|
STENT RX BILIARY 8.5FR. 10CM
|
Facility
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972370
|
|
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 8.5FR. 10CM
|
Facility
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972370
|
|
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 8.5FR. 12CM
|
Facility
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972666
|
|
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 8.5FR. 12CM
|
Facility
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972666
|
|
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 8.5FR. 5CM
|
Facility
OP
|
$1,812.00
|
|
| Hospital Charge Code |
2972469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.36 |
| Max. Negotiated Rate |
$7,248.00 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.32
|
| Rate for Payer: Aetna Managed Medicare |
$507.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,177.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$906.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,014.00
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,359.00
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,177.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,087.20
|
| Rate for Payer: The Alliance Commercial |
$7,248.00
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
|
STENT RX BILIARY 8.5FR. 5CM
|
Facility
IP
|
$1,812.00
|
|
| Hospital Charge Code |
2972469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.88 |
| Max. Negotiated Rate |
$1,667.04 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,087.20
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
|
STENT RX BILIARY 8.5FR. 7CM
|
Facility
IP
|
$1,812.00
|
|
| Hospital Charge Code |
2972470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$887.88 |
| Max. Negotiated Rate |
$1,667.04 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,087.20
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
|
STENT RX BILIARY 8.5FR. 7CM
|
Facility
OP
|
$1,812.00
|
|
| Hospital Charge Code |
2972470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$507.36 |
| Max. Negotiated Rate |
$7,248.00 |
| Rate for Payer: Aetna Commercial |
$1,630.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,558.32
|
| Rate for Payer: Aetna Managed Medicare |
$507.36
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,177.80
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$906.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$869.76
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$960.36
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,667.04
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,014.00
|
| Rate for Payer: Health EOS Commercial |
$1,612.68
|
| Rate for Payer: HFN Commercial |
$1,667.04
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,359.00
|
| Rate for Payer: Multiplan Commercial |
$1,449.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,087.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,667.04
|
| Rate for Payer: Quartz Beloit One Network |
$887.88
|
| Rate for Payer: Quartz Commercial |
$1,177.80
|
| Rate for Payer: Quartz Medicare Advantage |
$1,087.20
|
| Rate for Payer: The Alliance Commercial |
$7,248.00
|
| Rate for Payer: WEA Trust Commercial |
$996.60
|
| Rate for Payer: WPS Commercial |
$1,342.15
|
|
|
STENT SINGLE J 8FR
|
Facility
IP
|
$1,642.00
|
|
| Hospital Charge Code |
3072440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$804.58 |
| Max. Negotiated Rate |
$1,510.64 |
| Rate for Payer: Aetna Commercial |
$1,477.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$870.26
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,510.64
|
| Rate for Payer: Health EOS Commercial |
$1,461.38
|
| Rate for Payer: HFN Commercial |
$1,510.64
|
| Rate for Payer: Multiplan Commercial |
$1,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$985.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,510.64
|
| Rate for Payer: Quartz Beloit One Network |
$804.58
|
| Rate for Payer: Quartz Commercial |
$985.20
|
| Rate for Payer: WEA Trust Commercial |
$903.10
|
| Rate for Payer: WPS Commercial |
$1,216.23
|
|
|
STENT SINGLE J 8FR
|
Facility
OP
|
$1,642.00
|
|
| Hospital Charge Code |
3072440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$459.76 |
| Max. Negotiated Rate |
$6,568.00 |
| Rate for Payer: Aetna Commercial |
$1,477.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,412.12
|
| Rate for Payer: Aetna Managed Medicare |
$459.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,067.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$821.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$788.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$870.26
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,510.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$918.86
|
| Rate for Payer: Health EOS Commercial |
$1,461.38
|
| Rate for Payer: HFN Commercial |
$1,510.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,231.50
|
| Rate for Payer: Multiplan Commercial |
$1,313.60
|
| Rate for Payer: NAPHCARE Commercial |
$985.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,510.64
|
| Rate for Payer: Quartz Beloit One Network |
$804.58
|
| Rate for Payer: Quartz Commercial |
$1,067.30
|
| Rate for Payer: Quartz Medicare Advantage |
$985.20
|
| Rate for Payer: The Alliance Commercial |
$6,568.00
|
| Rate for Payer: WEA Trust Commercial |
$903.10
|
| Rate for Payer: WPS Commercial |
$1,216.23
|
|
|
STENT STRETCH VL 4.8FR X 22-30 W/O GUIDEWIRE M0061851550
|
Facility
OP
|
