|
STENT GENESIS 6 X 15mm PG1860BAX
|
Facility
IP
|
$1,854.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$908.46 |
| Max. Negotiated Rate |
$1,705.68 |
| Rate for Payer: Aetna Commercial |
$1,668.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.62
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$1,705.68
|
| Rate for Payer: Health EOS Commercial |
$1,650.06
|
| Rate for Payer: HFN Commercial |
$1,705.68
|
| Rate for Payer: Multiplan Commercial |
$1,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,112.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,705.68
|
| Rate for Payer: Quartz Beloit One Network |
$908.46
|
| Rate for Payer: Quartz Commercial |
$1,112.40
|
| Rate for Payer: WEA Trust Commercial |
$1,019.70
|
| Rate for Payer: WPS Commercial |
$1,373.26
|
|
|
STENT GENESIS 6 X 15mm PG1860BAX
|
Facility
OP
|
$1,854.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974849
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$519.12 |
| Max. Negotiated Rate |
$1,705.68 |
| Rate for Payer: Aetna Commercial |
$1,668.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,594.44
|
| Rate for Payer: Aetna Managed Medicare |
$519.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,205.10
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$927.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$889.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$982.62
|
| Rate for Payer: Cash Price |
$556.20
|
| Rate for Payer: Cigna Commercial |
$1,705.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,037.50
|
| Rate for Payer: Health EOS Commercial |
$1,650.06
|
| Rate for Payer: HFN Commercial |
$1,705.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,390.50
|
| Rate for Payer: Multiplan Commercial |
$1,483.20
|
| Rate for Payer: NAPHCARE Commercial |
$1,112.40
|
| Rate for Payer: Preferred Network Access Commercial |
$1,705.68
|
| Rate for Payer: Quartz Beloit One Network |
$908.46
|
| Rate for Payer: Quartz Commercial |
$1,205.10
|
| Rate for Payer: Quartz Medicare Advantage |
$1,112.40
|
| Rate for Payer: WEA Trust Commercial |
$1,019.70
|
| Rate for Payer: WPS Commercial |
$1,373.26
|
|
|
STENT GENESIS 7MM X 15MM PG1570BSX
|
Facility
IP
|
$8,817.00
|
|
| Hospital Charge Code |
2974845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,320.33 |
| Max. Negotiated Rate |
$8,111.64 |
| Rate for Payer: Aetna Commercial |
$7,935.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,673.01
|
| Rate for Payer: Cash Price |
$2,645.10
|
| Rate for Payer: Cigna Commercial |
$8,111.64
|
| Rate for Payer: Health EOS Commercial |
$7,847.13
|
| Rate for Payer: HFN Commercial |
$8,111.64
|
| Rate for Payer: Multiplan Commercial |
$7,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,290.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,111.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,320.33
|
| Rate for Payer: Quartz Commercial |
$5,290.20
|
| Rate for Payer: WEA Trust Commercial |
$4,849.35
|
| Rate for Payer: WPS Commercial |
$6,530.75
|
|
|
STENT GENESIS 7MM X 15MM PG1570BSX
|
Facility
OP
|
$8,817.00
|
|
| Hospital Charge Code |
2974845
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,468.76 |
| Max. Negotiated Rate |
$35,268.00 |
| Rate for Payer: Aetna Commercial |
$7,935.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,582.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,468.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,731.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,232.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,673.01
|
| Rate for Payer: Cash Price |
$2,645.10
|
| Rate for Payer: Cigna Commercial |
$8,111.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,933.99
|
| Rate for Payer: Health EOS Commercial |
$7,847.13
|
| Rate for Payer: HFN Commercial |
$8,111.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,612.75
|
| Rate for Payer: Multiplan Commercial |
$7,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,290.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,111.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,320.33
|
| Rate for Payer: Quartz Commercial |
$5,731.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,290.20
|
| Rate for Payer: The Alliance Commercial |
$35,268.00
|
| Rate for Payer: WEA Trust Commercial |
$4,849.35
|
| Rate for Payer: WPS Commercial |
$6,530.75
|
|
|
STENT GENESIS 7mm x 17mm PG1870BAX
|
Facility
IP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,054.75 |
| Max. Negotiated Rate |
$7,613.00 |
| Rate for Payer: Aetna Commercial |
$7,447.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,385.75
|
| Rate for Payer: Cash Price |
$2,482.50
|
| Rate for Payer: Cigna Commercial |
$7,613.00
|
| Rate for Payer: Health EOS Commercial |
$7,364.75
|
