75
|
| Rate for Payer: WPS Commercial |
$1,336.96
|
|
|
STENT 8 X 28 FIRM G49923
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.50
|
| Rate for Payer: Aetna Managed Medicare |
$399.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$926.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$712.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.25
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,311.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$797.43
|
| Rate for Payer: Health EOS Commercial |
$1,268.25
|
| Rate for Payer: HFN Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.75
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: NAPHCARE Commercial |
$855.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.00
|
| Rate for Payer: Quartz Beloit One Network |
$698.25
|
| Rate for Payer: Quartz Commercial |
$926.25
|
| Rate for Payer: Quartz Medicare Advantage |
$855.00
|
| Rate for Payer: The Alliance Commercial |
$5,700.00
|
| Rate for Payer: WEA Trust Commercial |
$783.75
|
| Rate for Payer: WPS Commercial |
$1,055.50
|
|
|
STENT 8 X 28 FIRM G49923
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965890
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.25
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,311.00
|
| Rate for Payer: Health EOS Commercial |
$1,268.25
|
| Rate for Payer: HFN Commercial |
$1,311.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: NAPHCARE Commercial |
$855.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.00
|
| Rate for Payer: Quartz Beloit One Network |
$698.25
|
| Rate for Payer: Quartz Commercial |
$855.00
|
| Rate for Payer: WEA Trust Commercial |
$783.75
|
| Rate for Payer: WPS Commercial |
$1,055.50
|
|
|
STENT 8 X 28 SOFT G49991
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.25
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,311.00
|
| Rate for Payer: Health EOS Commercial |
$1,268.25
|
| Rate for Payer: HFN Commercial |
$1,311.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: NAPHCARE Commercial |
$855.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.00
|
| Rate for Payer: Quartz Beloit One Network |
$698.25
|
| Rate for Payer: Quartz Commercial |
$855.00
|
| Rate for Payer: WEA Trust Commercial |
$783.75
|
| Rate for Payer: WPS Commercial |
$1,055.50
|
|
|
STENT 8 X 28 SOFT G49991
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965891
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.50
|
| Rate for Payer: Aetna Managed Medicare |
$399.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$926.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$712.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.25
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,311.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$797.43
|
| Rate for Payer: Health EOS Commercial |
$1,268.25
|
| Rate for Payer: HFN Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.75
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: NAPHCARE Commercial |
$855.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.00
|
| Rate for Payer: Quartz Beloit One Network |
$698.25
|
| Rate for Payer: Quartz Commercial |
$926.25
|
| Rate for Payer: Quartz Medicare Advantage |
$855.00
|
| Rate for Payer: The Alliance Commercial |
$5,700.00
|
| Rate for Payer: WEA Trust Commercial |
$783.75
|
| Rate for Payer: WPS Commercial |
$1,055.50
|
|
|
STENT 8 X 30 FIRM G49924
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.25
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,311.00
|
| Rate for Payer: Health EOS Commercial |
$1,268.25
|
| Rate for Payer: HFN Commercial |
$1,311.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: NAPHCARE Commercial |
$855.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.00
|
| Rate for Payer: Quartz Beloit One Network |
$698.25
|
| Rate for Payer: Quartz Commercial |
$855.00
|
| Rate for Payer: WEA Trust Commercial |
$783.75
|
| Rate for Payer: WPS Commercial |
$1,055.50
|
|
|
STENT 8 X 30 FIRM G49924
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965892
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.50
|
| Rate for Payer: Aetna Managed Medicare |
$399.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$926.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$712.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.25
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,311.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$797.43
|
| Rate for Payer: Health EOS Commercial |
$1,268.25
|
| Rate for Payer: HFN Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.75
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: NAPHCARE Commercial |
$855.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.00
|
| Rate for Payer: Quartz Beloit One Network |
$698.25
|
| Rate for Payer: Quartz Commercial |
$926.25
|
| Rate for Payer: Quartz Medicare Advantage |
$855.00
|
| Rate for Payer: The Alliance Commercial |
$5,700.00
|
| Rate for Payer: WEA Trust Commercial |
$783.75
|
| Rate for Payer: WPS Commercial |
$1,055.50
|
|
|
STENT 8 X 30 SOFT G49992
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$399.00 |
| Max. Negotiated Rate |
$5,700.00 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.50
|
| Rate for Payer: Aetna Managed Medicare |
$399.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$926.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$712.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$684.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.25
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,311.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$797.43
|
| Rate for Payer: Health EOS Commercial |
$1,268.25
|
| Rate for Payer: HFN Commercial |
