|
STENT 6 X 30 BLACK SILICONE LOOP G15148
|
Facility
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2965883
|
|
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 6X30 FIRM G49908
|
Facility
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965884
|
|
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 6X30 FIRM G49908
|
Facility
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965884
|
|
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 6X30 LOOP 155-235
|
Facility
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2964818
|
|
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 6X30 LOOP 155-235
|
Facility
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2964818
|
|
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 6X30 SOFT G49976
|
Facility
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965885
|
|
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 6X30 SOFT G49976
|
Facility
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965885
|
|
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 7 X 37mm 80cm PXB35-07-37-080
|
Facility
OP
|
$6,442.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3533500
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.76 |
| 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: 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: WEA Trust Commercial |
$3,543.10
|
| Rate for Payer: WPS Commercial |
$4,771.59
|
|
|
STENT 7 X 37mm 80cm PXB35-07-37-080
|
Facility
IP
|
$6,442.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3533500
|
|
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 8MMX17MM VISI-PRO #PXB35-08-17-135
|
Facility
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$9,088.68 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.29
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.25
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$6,421.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.40
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT 8MMX17MM VISI-PRO #PXB35-08-17-135
|
Facility
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973749
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.71 |
| Max. Negotiated Rate |
$9,088.68 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$5,927.40
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT 8MM X 27MM VISI-PRO #PXB350827135
|
Facility
IP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,841.69 |
| Max. Negotiated Rate |
$9,090.52 |
| Rate for Payer: Aetna Commercial |
$8,892.90
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,236.93
|
| Rate for Payer: Cash Price |
$2,964.30
|
| Rate for Payer: Cigna Commercial |
$9,090.52
|
| Rate for Payer: Health EOS Commercial |
$8,794.09
|
| Rate for Payer: HFN Commercial |
$9,090.52
|
| Rate for Payer: Multiplan Commercial |
$7,904.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,928.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,090.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,841.69
|
| Rate for Payer: Quartz Commercial |
$5,928.60
|
| Rate for Payer: WEA Trust Commercial |
$5,434.55
|
| Rate for Payer: WPS Commercial |
$7,318.86
|
|
|
STENT 8MM X 27MM VISI-PRO #PXB350827135
|
Facility
OP
|
$9,881.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973754
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.68 |
| Max. Negotiated Rate |
$9,090.52 |
| Rate for Payer: Aetna Commercial |
$8,892.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,497.66
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,422.65
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,940.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,742.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,236.93
|
| Rate for Payer: Cash Price |
$2,964.30
|
| Rate for Payer: Cigna Commercial |
$9,090.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,529.41
|
| Rate for Payer: Health EOS Commercial |
$8,794.09
|
| Rate for Payer: HFN Commercial |
$9,090.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,410.75
|
| Rate for Payer: Multiplan Commercial |
$7,904.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,928.60
|
| Rate for Payer: Preferred Network Access Commercial |
$9,090.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,841.69
|
| Rate for Payer: Quartz Commercial |
$6,422.65
|
| Rate for Payer: Quartz Medicare Advantage |
$5,928.60
|
| Rate for Payer: WEA Trust Commercial |
$5,434.55
|
| Rate for Payer: WPS Commercial |
$7,318.86
|
|
|
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: 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 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: 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 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: 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 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: 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: 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: 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
|
|