| Rate for Payer: HFN Commercial |
$7,613.00
|
| Rate for Payer: Multiplan Commercial |
$6,620.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,965.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,613.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,054.75
|
| Rate for Payer: Quartz Commercial |
$4,965.00
|
| Rate for Payer: WEA Trust Commercial |
$4,551.25
|
| Rate for Payer: WPS Commercial |
$6,129.29
|
|
|
STENT GENESIS 7mm x 17mm PG1870BAX
|
Facility
OP
|
$8,275.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974844
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,317.00 |
| Max. Negotiated Rate |
$7,613.00 |
| Rate for Payer: Aetna Commercial |
$7,447.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,116.50
|
| Rate for Payer: Aetna Managed Medicare |
$2,317.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,378.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,137.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,972.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,385.75
|
| Rate for Payer: Cash Price |
$2,482.50
|
| Rate for Payer: Cigna Commercial |
$7,613.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,630.69
|
| Rate for Payer: Health EOS Commercial |
$7,364.75
|
| Rate for Payer: HFN Commercial |
$7,613.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,206.25
|
| Rate for Payer: Multiplan Commercial |
$6,620.00
|
| Rate for Payer: NAPHCARE Commercial |
$4,965.00
|
| Rate for Payer: Preferred Network Access Commercial |
$7,613.00
|
| Rate for Payer: Quartz Beloit One Network |
$4,054.75
|
| Rate for Payer: Quartz Commercial |
$5,378.75
|
| Rate for Payer: Quartz Medicare Advantage |
$4,965.00
|
| Rate for Payer: WEA Trust Commercial |
$4,551.25
|
| Rate for Payer: WPS Commercial |
$6,129.29
|
|
|
STENT GENESIS 7MM X 18MM PG1870BSX
|
Facility
IP
|
$8,817.00
|
|
| Hospital Charge Code |
2974843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,320.33 |
| Max. Negotiated Rate |
$8,111.64 |
| Rate for Payer: Aetna Commercial |
$7,935.30
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,673.01
|
| Rate for Payer: Cash Price |
$2,645.10
|
| Rate for Payer: Cigna Commercial |
$8,111.64
|
| Rate for Payer: Health EOS Commercial |
$7,847.13
|
| Rate for Payer: HFN Commercial |
$8,111.64
|
| Rate for Payer: Multiplan Commercial |
$7,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,290.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,111.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,320.33
|
| Rate for Payer: Quartz Commercial |
$5,290.20
|
| Rate for Payer: WEA Trust Commercial |
$4,849.35
|
| Rate for Payer: WPS Commercial |
$6,530.75
|
|
|
STENT GENESIS 7MM X 18MM PG1870BSX
|
Facility
OP
|
$8,817.00
|
|
| Hospital Charge Code |
2974843
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,468.76 |
| Max. Negotiated Rate |
$35,268.00 |
| Rate for Payer: Aetna Commercial |
$7,935.30
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,582.62
|
| Rate for Payer: Aetna Managed Medicare |
$2,468.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,731.05
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,408.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,232.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,673.01
|
| Rate for Payer: Cash Price |
$2,645.10
|
| Rate for Payer: Cigna Commercial |
$8,111.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,933.99
|
| Rate for Payer: Health EOS Commercial |
$7,847.13
|
| Rate for Payer: HFN Commercial |
$8,111.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,612.75
|
| Rate for Payer: Multiplan Commercial |
$7,053.60
|
| Rate for Payer: NAPHCARE Commercial |
$5,290.20
|
| Rate for Payer: Preferred Network Access Commercial |
$8,111.64
|
| Rate for Payer: Quartz Beloit One Network |
$4,320.33
|
| Rate for Payer: Quartz Commercial |
$5,731.05
|
| Rate for Payer: Quartz Medicare Advantage |
$5,290.20
|
| Rate for Payer: The Alliance Commercial |
$35,268.00
|
| Rate for Payer: WEA Trust Commercial |
$4,849.35
|
| Rate for Payer: WPS Commercial |
$6,530.75
|
|
|
STENT GENESIS 7 X 14mm PG1570BAX
|
Facility
IP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,960.18 |
| Max. Negotiated Rate |
$7,435.44 |
| Rate for Payer: Aetna Commercial |
$7,273.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,283.46
|
| Rate for Payer: Cash Price |
$2,424.60
|
| Rate for Payer: Cigna Commercial |
$7,435.44
|
| Rate for Payer: Health EOS Commercial |
$7,192.98
|
| Rate for Payer: HFN Commercial |
$7,435.44
|
| Rate for Payer: Multiplan Commercial |
$6,465.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,849.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,435.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,960.18
|
| Rate for Payer: Quartz Commercial |
$4,849.20
|