$1,311.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,068.75
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: NAPHCARE Commercial |
$855.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.00
|
| Rate for Payer: Quartz Beloit One Network |
$698.25
|
| Rate for Payer: Quartz Commercial |
$926.25
|
| Rate for Payer: Quartz Medicare Advantage |
$855.00
|
| Rate for Payer: The Alliance Commercial |
$5,700.00
|
| Rate for Payer: WEA Trust Commercial |
$783.75
|
| Rate for Payer: WPS Commercial |
$1,055.50
|
|
|
STENT 8 X 30 SOFT G49992
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965893
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$698.25 |
| Max. Negotiated Rate |
$1,311.00 |
| Rate for Payer: Aetna Commercial |
$1,282.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,225.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$755.25
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,311.00
|
| Rate for Payer: Health EOS Commercial |
$1,268.25
|
| Rate for Payer: HFN Commercial |
$1,311.00
|
| Rate for Payer: Multiplan Commercial |
$1,140.00
|
| Rate for Payer: NAPHCARE Commercial |
$855.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,311.00
|
| Rate for Payer: Quartz Beloit One Network |
$698.25
|
| Rate for Payer: Quartz Commercial |
$855.00
|
| Rate for Payer: WEA Trust Commercial |
$783.75
|
| Rate for Payer: WPS Commercial |
$1,055.50
|
|
|
STENT 8 x 37mm 80cm PXB35-08-37-080
|
Facility
|
OP
|
$6,442.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3533497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.76 |
| Max. Negotiated Rate |
$25,768.00 |
| Rate for Payer: Aetna Commercial |
$5,797.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,540.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,187.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,221.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,092.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.26
|
| Rate for Payer: Cash Price |
$1,932.60
|
| Rate for Payer: Cigna Commercial |
$5,926.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.94
|
| Rate for Payer: Health EOS Commercial |
$5,733.38
|
| Rate for Payer: HFN Commercial |
$5,926.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.50
|
| Rate for Payer: Multiplan Commercial |
$5,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.58
|
| Rate for Payer: Quartz Commercial |
$4,187.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.20
|
| Rate for Payer: The Alliance Commercial |
$25,768.00
|
| Rate for Payer: WEA Trust Commercial |
$3,543.10
|
| Rate for Payer: WPS Commercial |
$4,771.59
|
|
|
STENT 8 x 37mm 80cm PXB35-08-37-080
|
Facility
|
IP
|
$6,442.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3533497
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,156.58 |
| Max. Negotiated Rate |
$5,926.64 |
| Rate for Payer: Aetna Commercial |
$5,797.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,540.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.26
|
| Rate for Payer: Cash Price |
$1,932.60
|
| Rate for Payer: Cigna Commercial |
$5,926.64
|
| Rate for Payer: Health EOS Commercial |
$5,733.38
|
| Rate for Payer: HFN Commercial |
$5,926.64
|
| Rate for Payer: Multiplan Commercial |
$5,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.58
|
| Rate for Payer: Quartz Commercial |
$3,865.20
|
| Rate for Payer: WEA Trust Commercial |
$3,543.10
|
| Rate for Payer: WPS Commercial |
$4,771.59
|
|
|
STENT 9 x 37mm 80cm PXB35-09-37-080
|
Facility
|
IP
|
$6,442.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3533498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,156.58 |
| Max. Negotiated Rate |
$5,926.64 |
| Rate for Payer: Aetna Commercial |
$5,797.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,540.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.26
|
| Rate for Payer: Cash Price |
$1,932.60
|
| Rate for Payer: Cigna Commercial |
$5,926.64
|
| Rate for Payer: Health EOS Commercial |
$5,733.38
|
| Rate for Payer: HFN Commercial |
$5,926.64
|
| Rate for Payer: Multiplan Commercial |
$5,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.58
|
| Rate for Payer: Quartz Commercial |
$3,865.20
|
| Rate for Payer: WEA Trust Commercial |
$3,543.10
|
| Rate for Payer: WPS Commercial |
$4,771.59
|
|
|
STENT 9 x 37mm 80cm PXB35-09-37-080
|
Facility
|
OP
|
$6,442.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3533498
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.76 |
| Max. Negotiated Rate |
$25,768.00 |
| Rate for Payer: Aetna Commercial |
$5,797.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,540.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,187.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,221.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,092.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.26
|
| Rate for Payer: Cash Price |
$1,932.60
|
| Rate for Payer: Cigna Commercial |
$5,926.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.94
|
| Rate for Payer: Health EOS Commercial |
$5,733.38
|
| Rate for Payer: HFN Commercial |
$5,926.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.50
|
| Rate for Payer: Multiplan Commercial |
$5,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.58
|
| Rate for Payer: Quartz Commercial |
$4,187.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.20
|
| Rate for Payer: The Alliance Commercial |
$25,768.00
|
| Rate for Payer: WEA Trust Commercial |
$3,543.10
|
| Rate for Payer: WPS Commercial |
$4,771.59
|
|
|
Stent Artery (Ex LE,Car,Cor,Vert) ea add +
|
Facility
|
OP
|
$1,579.00
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
4125707
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$442.12 |
| Max. Negotiated Rate |