$1,646.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5384847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$460.88 |
| Max. Negotiated Rate |
$1,514.32 |
| Rate for Payer: Aetna Commercial |
$1,481.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,415.56
|
| Rate for Payer: Aetna Managed Medicare |
$460.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,069.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$823.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$790.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.38
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$1,514.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$921.10
|
| Rate for Payer: Health EOS Commercial |
$1,464.94
|
| Rate for Payer: HFN Commercial |
$1,514.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,234.50
|
| Rate for Payer: Multiplan Commercial |
$1,316.80
|
| Rate for Payer: NAPHCARE Commercial |
$987.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,514.32
|
| Rate for Payer: Quartz Beloit One Network |
$806.54
|
| Rate for Payer: Quartz Commercial |
$1,069.90
|
| Rate for Payer: Quartz Medicare Advantage |
$987.60
|
| Rate for Payer: WEA Trust Commercial |
$905.30
|
| Rate for Payer: WPS Commercial |
$1,219.19
|
|
|
STENT STRETCH VL 4.8FR X 22-30 W/O GUIDEWIRE M0061851550
|
Facility
IP
|
$1,646.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5384847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$806.54 |
| Max. Negotiated Rate |
$1,514.32 |
| Rate for Payer: Aetna Commercial |
$1,481.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$872.38
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$1,514.32
|
| Rate for Payer: Health EOS Commercial |
$1,464.94
|
| Rate for Payer: HFN Commercial |
$1,514.32
|
| Rate for Payer: Multiplan Commercial |
$1,316.80
|
| Rate for Payer: NAPHCARE Commercial |
$987.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,514.32
|
| Rate for Payer: Quartz Beloit One Network |
$806.54
|
| Rate for Payer: Quartz Commercial |
$987.60
|
| Rate for Payer: WEA Trust Commercial |
$905.30
|
| Rate for Payer: WPS Commercial |
$1,219.19
|
|
|
STENT STRETCH VL 6 X 22-30 W/O GUIDEWIRE M0061851560
|
Facility
OP
|
$1,622.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$454.16 |
| Max. Negotiated Rate |
$1,492.24 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,394.92
|
| Rate for Payer: Aetna Managed Medicare |
$454.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,054.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$811.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$778.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.66
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,492.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$907.67
|
| Rate for Payer: Health EOS Commercial |
$1,443.58
|
| Rate for Payer: HFN Commercial |
$1,492.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,216.50
|
| Rate for Payer: Multiplan Commercial |
$1,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$973.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,492.24
|
| Rate for Payer: Quartz Beloit One Network |
$794.78
|
| Rate for Payer: Quartz Commercial |
$1,054.30
|
| Rate for Payer: Quartz Medicare Advantage |
$973.20
|
| Rate for Payer: WEA Trust Commercial |
$892.10
|
| Rate for Payer: WPS Commercial |
$1,201.42
|
|
|
STENT STRETCH VL 6 X 22-30 W/O GUIDEWIRE M0061851560
|
Facility
IP
|
$1,622.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520088
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$794.78 |
| Max. Negotiated Rate |
$1,492.24 |
| Rate for Payer: Aetna Commercial |
$1,459.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$859.66
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,492.24
|
| Rate for Payer: Health EOS Commercial |
$1,443.58
|
| Rate for Payer: HFN Commercial |
$1,492.24
|
| Rate for Payer: Multiplan Commercial |
$1,297.60
|
| Rate for Payer: NAPHCARE Commercial |
$973.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,492.24
|
| Rate for Payer: Quartz Beloit One Network |
$794.78
|
| Rate for Payer: Quartz Commercial |
$973.20
|
| Rate for Payer: WEA Trust Commercial |
$892.10
|
| Rate for Payer: WPS Commercial |
$1,201.42
|
|
|
STENT STRETCH VL 7 X 22-30 W/O GUIDEWIRE M0061851570
|
Facility
IP
|
$1,685.00
|
|
| Hospital Charge Code |
4520087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$825.65 |
| Max. Negotiated Rate |
$1,550.20 |
| Rate for Payer: Aetna Commercial |
$1,516.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$893.05
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,550.20
|
| Rate for Payer: Health EOS Commercial |
$1,499.65
|
| Rate for Payer: HFN Commercial |
$1,550.20
|
| Rate for Payer: Multiplan Commercial |
$1,348.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,011.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,550.20
|
| Rate for Payer: Quartz Beloit One Network |
$825.65
|
| Rate for Payer: Quartz Commercial |
$1,011.00
|
| Rate for Payer: WEA Trust Commercial |
$926.75
|
| Rate for Payer: WPS Commercial |
$1,248.08
|
|
|
STENT STRETCH VL 7 X 22-30 W/O GUIDEWIRE M0061851570
|
Facility
OP
|
$1,685.00
|
|
| Hospital Charge Code |
4520087
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$471.80 |
| Max. Negotiated Rate |
$6,740.00 |
| Rate for Payer: Aetna Commercial |
$1,516.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,449.10
|
| Rate for Payer: Aetna Managed Medicare |
$471.80
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,095.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$842.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$808.80
