|
STENT PROTEGE 9mm x 80mm
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974801
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| 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 PROTEGE 9mm x 80mm
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| 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: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT PROTEGE EVERFLEX 6mm X 20mm X 120
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107486
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| 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: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT PROTEGE EVERFLEX 6mm X 20mm X 120
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107486
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| 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 PROTEGE EVERFLEX 6mm X 80mm X 80
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107487
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| 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 PROTEGE EVERFLEX 6mm X 80mm X 80
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107487
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| 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: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT PROTEGE EVERFLEX 8mm x 60mm X 80
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107485
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| 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: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT PROTEGE EVERFLEX 8mm x 60mm X 80
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107485
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| 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 PROTEGE EVERFLEX 8mm X 80mm X 120mm
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107490
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| 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: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT PROTEGE EVERFLEX 8mm X 80mm X 120mm
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107490
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| 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 PROTEGE EVERFLREX 8.0 x 60mm x 120cm PRB35-08-060-120
|
Facility
|
OP
|
$7,694.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3505518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,154.32 |
| Max. Negotiated Rate |
$30,776.00 |
| Rate for Payer: Aetna Commercial |
$6,924.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,616.84
|
| Rate for Payer: Aetna Managed Medicare |
$2,154.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,001.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,847.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,693.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,077.82
|
| Rate for Payer: Cash Price |
$2,308.20
|
| Rate for Payer: Cigna Commercial |
$7,078.48
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,305.56
|
| Rate for Payer: Health EOS Commercial |
$6,847.66
|
| Rate for Payer: HFN Commercial |
$7,078.48
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,770.50
|
| Rate for Payer: Multiplan Commercial |
$6,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,616.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,078.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,770.06
|
| Rate for Payer: Quartz Commercial |
$5,001.10
|
| Rate for Payer: Quartz Medicare Advantage |
$4,616.40
|
| Rate for Payer: The Alliance Commercial |
$30,776.00
|
| Rate for Payer: WEA Trust Commercial |
$4,231.70
|
| Rate for Payer: WPS Commercial |
$5,698.95
|
|
|
STENT PROTEGE EVERFLREX 8.0 x 60mm x 120cm PRB35-08-060-120
|
Facility
|
IP
|
$7,694.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3505518
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,770.06 |
| Max. Negotiated Rate |
$7,078.48 |
| Rate for Payer: Aetna Commercial |
$6,924.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,616.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,077.82
|
| Rate for Payer: Cash Price |
$2,308.20
|
| Rate for Payer: Cigna Commercial |
$7,078.48
|
| Rate for Payer: Health EOS Commercial |
$6,847.66
|
| Rate for Payer: HFN Commercial |
$7,078.48
|
| Rate for Payer: Multiplan Commercial |
$6,155.20
|
| Rate for Payer: NAPHCARE Commercial |
$4,616.40
|
| Rate for Payer: Preferred Network Access Commercial |
$7,078.48
|
| Rate for Payer: Quartz Beloit One Network |
$3,770.06
|
| Rate for Payer: Quartz Commercial |
$4,616.40
|
| Rate for Payer: WEA Trust Commercial |
$4,231.70
|
| Rate for Payer: WPS Commercial |
$5,698.95
|
|
|
STENT PROTEGE GPS 9mm X 60mm #SERB65-09-60-120
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107488
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| 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 PROTEGE GPS 9mm X 60mm #SERB65-09-60-120
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107488
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| 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: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT PROTEGE GPS 9mm X 80mm #SERB65-09-80-120
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| 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: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT PROTEGE GPS 9mm X 80mm #SERB65-09-80-120
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107489
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| 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/PTA Iliac Artery
|
Facility
|
IP
|
$9,224.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
3052442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,519.76 |
| Max. Negotiated Rate |
$8,486.08 |
| Rate for Payer: Aetna Commercial |
$8,301.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,932.64
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,888.72
|
| Rate for Payer: Cash Price |
$2,767.20
|
| Rate for Payer: Cigna Commercial |
$8,486.08
|
| Rate for Payer: Health EOS Commercial |
$8,209.36
|
| Rate for Payer: HFN Commercial |
$8,486.08
|
| Rate for Payer: Multiplan Commercial |
$7,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,534.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,486.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,519.76
|
| Rate for Payer: Quartz Commercial |
$5,534.40
|
| Rate for Payer: WEA Trust Commercial |
$5,073.20
|
| Rate for Payer: WPS Commercial |
$6,832.22
|
|
|
Stent/PTA Iliac Artery
|
Facility
|
OP
|
$9,224.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
3052442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,519.76 |
| Max. Negotiated Rate |
$43,494.48 |
| Rate for Payer: Aetna Commercial |
$8,301.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,932.64
|
| 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 |
$4,888.72
|
| 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 |
$2,767.20
|
| Rate for Payer: Cash Price |
$2,767.20
|
| Rate for Payer: Cash Price |
$2,767.20
|
| Rate for Payer: Cigna Commercial |
$8,486.08
|
| 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 |
$8,209.36
|
| Rate for Payer: HFN Commercial |
$8,486.08
|
| 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 |
$7,379.20
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$8,486.08
|
| Rate for Payer: Quartz Beloit One Network |