$11,874.87 |
| Rate for Payer: Aetna Commercial |
$1,421.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,357.94
|
| Rate for Payer: Aetna Managed Medicare |
$442.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,026.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$789.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$757.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$836.87
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cigna Commercial |
$1,452.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$1,405.31
|
| Rate for Payer: HFN Commercial |
$1,452.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,184.25
|
| Rate for Payer: Multiplan Commercial |
$1,263.20
|
| Rate for Payer: NAPHCARE Commercial |
$947.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,452.68
|
| Rate for Payer: Quartz Beloit One Network |
$773.71
|
| Rate for Payer: Quartz Commercial |
$1,026.35
|
| Rate for Payer: Quartz Medicare Advantage |
$947.40
|
| Rate for Payer: The Alliance Commercial |
$6,316.00
|
| Rate for Payer: WEA Trust Commercial |
$868.45
|
| Rate for Payer: WPS Commercial |
$1,169.57
|
|
|
Stent Artery (Ex LE,Car,Cor,Vert) ea add +
|
Facility
|
IP
|
$1,579.00
|
|
|
Service Code
|
CPT 37237
|
| Hospital Charge Code |
4125707
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$773.71 |
| Max. Negotiated Rate |
$1,452.68 |
| Rate for Payer: Aetna Commercial |
$1,421.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,357.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$836.87
|
| Rate for Payer: Cash Price |
$473.70
|
| Rate for Payer: Cigna Commercial |
$1,452.68
|
| Rate for Payer: Health EOS Commercial |
$1,405.31
|
| Rate for Payer: HFN Commercial |
$1,452.68
|
| Rate for Payer: Multiplan Commercial |
$1,263.20
|
| Rate for Payer: NAPHCARE Commercial |
$947.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,452.68
|
| Rate for Payer: Quartz Beloit One Network |
$773.71
|
| Rate for Payer: Quartz Commercial |
$947.40
|
| Rate for Payer: WEA Trust Commercial |
$868.45
|
| Rate for Payer: WPS Commercial |
$1,169.57
|
|
|
Stent Artery (EX LE,Car,Cor,Vert) Incl PTA
|
Facility
|
OP
|
$5,371.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
4125708
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,631.79 |
| Max. Negotiated Rate |
$43,494.48 |
| Rate for Payer: Aetna Commercial |
$4,833.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,619.06
|
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,846.63
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cash Price |
$1,611.30
|
| Rate for Payer: Cash Price |
$1,611.30
|
| Rate for Payer: Cash Price |
$1,611.30
|
| Rate for Payer: Cigna Commercial |
$4,941.32
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Health EOS Commercial |
$4,780.19
|
| Rate for Payer: HFN Commercial |
$4,941.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: Multiplan Commercial |
$4,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$4,941.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,631.79
|
| Rate for Payer: Quartz Commercial |
$3,491.15
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: The Alliance Commercial |
$43,494.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$2,954.05
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$3,978.30
|
|
|
Stent Artery (EX LE,Car,Cor,Vert) Incl PTA
|
Facility
|
IP
|
$5,371.00
|
|
|
Service Code
|
CPT 37236
|
| Hospital Charge Code |
4125708
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,631.79 |
| Max. Negotiated Rate |
$4,941.32 |
| Rate for Payer: Aetna Commercial |
$4,833.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,619.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,846.63
|
| Rate for Payer: Cash Price |
$1,611.30
|
| Rate for Payer: Cigna Commercial |
$4,941.32
|
| Rate for Payer: Health EOS Commercial |
$4,780.19
|
| Rate for Payer: HFN Commercial |
$4,941.32
|
| Rate for Payer: Multiplan Commercial |
$4,296.80
|
| Rate for Payer: NAPHCARE Commercial |
$3,222.60
|
| Rate for Payer: Preferred Network Access Commercial |
$4,941.32
|
| Rate for Payer: Quartz Beloit One Network |
$2,631.79
|
| Rate for Payer: Quartz Commercial |
$3,222.60
|
| Rate for Payer: WEA Trust Commercial |
$2,954.05
|
| Rate for Payer: WPS Commercial |
$3,978.30
|
|
|
STENT BANDER URETERAL DIVERSION 7.2FR X75CM G18070
|
Facility
|
OP
|
$4,290.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
2965894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,201.20 |
| Max. Negotiated Rate |
$17,160.00 |
| Rate for Payer: Aetna Commercial |
$3,861.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,689.40
|
| Rate for Payer: Aetna Managed Medicare |
$1,201.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,788.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,145.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,059.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,273.70
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna Commercial |
$3,946.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,400.68
|
| Rate for Payer: Health EOS Commercial |
$3,818.10
|
| Rate for Payer: HFN Commercial |
$3,946.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,217.50
|
| Rate for Payer: Multiplan Commercial |
$3,432.00
|
| Rate for Payer: NAPHCARE Commercial |
$2,574.00
|
| Rate for Payer: Preferred Network Access Commercial |
$3,946.80
|
| Rate for Payer: Quartz Beloit One Network |
$2,102.10
|
| Rate for Payer: Quartz Commercial |
$2,788.50
|
| Rate for Payer: Quartz Medicare Advantage |
$2,574.00
|
| Rate for Payer: The Alliance Commercial |
$17,160.00
|
| Rate for Payer: WEA Trust Commercial |
$2,359.50
|
| Rate for Payer: WPS Commercial |
$3,177.60
|
|