| Rate for Payer: WEA Trust Commercial |
$4,445.10
|
| Rate for Payer: WPS Commercial |
$5,986.34
|
|
|
STENT GENESIS 7 X 14mm PG1570BAX
|
Facility
OP
|
$8,082.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974846
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,262.96 |
| Max. Negotiated Rate |
$7,435.44 |
| Rate for Payer: Aetna Commercial |
$7,273.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,950.52
|
| Rate for Payer: Aetna Managed Medicare |
$2,262.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,253.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,041.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,879.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,283.46
|
| Rate for Payer: Cash Price |
$2,424.60
|
| Rate for Payer: Cigna Commercial |
$7,435.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,522.69
|
| Rate for Payer: Health EOS Commercial |
$7,192.98
|
| Rate for Payer: HFN Commercial |
$7,435.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,061.50
|
| Rate for Payer: Multiplan Commercial |
$6,465.60
|
| Rate for Payer: NAPHCARE Commercial |
$4,849.20
|
| Rate for Payer: Preferred Network Access Commercial |
$7,435.44
|
| Rate for Payer: Quartz Beloit One Network |
$3,960.18
|
| Rate for Payer: Quartz Commercial |
$5,253.30
|
| Rate for Payer: Quartz Medicare Advantage |
$4,849.20
|
| Rate for Payer: WEA Trust Commercial |
$4,445.10
|
| Rate for Payer: WPS Commercial |
$5,986.34
|
|
|
STENT GRAFT 3.0 x 12mm JOS #12744-12
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT GRAFT 3.0 x 12mm JOS #12744-12
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973904
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT GRAFT 3.0 x 16mm JOS #12744-16
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT GRAFT 3.0 x 16mm JOS #12744-16
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973905
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT GRAFT 3.0 x 19mm JOS #12744-19
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT GRAFT 3.0 x 19mm JOS #12744-19
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973906
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT GRAFT 4.0 x 16mm ***DISCONTINUED
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT GRAFT 4.0 x 16mm ***DISCONTINUED
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973907
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT GRAFT 4.0 x 19mm JOS #12746-19
|
Facility
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,239.04 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT GRAFT 4.0 x 19mm JOS #12746-19
|
Facility
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973908
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,850.88 |
| Max. Negotiated Rate |
$19,224.32 |
| Rate for Payer: Aetna Commercial |
$18,806.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$17,970.56
|
| Rate for Payer: Aetna Managed Medicare |
$5,850.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$13,582.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,448.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,030.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,074.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,224.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,693.40
|
| Rate for Payer: Health EOS Commercial |
$18,597.44
|
| Rate for Payer: HFN Commercial |
$19,224.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$15,672.00
|
| Rate for Payer: Multiplan Commercial |
$16,716.80
|
| Rate for Payer: NAPHCARE Commercial |
$12,537.60
|
| Rate for Payer: Preferred Network Access Commercial |
$19,224.32
|
| Rate for Payer: Quartz Beloit One Network |
$10,239.04
|
| Rate for Payer: Quartz Commercial |
$13,582.40
|
| Rate for Payer: Quartz Medicare Advantage |
$12,537.60
|
| Rate for Payer: WEA Trust Commercial |
$11,492.80
|
| Rate for Payer: WPS Commercial |
$15,477.67
|
|
|
STENT GRAFT FLUENCY 12MM X 60MM X 80CM FEM12060
|
Facility
IP
|
$11,348.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,560.52 |
| Max. Negotiated Rate |
$10,440.16 |
| Rate for Payer: Aetna Commercial |
$10,213.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,014.44
|
| Rate for Payer: Cash Price |
$3,404.40
|
| Rate for Payer: Cigna Commercial |
$10,440.16
|
| Rate for Payer: Health EOS Commercial |
$10,099.72
|
| Rate for Payer: HFN Commercial |
$10,440.16
|
| Rate for Payer: Multiplan Commercial |
$9,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,440.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,560.52
|
| Rate for Payer: Quartz Commercial |
$6,808.80
|
| Rate for Payer: WEA Trust Commercial |
$6,241.40
|
| Rate for Payer: WPS Commercial |
$8,405.46
|
|
|
STENT GRAFT FLUENCY 12MM X 60MM X 80CM FEM12060
|
Facility
OP
|
$11,348.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204964
