|
STENT VERIFLEX 3.0 X 28MM
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT VERIFLEX 3.0 X 28MM
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT VERIFLEX 4.0 X 12
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT VERIFLEX 4.0 X 12
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT VERIFLEX 4.0 X 16
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT VERIFLEX 4.0 X 16
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT VERIFLEX 4.0 X 20
|
Facility
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,529.92 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT VERIFLEX 4.0 X 20
|
Facility
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,874.24 |
| Max. Negotiated Rate |
$16,015.36 |
| Rate for Payer: Aetna Commercial |
$15,667.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,970.88
|
| Rate for Payer: Aetna Managed Medicare |
$4,874.24
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,315.20
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,704.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,355.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,226.24
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,015.36
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,741.52
|
| Rate for Payer: Health EOS Commercial |
$15,493.12
|
| Rate for Payer: HFN Commercial |
$16,015.36
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,056.00
|
| Rate for Payer: Multiplan Commercial |
$13,926.40
|
| Rate for Payer: NAPHCARE Commercial |
$10,444.80
|
| Rate for Payer: Preferred Network Access Commercial |
$16,015.36
|
| Rate for Payer: Quartz Beloit One Network |
$8,529.92
|
| Rate for Payer: Quartz Commercial |
$11,315.20
|
| Rate for Payer: Quartz Medicare Advantage |
$10,444.80
|
| Rate for Payer: WEA Trust Commercial |
$9,574.40
|
| Rate for Payer: WPS Commercial |
$12,894.11
|
|
|
STENT VERIFLEX BARE 3.5 X 8MM
|
Facility
OP
|
$14,790.00
|
|
| Hospital Charge Code |
2974795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,141.20 |
| Max. Negotiated Rate |
$59,160.00 |
| Rate for Payer: Aetna Commercial |
$13,311.00
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$12,719.40
|
| Rate for Payer: Aetna Managed Medicare |
$4,141.20
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,613.50
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,395.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,099.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,838.70
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$13,606.80
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,276.48
|
| Rate for Payer: Health EOS Commercial |
$13,163.10
|
| Rate for Payer: HFN Commercial |
$13,606.80
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,092.50
|
| Rate for Payer: Multiplan Commercial |
$11,832.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,874.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,606.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,247.10
|
| Rate for Payer: Quartz Commercial |
$9,613.50
|
| Rate for Payer: Quartz Medicare Advantage |
$8,874.00
|
| Rate for Payer: The Alliance Commercial |
$59,160.00
|
| Rate for Payer: WEA Trust Commercial |
$8,134.50
|
| Rate for Payer: WPS Commercial |
$10,954.95
|
|
|
STENT VERIFLEX BARE 3.5 X 8MM
|
Facility
IP
|
$14,790.00
|
|
| Hospital Charge Code |
2974795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,247.10 |
| Max. Negotiated Rate |
$13,606.80 |
| Rate for Payer: Aetna Commercial |
$13,311.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$7,838.70
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$13,606.80
|
| Rate for Payer: Health EOS Commercial |
$13,163.10
|
| Rate for Payer: HFN Commercial |
$13,606.80
|
| Rate for Payer: Multiplan Commercial |
$11,832.00
|
| Rate for Payer: NAPHCARE Commercial |
$8,874.00
|
| Rate for Payer: Preferred Network Access Commercial |
$13,606.80
|
| Rate for Payer: Quartz Beloit One Network |
$7,247.10
|
| Rate for Payer: Quartz Commercial |
$8,874.00
|
| Rate for Payer: WEA Trust Commercial |
$8,134.50
|
| Rate for Payer: WPS Commercial |
$10,954.95
|
|
|
STENT VISION 3.0 x 12mm #1007848-12
|
Facility
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| Rate for Payer: Aetna Managed Medicare |
$4,873.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,313.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,703.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,354.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,740.40
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,054.50
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$11,313.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.0 x 12mm #1007848-12
|
Facility
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,528.94 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.0 x 18mm
|
Facility
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,528.94 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.0 x 18mm
|
Facility
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| Rate for Payer: Aetna Managed Medicare |
$4,873.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,313.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,703.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,354.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,740.40
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,054.50
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$11,313.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.0 x 28mm
|
Facility
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| Rate for Payer: Aetna Managed Medicare |
$4,873.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,313.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,703.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,354.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,740.40
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,054.50
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$11,313.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.0 x 28mm
|
Facility
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,528.94 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.5 x 12mm
|
Facility
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,528.94 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.5 x 12mm
|
Facility
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| Rate for Payer: Aetna Managed Medicare |
$4,873.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,313.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,703.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,354.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,740.40
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,054.50
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$11,313.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.5 x 18mm
|
Facility
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,528.94 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.5 x 18mm
|
Facility
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| Rate for Payer: Aetna Managed Medicare |
$4,873.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,313.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,703.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,354.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,740.40
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,054.50
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$11,313.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.5 x 28mm
|
Facility
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,528.94 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION 3.5 x 28mm
|
Facility
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| Rate for Payer: Aetna Managed Medicare |
$4,873.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,313.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,703.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,354.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,740.40
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,054.50
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$11,313.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION MULTI-LINK 4.0 x 12mm
|
Facility
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,528.94 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION MULTI-LINK 4.0 x 12mm
|
Facility
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107484
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| Rate for Payer: Aetna Managed Medicare |
$4,873.68
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,313.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$8,703.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,354.88
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$9,740.40
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,054.50
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$11,313.90
|
| Rate for Payer: Quartz Medicare Advantage |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT VISION MULTI-LINK 4.0 x 18mm
|
Facility
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107483
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,528.94 |
| Max. Negotiated Rate |
$16,013.52 |
| Rate for Payer: Aetna Commercial |
$15,665.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,225.18
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,013.52
|
| Rate for Payer: Health EOS Commercial |
$15,491.34
|
| Rate for Payer: HFN Commercial |
$16,013.52
|
| Rate for Payer: Multiplan Commercial |
$13,924.80
|
| Rate for Payer: NAPHCARE Commercial |
$10,443.60
|
| Rate for Payer: Preferred Network Access Commercial |
$16,013.52
|
| Rate for Payer: Quartz Beloit One Network |
$8,528.94
|
| Rate for Payer: Quartz Commercial |
$10,443.60
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