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$893.05
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,550.20
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$942.93
|
| Rate for Payer: Health EOS Commercial |
$1,499.65
|
| Rate for Payer: HFN Commercial |
$1,550.20
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,263.75
|
| Rate for Payer: Multiplan Commercial |
$1,348.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,011.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,550.20
|
| Rate for Payer: Quartz Beloit One Network |
$825.65
|
| Rate for Payer: Quartz Commercial |
$1,095.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,011.00
|
| Rate for Payer: The Alliance Commercial |
$6,740.00
|
| Rate for Payer: WEA Trust Commercial |
$926.75
|
| Rate for Payer: WPS Commercial |
$1,248.08
|
|
|
Stent Tib/Peroneal Ea Add Vessel +
|
Facility
IP
|
$3,223.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
3052455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,579.27 |
| Max. Negotiated Rate |
$2,965.16 |
| Rate for Payer: Aetna Commercial |
$2,900.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,708.19
|
| Rate for Payer: Cash Price |
$966.90
|
| Rate for Payer: Cigna Commercial |
$2,965.16
|
| Rate for Payer: Health EOS Commercial |
$2,868.47
|
| Rate for Payer: HFN Commercial |
$2,965.16
|
| Rate for Payer: Multiplan Commercial |
$2,578.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,933.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,965.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,579.27
|
| Rate for Payer: Quartz Commercial |
$1,933.80
|
| Rate for Payer: WEA Trust Commercial |
$1,772.65
|
| Rate for Payer: WPS Commercial |
$2,387.28
|
|
|
Stent Tib/Peroneal Ea Add Vessel +
|
Facility
OP
|
$3,223.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
3052455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$902.44 |
| Max. Negotiated Rate |
$20,943.68 |
| Rate for Payer: Aetna Commercial |
$2,900.70
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,771.78
|
| Rate for Payer: Aetna Managed Medicare |
$902.44
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,094.95
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,611.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,547.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,708.19
|
| Rate for Payer: Cash Price |
$966.90
|
| Rate for Payer: Cash Price |
$966.90
|
| Rate for Payer: Cigna Commercial |
$2,965.16
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Health EOS Commercial |
$2,868.47
|
| Rate for Payer: HFN Commercial |
$2,965.16
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,417.25
|
| Rate for Payer: Multiplan Commercial |
$2,578.40
|
| Rate for Payer: NAPHCARE Commercial |
$1,933.80
|
| Rate for Payer: Preferred Network Access Commercial |
$2,965.16
|
| Rate for Payer: Quartz Beloit One Network |
$1,579.27
|
| Rate for Payer: Quartz Commercial |
$2,094.95
|
| Rate for Payer: Quartz Medicare Advantage |
$1,933.80
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: WEA Trust Commercial |
$1,772.65
|
| Rate for Payer: WPS Commercial |
$2,387.28
|
|
|
Stent Tib/Peroneal Incl PTA
|
Facility
IP
|
$9,506.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
3052451
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,657.94 |
| Max. Negotiated Rate |
$8,745.52 |
| Rate for Payer: Aetna Commercial |
$8,555.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,038.18
|
| Rate for Payer: Cash Price |
$2,851.80
|
| Rate for Payer: Cigna Commercial |
$8,745.52
|
| Rate for Payer: Health EOS Commercial |
$8,460.34
|
| Rate for Payer: HFN Commercial |
$8,745.52
|
| Rate for Payer: Multiplan Commercial |
$7,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$5,703.60
|
| Rate for Payer: Preferred Network Access Commercial |
$8,745.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,657.94
|
| Rate for Payer: Quartz Commercial |
$5,703.60
|
| Rate for Payer: WEA Trust Commercial |
$5,228.30
|
| Rate for Payer: WPS Commercial |
$7,041.09
|
|
|
Stent Tib/Peroneal Incl PTA
|
Facility
OP
|
$9,506.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
3052451
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,657.94 |
| Max. Negotiated Rate |
$64,474.41 |
| Rate for Payer: Aetna Commercial |
$8,555.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,175.16
|
| Rate for Payer: Aetna Managed Medicare |
$17,331.83
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,815.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,378.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,460.00
|
| Rate for Payer: Anthem Medicare Advantage |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,038.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$17,331.83
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$17,331.83
|
| Rate for Payer: Cash Price |
$2,851.80
|
| Rate for Payer: Cash Price |
$2,851.80
|
| Rate for Payer: Cash Price |
$2,851.80
|
| Rate for Payer: Cigna Commercial |
$8,745.52
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$17,331.83
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$17,331.83
|
| Rate for Payer: Health EOS Commercial |
$8,460.34
|
| Rate for Payer: HFN Commercial |
$8,745.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$64,474.41
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$17,331.83
|
| Rate for Payer: Independent Care Health Plan Medicare |
$17,331.83
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$17,331.83