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,177.44 |
| Max. Negotiated Rate |
$10,440.16 |
| Rate for Payer: Aetna Commercial |
$10,213.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,759.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,177.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,376.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,674.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,447.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,014.44
|
| Rate for Payer: Cash Price |
$3,404.40
|
| Rate for Payer: Cigna Commercial |
$10,440.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,350.34
|
| Rate for Payer: Health EOS Commercial |
$10,099.72
|
| Rate for Payer: HFN Commercial |
$10,440.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,511.00
|
| Rate for Payer: Multiplan Commercial |
$9,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,440.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,560.52
|
| Rate for Payer: Quartz Commercial |
$7,376.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,808.80
|
| Rate for Payer: WEA Trust Commercial |
$6,241.40
|
| Rate for Payer: WPS Commercial |
$8,405.46
|
|
|
STENT GRAFT FLUENCY 13.5MM X 60MM X 80CM FEM14060
|
Facility
IP
|
$11,348.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,560.52 |
| Max. Negotiated Rate |
$10,440.16 |
| Rate for Payer: Aetna Commercial |
$10,213.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,014.44
|
| Rate for Payer: Cash Price |
$3,404.40
|
| Rate for Payer: Cigna Commercial |
$10,440.16
|
| Rate for Payer: Health EOS Commercial |
$10,099.72
|
| Rate for Payer: HFN Commercial |
$10,440.16
|
| Rate for Payer: Multiplan Commercial |
$9,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,440.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,560.52
|
| Rate for Payer: Quartz Commercial |
$6,808.80
|
| Rate for Payer: WEA Trust Commercial |
$6,241.40
|
| Rate for Payer: WPS Commercial |
$8,405.46
|
|
|
STENT GRAFT FLUENCY 13.5MM X 60MM X 80CM FEM14060
|
Facility
OP
|
$11,348.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204962
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,177.44 |
| Max. Negotiated Rate |
$10,440.16 |
| Rate for Payer: Aetna Commercial |
$10,213.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,759.28
|
| Rate for Payer: Aetna Managed Medicare |
$3,177.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,376.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,674.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,447.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,014.44
|
| Rate for Payer: Cash Price |
$3,404.40
|
| Rate for Payer: Cigna Commercial |
$10,440.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,350.34
|
| Rate for Payer: Health EOS Commercial |
$10,099.72
|
| Rate for Payer: HFN Commercial |
$10,440.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,511.00
|
| Rate for Payer: Multiplan Commercial |
$9,078.40
|
| Rate for Payer: NAPHCARE Commercial |
$6,808.80
|
| Rate for Payer: Preferred Network Access Commercial |
$10,440.16
|
| Rate for Payer: Quartz Beloit One Network |
$5,560.52
|
| Rate for Payer: Quartz Commercial |
$7,376.20
|
| Rate for Payer: Quartz Medicare Advantage |
$6,808.80
|
| Rate for Payer: WEA Trust Commercial |
$6,241.40
|
| Rate for Payer: WPS Commercial |
$8,405.46
|
|
|
STENT ICAST 10mm x 38mm X 120 85424
|
Facility
OP
|
$16,316.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2973919
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,568.48 |
| Max. Negotiated Rate |
$15,010.72 |
| Rate for Payer: Aetna Commercial |
$14,684.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,031.76
|
| Rate for Payer: Aetna Managed Medicare |
$4,568.48
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$10,605.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,158.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,831.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,647.48
|
| Rate for Payer: Cash Price |
$4,894.80
|
| Rate for Payer: Cigna Commercial |
$15,010.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,130.43
|
| Rate for Payer: Health EOS Commercial |
$14,521.24
|
| Rate for Payer: HFN Commercial |
$15,010.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$12,237.00
|
| Rate for Payer: Multiplan Commercial |
$13,052.80
|
| Rate for Payer: NAPHCARE Commercial |
$9,789.60
|
| Rate for Payer: Preferred Network Access Commercial |
$15,010.72
|
| Rate for Payer: Quartz Beloit One Network |
$7,994.84
|
| Rate for Payer: Quartz Commercial |
$10,605.40
|
| Rate for Payer: Quartz Medicare Advantage |
$9,789.60
|
| Rate for Payer: WEA Trust Commercial |
$8,973.80
|
| Rate for Payer: WPS Commercial |
$12,085.26
|
|
