STENT 10 X 37mm 80cm PXB35-10-37
|
Facility
IP
|
$6,442.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
3533499
|
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: 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 3.0 X 23mm
|
Facility
IP
|
$17,406.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
2973743
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,528.94 |
Max. Negotiated Rate |
$16,013.52 |
Rate for Payer: Aetna Commercial |
$15,665.40
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
Rate for Payer: Cash Price |
$5,221.80
|
Rate for Payer: Cigna Commercial |
$16,013.52
|
Rate for Payer: Health EOS Commercial |
$15,491.34
|
Rate for Payer: HFN Commercial |
$16,013.52
|
Rate for Payer: Multiplan Commercial |
$13,924.80
|
Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
Rate for Payer: Quartz Commercial |
$10,443.60
|
Rate for Payer: WEA Trust Commercial |
$9,573.30
|
Rate for Payer: WPS Commercial |
$12,892.62
|
|
STENT 3.0 X 23mm
|
Facility
OP
|
$17,406.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
2973743
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,873.68 |
Max. Negotiated Rate |
$16,013.52 |
Rate for Payer: Aetna Commercial |
$15,665.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
Rate for Payer: Aetna Managed Medicare |
$4,873.68
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,313.90
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,703.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,354.88
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
Rate for Payer: Cash Price |
$5,221.80
|
Rate for Payer: Cigna Commercial |
$16,013.52
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$9,740.40
|
Rate for Payer: Health EOS Commercial |
$15,491.34
|
Rate for Payer: HFN Commercial |
$16,013.52
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,054.50
|
Rate for Payer: Multiplan Commercial |
$13,924.80
|
Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
Rate for Payer: Quartz Commercial |
$11,313.90
|
Rate for Payer: Quartz Medicare Advantage |
$10,443.60
|
Rate for Payer: WEA Trust Commercial |
$9,573.30
|
Rate for Payer: WPS Commercial |
$12,892.62
|
|
STENT 3.5 X 23mm #1007849-23
|
Facility
OP
|
$17,406.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
2973850
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$4,873.68 |
Max. Negotiated Rate |
$16,013.52 |
Rate for Payer: Aetna Commercial |
$15,665.40
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
Rate for Payer: Aetna Managed Medicare |
$4,873.68
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,313.90
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,703.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,354.88
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
Rate for Payer: Cash Price |
$5,221.80
|
Rate for Payer: Cigna Commercial |
$16,013.52
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$9,740.40
|
Rate for Payer: Health EOS Commercial |
$15,491.34
|
Rate for Payer: HFN Commercial |
$16,013.52
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,054.50
|
Rate for Payer: Multiplan Commercial |
$13,924.80
|
Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
Rate for Payer: Quartz Commercial |
$11,313.90
|
Rate for Payer: Quartz Medicare Advantage |
$10,443.60
|
Rate for Payer: WEA Trust Commercial |
$9,573.30
|
Rate for Payer: WPS Commercial |
$12,892.62
|
|
STENT 3.5 X 23mm #1007849-23
|
Facility
IP
|
$17,406.00
|
|
Service Code
|
HCPCS C1876
|
Hospital Charge Code |
2973850
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$8,528.94 |
Max. Negotiated Rate |
$16,013.52 |
Rate for Payer: Aetna Commercial |
$15,665.40
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
Rate for Payer: Cash Price |
$5,221.80
|
Rate for Payer: Cigna Commercial |
$16,013.52
|
Rate for Payer: Health EOS Commercial |
$15,491.34
|
Rate for Payer: HFN Commercial |
$16,013.52
|
Rate for Payer: Multiplan Commercial |
$13,924.80
|
Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
Rate for Payer: Quartz Commercial |
$10,443.60
|
Rate for Payer: WEA Trust Commercial |
$9,573.30
|
Rate for Payer: WPS Commercial |
$12,892.62
|
|
STENT 4X BILIARY 7FR. 5CM
|
Facility
IP
|
$1,630.00
|
|
Hospital Charge Code |
2972365
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$798.70 |
Max. Negotiated Rate |
$1,499.60 |
Rate for Payer: Aetna Commercial |
$1,467.00
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
Rate for Payer: Cash Price |
$489.00
|
Rate for Payer: Cigna Commercial |
$1,499.60
|
Rate for Payer: Health EOS Commercial |
$1,450.70
|
Rate for Payer: HFN Commercial |
$1,499.60
|
Rate for Payer: Multiplan Commercial |
$1,304.00
|