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$17,331.83
|
| Rate for Payer: Multiplan Commercial |
$7,604.80
|
| Rate for Payer: NAPHCARE Commercial |
$25,997.74
|
| Rate for Payer: Preferred Network Access Commercial |
$8,745.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,657.94
|
| Rate for Payer: Quartz Commercial |
$6,178.90
|
| Rate for Payer: Quartz Medicare Advantage |
$17,331.83
|
| Rate for Payer: The Alliance Commercial |
$20,943.68
|
| Rate for Payer: United Healthcare Medicare Advantage |
$17,331.83
|
| Rate for Payer: United Healthcare PPO |
$11,078.00
|
| Rate for Payer: WEA Trust Commercial |
$5,228.30
|
| Rate for Payer: Wellcare Medicare |
$17,331.83
|
| Rate for Payer: WPS Commercial |
$7,041.09
|
|
|
STENT TRIA FIRM WITH SIDE HOLES 6 X 20 M0061902200
|
Facility
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5617782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.68 |
| Max. Negotiated Rate |
$1,891.52 |
| Rate for Payer: Aetna Commercial |
$1,850.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,768.16
|
| Rate for Payer: Aetna Managed Medicare |
$575.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,336.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,028.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$986.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.68
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,891.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,150.54
|
| Rate for Payer: Health EOS Commercial |
$1,829.84
|
| Rate for Payer: HFN Commercial |
$1,891.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,542.00
|
| Rate for Payer: Multiplan Commercial |
$1,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.44
|
| Rate for Payer: Quartz Commercial |
$1,336.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,233.60
|
| Rate for Payer: WEA Trust Commercial |
$1,130.80
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
|
STENT TRIA FIRM WITH SIDE HOLES 6 X 20 M0061902200
|
Facility
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5617782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,007.44 |
| Max. Negotiated Rate |
$1,891.52 |
| Rate for Payer: Aetna Commercial |
$1,850.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.68
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,891.52
|
| Rate for Payer: Health EOS Commercial |
$1,829.84
|
| Rate for Payer: HFN Commercial |
$1,891.52
|
| Rate for Payer: Multiplan Commercial |
$1,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.44
|
| Rate for Payer: Quartz Commercial |
$1,233.60
|
| Rate for Payer: WEA Trust Commercial |
$1,130.80
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
|
STENT TRIA FIRM WITH SIDE HOLES 6 X 22 M0061902210
|
Facility
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5617783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,007.44 |
| Max. Negotiated Rate |
$1,891.52 |
| Rate for Payer: Aetna Commercial |
$1,850.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.68
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,891.52
|
| Rate for Payer: Health EOS Commercial |
$1,829.84
|
| Rate for Payer: HFN Commercial |
$1,891.52
|
| Rate for Payer: Multiplan Commercial |
$1,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.44
|
| Rate for Payer: Quartz Commercial |
$1,233.60
|
| Rate for Payer: WEA Trust Commercial |
$1,130.80
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
|
STENT TRIA FIRM WITH SIDE HOLES 6 X 22 M0061902210
|
Facility
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5617783
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$575.68 |
| Max. Negotiated Rate |
$1,891.52 |
| Rate for Payer: Aetna Commercial |
$1,850.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,768.16
|
| Rate for Payer: Aetna Managed Medicare |
$575.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,336.40
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,028.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$986.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.68
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,891.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,150.54
|
| Rate for Payer: Health EOS Commercial |
$1,829.84
|
| Rate for Payer: HFN Commercial |
$1,891.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,542.00
|
| Rate for Payer: Multiplan Commercial |
$1,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.44
|
| Rate for Payer: Quartz Commercial |
$1,336.40
|
| Rate for Payer: Quartz Medicare Advantage |
$1,233.60
|
| Rate for Payer: WEA Trust Commercial |
$1,130.80
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
|
STENT TRIA FIRM WITH SIDE HOLES 6 X 24 M0061902220
|
Facility
IP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5547376
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,007.44 |
| Max. Negotiated Rate |
$1,891.52 |
| Rate for Payer: Aetna Commercial |
$1,850.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,089.68
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,891.52
|
| Rate for Payer: Health EOS Commercial |
$1,829.84
|
| Rate for Payer: HFN Commercial |
$1,891.52
|
| Rate for Payer: Multiplan Commercial |
$1,644.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,233.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,891.52
|
| Rate for Payer: Quartz Beloit One Network |
$1,007.44
|
| Rate for Payer: Quartz Commercial |
$1,233.60
|
| Rate for Payer: WEA Trust Commercial |
$1,130.80
|
| Rate for Payer: WPS Commercial |
$1,522.88
|
|
