|
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: 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: 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 |
$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 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: 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: 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 |
$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 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 |
$12,148.04 |
| 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 |
$12,148.04
|
| 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: 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 |
$40,449.87 |
| 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 |
$20,943.68
|
| 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: 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 |
$3,946.80 |
| 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: WEA Trust Commercial |
$2,359.50
|
| Rate for Payer: WPS Commercial |
$3,177.60
|
|
|
STENT BANDER URETERAL DIVERSION 7.2FR X75CM G18070
|
Facility
IP
|
$4,290.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
2965894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,102.10 |
| Max. Negotiated Rate |
$3,946.80 |
| Rate for Payer: Aetna Commercial |
$3,861.00
|
| 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: Health EOS Commercial |
$3,818.10
|
| Rate for Payer: HFN Commercial |
$3,946.80
|
| 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 |
$2,574.00
|
| Rate for Payer: WEA Trust Commercial |
$2,359.50
|
| Rate for Payer: WPS Commercial |
$3,177.60
|
|
|
STENT BM VeriFLEX 3.0 x 12mm
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT BM VeriFLEX 3.0 x 12mm
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT BM VeriFLEX 3.0 x 16mm
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT BM VeriFLEX 3.0 x 16mm
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT CATHETER BALLOON GRAFT REL46
|
Facility
OP
|
$5,059.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3104708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,416.52 |
| Max. Negotiated Rate |
$4,654.28 |
| Rate for Payer: Aetna Commercial |
$4,553.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,350.74
|
| Rate for Payer: Aetna Managed Medicare |
$1,416.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,288.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,529.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,428.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,681.27
|
| Rate for Payer: Cash Price |
$1,517.70
|
| Rate for Payer: Cigna Commercial |
$4,654.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,831.02
|
| Rate for Payer: Health EOS Commercial |
$4,502.51
|
| Rate for Payer: HFN Commercial |
$4,654.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,794.25
|
| Rate for Payer: Multiplan Commercial |
$4,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,035.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,654.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.91
|
| Rate for Payer: Quartz Commercial |
$3,288.35
|
| Rate for Payer: Quartz Medicare Advantage |
$3,035.40
|
| Rate for Payer: WEA Trust Commercial |
$2,782.45
|
| Rate for Payer: WPS Commercial |
$3,747.20
|
|
|
STENT CATHETER BALLOON GRAFT REL46
|
Facility
IP
|
$5,059.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3104708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,478.91 |
| Max. Negotiated Rate |
$4,654.28 |
| Rate for Payer: Aetna Commercial |
$4,553.10
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,681.27
|
| Rate for Payer: Cash Price |
$1,517.70
|
| Rate for Payer: Cigna Commercial |
$4,654.28
|
| Rate for Payer: Health EOS Commercial |
$4,502.51
|
| Rate for Payer: HFN Commercial |
$4,654.28
|
| Rate for Payer: Multiplan Commercial |
$4,047.20
|
| Rate for Payer: NAPHCARE Commercial |
$3,035.40
|
| Rate for Payer: Preferred Network Access Commercial |
$4,654.28
|
| Rate for Payer: Quartz Beloit One Network |
$2,478.91
|
| Rate for Payer: Quartz Commercial |
$3,035.40
|
| Rate for Payer: WEA Trust Commercial |
$2,782.45
|
| Rate for Payer: WPS Commercial |
$3,747.20
|
|
|
STENT/CATHETER NEPHROSTOMY PERCUTANEOUS COMBINATION 8FR X 25CM M0064101260
|
Facility
IP
|
$1,334.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5459834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$653.66 |
| Max. Negotiated Rate |
$1,227.28 |
| Rate for Payer: Aetna Commercial |
$1,200.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$707.02
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$1,227.28
|
| Rate for Payer: Health EOS Commercial |
$1,187.26
|
| Rate for Payer: HFN Commercial |
$1,227.28
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$800.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,227.28
|
| Rate for Payer: Quartz Beloit One Network |
$653.66
|
| Rate for Payer: Quartz Commercial |
$800.40
|
| Rate for Payer: WEA Trust Commercial |
$733.70
|
| Rate for Payer: WPS Commercial |
$988.09
|
|
|
STENT/CATHETER NEPHROSTOMY PERCUTANEOUS COMBINATION 8FR X 25CM M0064101260
|
Facility
OP
|
$1,334.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5459834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$373.52 |
| Max. Negotiated Rate |
$1,227.28 |
| Rate for Payer: Aetna Commercial |
$1,200.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,147.24
|
| Rate for Payer: Aetna Managed Medicare |
$373.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$867.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$667.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$640.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$707.02
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$1,227.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$746.51
|
| Rate for Payer: Health EOS Commercial |
$1,187.26
|
| Rate for Payer: HFN Commercial |
$1,227.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,000.50
|
| Rate for Payer: Multiplan Commercial |
$1,067.20
|
| Rate for Payer: NAPHCARE Commercial |
$800.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,227.28
|
| Rate for Payer: Quartz Beloit One Network |
$653.66
|
| Rate for Payer: Quartz Commercial |
$867.10
|
| Rate for Payer: Quartz Medicare Advantage |
$800.40
|
| Rate for Payer: WEA Trust Commercial |
$733.70
|
| Rate for Payer: WPS Commercial |
$988.09
|
|
|
STENT C-FLEX 10x10 PIGTAIL
|
Facility
OP
|
$915.00
|
|
| Hospital Charge Code |
2971853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$256.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$594.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$457.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.03
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.25
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$594.75
|
| Rate for Payer: Quartz Medicare Advantage |
$549.00
|
| Rate for Payer: The Alliance Commercial |
$3,660.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
STENT C-FLEX 10x10 PIGTAIL
|
Facility
IP
|
$915.00
|
|
| Hospital Charge Code |
2971853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$448.35 |
| Max. Negotiated Rate |
$841.80 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$549.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
|
STENT C-FLEX 10x5 PIGTAIL
|
Facility
OP
|
$915.00
|
|
| Hospital Charge Code |
2971852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$256.20 |
| Max. Negotiated Rate |
$3,660.00 |
| Rate for Payer: Aetna Commercial |
$823.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$786.90
|
| Rate for Payer: Aetna Managed Medicare |
$256.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$594.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$457.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$439.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$484.95
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$841.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$512.03
|
| Rate for Payer: Health EOS Commercial |
$814.35
|
| Rate for Payer: HFN Commercial |
$841.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$686.25
|
| Rate for Payer: Multiplan Commercial |
$732.00
|
| Rate for Payer: NAPHCARE Commercial |
$549.00
|
| Rate for Payer: Preferred Network Access Commercial |
$841.80
|
| Rate for Payer: Quartz Beloit One Network |
$448.35
|
| Rate for Payer: Quartz Commercial |
$594.75
|
| Rate for Payer: Quartz Medicare Advantage |
$549.00
|
| Rate for Payer: The Alliance Commercial |
$3,660.00
|
| Rate for Payer: WEA Trust Commercial |
$503.25
|
| Rate for Payer: WPS Commercial |
$677.74
|
|