$4,519.76
|
| Rate for Payer: Quartz Commercial |
$5,995.60
|
| 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 |
$5,073.20
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$6,832.22
|
|
|
Stent/PTA Iliac Artery BILAT 3722150
|
Facility
|
OP
|
$18,448.00
|
|
|
Service Code
|
CPT 37221 50
|
| Hospital Charge Code |
6017631
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,039.52 |
| Max. Negotiated Rate |
$43,494.48 |
| Rate for Payer: Aetna Commercial |
$16,603.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,865.28
|
| 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 |
$9,777.44
|
| 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 |
$5,534.40
|
| Rate for Payer: Cash Price |
$5,534.40
|
| Rate for Payer: Cash Price |
$5,534.40
|
| Rate for Payer: Cigna Commercial |
$16,972.16
|
| 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 |
$16,418.72
|
| Rate for Payer: HFN Commercial |
$16,972.16
|
| 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 |
$14,758.40
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$16,972.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,039.52
|
| Rate for Payer: Quartz Commercial |
$11,991.20
|
| 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 |
$10,146.40
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$13,664.43
|
|
|
Stent/PTA Iliac Artery BILAT 3722150
|
Facility
|
IP
|
$18,448.00
|
|
|
Service Code
|
CPT 37221 50
|
| Hospital Charge Code |
6017631
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,039.52 |
| Max. Negotiated Rate |
$16,972.16 |
| Rate for Payer: Aetna Commercial |
$16,603.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,865.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,777.44
|
| Rate for Payer: Cash Price |
$5,534.40
|
| Rate for Payer: Cigna Commercial |
$16,972.16
|
| Rate for Payer: Health EOS Commercial |
$16,418.72
|
| Rate for Payer: HFN Commercial |
$16,972.16
|
| Rate for Payer: Multiplan Commercial |
$14,758.40
|
| Rate for Payer: NAPHCARE Commercial |
$11,068.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,972.16
|
| Rate for Payer: Quartz Beloit One Network |
$9,039.52
|
| Rate for Payer: Quartz Commercial |
$11,068.80
|
| Rate for Payer: WEA Trust Commercial |
$10,146.40
|
| Rate for Payer: WPS Commercial |
$13,664.43
|
|
|
Stent/PTA Iliac Artery Ea Add +
|
Facility
|
IP
|
$3,166.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
3052444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,551.34 |
| Max. Negotiated Rate |
$2,912.72 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$1,899.60
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
Stent/PTA Iliac Artery Ea Add +
|
Facility
|
OP
|
$3,166.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
3052444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$886.48 |
| Max. Negotiated Rate |
$12,664.00 |
| Rate for Payer: Aetna Commercial |
$2,849.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,722.76
|
| Rate for Payer: Aetna Managed Medicare |
$886.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,057.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,583.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,519.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,677.98
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$2,912.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$2,817.74
|
| Rate for Payer: HFN Commercial |
$2,912.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,374.50
|
| Rate for Payer: Multiplan Commercial |
$2,532.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,899.60
|
| Rate for Payer: Preferred Network Access Commercial |
$2,912.72
|
| Rate for Payer: Quartz Beloit One Network |
$1,551.34
|
| Rate for Payer: Quartz Commercial |
$2,057.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,899.60
|
| Rate for Payer: The Alliance Commercial |
$12,664.00
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
STENT QUICKERT LACRIMAL SP732871
|
Facility
|
OP
|
$1,736.00
|
|
| Hospital Charge Code |
2964772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$486.08 |
| Max. Negotiated Rate |
$6,944.00 |
| Rate for Payer: Aetna Commercial |
$1,562.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,492.96
|
| Rate for Payer: Aetna Managed Medicare |
$486.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,128.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$868.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$833.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$920.08
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,597.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$971.47
|
| Rate for Payer: Health EOS Commercial |
$1,545.04
|
| Rate for Payer: HFN Commercial |
$1,597.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,302.00
|
| Rate for Payer: Multiplan Commercial |
$1,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,041.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,597.12
|
| Rate for Payer: Quartz Beloit One Network |
$850.64
|
| Rate for Payer: Quartz Commercial |
$1,128.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,041.60
|
| Rate for Payer: The Alliance Commercial |
$6,944.00
|
| Rate for Payer: WEA Trust Commercial |
$954.80
|
| Rate for Payer: WPS Commercial |
$1,285.86
|
|
|
STENT QUICKERT LACRIMAL SP732871
|
Facility
|
IP
|
$1,736.00
|
|
| Hospital Charge Code |
2964772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$850.64 |
| Max. Negotiated Rate |
$1,597.12 |
| Rate for Payer: Aetna Commercial |
$1,562.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,492.96
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$920.08
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,597.12
|
| Rate for Payer: Health EOS Commercial |
$1,545.04
|
| Rate for Payer: HFN Commercial |
$1,597.12
|
| Rate for Payer: Multiplan Commercial |
$1,388.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,041.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,597.12
|
| Rate for Payer: Quartz Beloit One Network |
$850.64
|
| Rate for Payer: Quartz Commercial |
$1,041.60
|
| Rate for Payer: WEA Trust Commercial |
$954.80
|
| Rate for Payer: WPS Commercial |
$1,285.86
|
|
|
STENT RAINS FRONTAL SINUS LARGE 7089-0931
|
Facility
|
OP
|
$896.00
|
|
| Hospital Charge Code |
3701495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$250.88 |
| Max. Negotiated Rate |
$3,584.00 |
| Rate for Payer: Aetna Commercial |
$806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$770.56
|
| Rate for Payer: Aetna Managed Medicare |
$250.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$430.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$474.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$824.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$501.40
|
| Rate for Payer: Health EOS Commercial |
$797.44
|
| Rate for Payer: HFN Commercial |
$824.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$672.00
|
| Rate for Payer: Multiplan Commercial |
$716.80
|
| Rate for Payer: NAPHCARE Commercial |
$537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$824.32
|
| Rate for Payer: Quartz Beloit One Network |
$439.04
|
| Rate for Payer: Quartz Commercial |
$582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$537.60
|
| Rate for Payer: The Alliance Commercial |
$3,584.00
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
