|
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: 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
OP
|
$3,166.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
3052444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$886.48 |
| Max. Negotiated Rate |
$11,874.87 |
| 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 |
$6,103.72
|
| Rate for Payer: WEA Trust Commercial |
$1,741.30
|
| Rate for Payer: WPS Commercial |
$2,345.06
|
|
|
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: 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 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: 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 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 RAINS FRONTAL SINUS LARGE 7089-0931
|
Facility
IP
|
$896.00
|
|
| Hospital Charge Code |
3701495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.04 |
| Max. Negotiated Rate |
$824.32 |
| Rate for Payer: Aetna Commercial |
$806.40
|
| 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: Health EOS Commercial |
$797.44
|
| Rate for Payer: HFN Commercial |
$824.32
|
| 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 |
$537.60
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
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
|
|
|
STENT RAINS FRONTAL SINUS STD 7089-0932
|
Facility
IP
|
$896.00
|
|
| Hospital Charge Code |
3701496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$439.04 |
| Max. Negotiated Rate |
$824.32 |
| Rate for Payer: Aetna Commercial |
$806.40
|
| 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: Health EOS Commercial |
$797.44
|
| Rate for Payer: HFN Commercial |
$824.32
|
| 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 |
$537.60
|
| Rate for Payer: WEA Trust Commercial |
$492.80
|
| Rate for Payer: WPS Commercial |
$663.67
|
|
|
STENT RAINS FRONTAL SINUS STD 7089-0932
|
Facility
OP
|
$896.00
|
|
| Hospital Charge Code |
3701496
|
|
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
|
|
|
STENT RX BILIARY 10FR 10CM
|
Facility
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 10FR 10CM
|
Facility
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972468
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10FR 5CM #4560
|
Facility
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10FR 5CM #4560
|
Facility
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972368
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10fr x 12cm
|
Facility
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10fr x 12cm
|
Facility
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972369
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10fr x 7cm
|
Facility
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2983113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RXBILIARY 10fr x 7cm
|
Facility
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2983113
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 10fr x 7cm 4561
|
Facility
IP
|
$8,784.00
|
|
| Hospital Charge Code |
2969417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,304.16 |
| Max. Negotiated Rate |
$8,081.28 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,270.40
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STENT RX BILIARY 10fr x 7cm 4561
|
Facility
OP
|
$8,784.00
|
|
| Hospital Charge Code |
2969417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,459.52 |
| Max. Negotiated Rate |
$35,136.00 |
| Rate for Payer: Aetna Commercial |
$7,905.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,554.24
|
| Rate for Payer: Aetna Managed Medicare |
$2,459.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,709.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,392.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,216.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,655.52
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,081.28
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,915.53
|
| Rate for Payer: Health EOS Commercial |
$7,817.76
|
| Rate for Payer: HFN Commercial |
$8,081.28
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,588.00
|
| Rate for Payer: Multiplan Commercial |
$7,027.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,270.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,081.28
|
| Rate for Payer: Quartz Beloit One Network |
$4,304.16
|
| Rate for Payer: Quartz Commercial |
$5,709.60
|
| Rate for Payer: Quartz Medicare Advantage |
$5,270.40
|
| Rate for Payer: The Alliance Commercial |
$35,136.00
|
| Rate for Payer: WEA Trust Commercial |
$4,831.20
|
| Rate for Payer: WPS Commercial |
$6,506.31
|
|
|
STENT RX BILIARY 7FR. 10CM
|
Facility
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2983112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 7FR. 10CM
|
Facility
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2983112
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 7FR. 12CM 4558
|
Facility
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 7FR. 12CM 4558
|
Facility
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972367
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 7FR. 7CM
|
Facility
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$798.70 |
| Max. Negotiated Rate |
$1,499.60 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$978.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
|
STENT RX BILIARY 7FR. 7CM
|
Facility
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972366
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$456.40 |
| Max. Negotiated Rate |
$6,520.00 |
| Rate for Payer: Aetna Commercial |
$1,467.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,401.80
|
| Rate for Payer: Aetna Managed Medicare |
$456.40
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,059.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$815.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$782.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$863.90
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,499.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$912.15
|
| Rate for Payer: Health EOS Commercial |
$1,450.70
|
| Rate for Payer: HFN Commercial |
$1,499.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,222.50
|
| Rate for Payer: Multiplan Commercial |
$1,304.00
|
| Rate for Payer: NAPHCARE Commercial |
$978.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,499.60
|
| Rate for Payer: Quartz Beloit One Network |
$798.70
|
| Rate for Payer: Quartz Commercial |
$1,059.50
|
| Rate for Payer: Quartz Medicare Advantage |
$978.00
|
| Rate for Payer: The Alliance Commercial |
$6,520.00
|
| Rate for Payer: WEA Trust Commercial |
$896.50
|
| Rate for Payer: WPS Commercial |
$1,207.34
|
|