Rate for Payer: NAPHCARE Commercial |
$978.00
|
Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
Rate for Payer: Quartz Beloit One Network |
$798.70
|
Rate for Payer: Quartz Commercial |
$978.00
|
Rate for Payer: WEA Trust Commercial |
$896.50
|
Rate for Payer: WPS Commercial |
$1,207.34
|
|
STENT 4X BILIARY 7FR. 5CM
|
Facility
OP
|
$1,630.00
|
|
Hospital Charge Code |
2972365
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$456.40 |
Max. Negotiated Rate |
$6,520.00 |
Rate for Payer: Aetna Commercial |
$1,467.00
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
Rate for Payer: Aetna Managed Medicare |
$456.40
|
Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
Rate for Payer: Cash Price |
$489.00
|
Rate for Payer: Cigna Commercial |
$1,499.60
|
Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
Rate for Payer: Health EOS Commercial |
$1,450.70
|
Rate for Payer: HFN Commercial |
$1,499.60
|
Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
Rate for Payer: Multiplan Commercial |
$1,304.00
|
Rate for Payer: NAPHCARE Commercial |
$978.00
|
Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
Rate for Payer: Quartz Beloit One Network |
$798.70
|
Rate for Payer: Quartz Commercial |
$1,059.50
|
Rate for Payer: Quartz Medicare Advantage |
$978.00
|
Rate for Payer: The Alliance Commercial |
$6,520.00
|
Rate for Payer: WEA Trust Commercial |
$896.50
|
Rate for Payer: WPS Commercial |
$1,207.34
|
|
STENT 5X20 LOOP 155-220
|
Facility
OP
|
$1,805.00
|
|
Hospital Charge Code |
2964811
|
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 5X20 LOOP 155-220
|
Facility
IP
|
$1,805.00
|
|
Hospital Charge Code |
2964811
|
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: 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 5X22 LOOP 155-221
|
Facility
OP
|
$1,805.00
|
|
Hospital Charge Code |
2964812
|
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 5X22 LOOP 155-221
|
Facility
IP
|
$1,805.00
|
|
Hospital Charge Code |
2964812
|
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: 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 6 X 20 BLACK SILICONE LOOP G15193
|
Facility
IP
|
$1,805.00
|
|
Hospital Charge Code |
2965868
|
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: 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 6 X 20 BLACK SILICONE LOOP G15193
|
Facility
OP
|
$1,805.00
|
|
Hospital Charge Code |
2965868
|
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 6 X 20 FIRM G44903
|
Facility
IP
|
$1,425.00
|
|
Hospital Charge Code |
2965869
|
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: 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 6 X 20 FIRM G44903
|
Facility
OP
|
$1,425.00
|
|
Hospital Charge Code |
2965869
|
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 6X20 LOOP 155-230
|
Facility
IP
|
$1,805.00
|
|
Hospital Charge Code |
2964813
|
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: 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 6X20 LOOP 155-230
|
Facility
OP
|
$1,805.00
|
|
Hospital Charge Code |
2964813
|
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 6X20 SOFT G49971
|
Facility
IP
|
$1,425.00
|
|
Hospital Charge Code |
2965870
|
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: 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 6X20 SOFT G49971
|
Facility
OP
|
$1,425.00
|
|
Hospital Charge Code |
2965870
|
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 6 X 22 BLACK SILICONE LOOP G15144
|
Facility
IP
|
$1,805.00
|
|
Hospital Charge Code |
2965871
|
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: 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 6 X 22 BLACK SILICONE LOOP G15144
|
Facility
OP
|
$1,805.00
|
|
Hospital Charge Code |
2965871
|
Hospital Revenue Code
|
278
|
Min. Negotiated Rate |
$505.40 |
Max. Negotiated Rate |
$7,220.00 |
Rate for Payer: Aetna Managed Medicare |
$505.40
|
Rate for Payer: Aetna Commercial |
$1,624.50
|
Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.30
|
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 6X22 FIRM G49904
|
Facility
OP
|
$1,425.00
|
|
Hospital Charge Code |
2965872
|
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 6X22 FIRM G49904
|
Facility
IP
|
$1,425.00
|
|
Hospital Charge Code |
2965872
|
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: 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 6X22 LOOP 155-231
|
Facility
IP
|
$1,805.00
|
|
Hospital Charge Code |
2964814
|
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: 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 6X22 LOOP 155-231
|
Facility
OP
|
$1,805.00
|
|
Hospital Charge Code |
2964814
|
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
|
|