|
STENT 6 X 24 BLACK SILICONE LOOP G15145
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2965874
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6X24 FIRM G49905
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.18 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$889.20
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6X24 FIRM G49905
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965875
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.96 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Aetna Managed Medicare |
$414.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.35
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$963.30
|
| Rate for Payer: Quartz Medicare Advantage |
$889.20
|
| Rate for Payer: The Alliance Commercial |
$741.00
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6X24 LOOP 155-232
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2964815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.83 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,126.32
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6X24 LOOP 155-232
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2964815
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6X24 SOFT G49973
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.96 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Aetna Managed Medicare |
$414.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.35
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$963.30
|
| Rate for Payer: Quartz Medicare Advantage |
$889.20
|
| Rate for Payer: The Alliance Commercial |
$741.00
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6X24 SOFT G49973
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965876
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.18 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$889.20
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6 X 26 BLACK SILICONE LOOP G15146
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2965877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.83 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,126.32
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6 X 26 BLACK SILICONE LOOP G15146
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2965877
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6X26 FIRM G49906
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.18 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$889.20
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6X26 FIRM G49906
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965878
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.96 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Aetna Managed Medicare |
$414.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.35
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$963.30
|
| Rate for Payer: Quartz Medicare Advantage |
$889.20
|
| Rate for Payer: The Alliance Commercial |
$741.00
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6X26 LOOP 155-233
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2964816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.83 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,126.32
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6X26 LOOP 155-233
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2964816
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6X26 SOFT G49974
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.18 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$889.20
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6X26 SOFT G49974
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965879
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.96 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Aetna Managed Medicare |
$414.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.35
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$963.30
|
| Rate for Payer: Quartz Medicare Advantage |
$889.20
|
| Rate for Payer: The Alliance Commercial |
$741.00
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6 X 28 BLACK SILICONE LOOP G15147
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2965880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6 X 28 BLACK SILICONE LOOP G15147
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2965880
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.83 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,126.32
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6X28 LOOP 155-234
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2964817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.83 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,126.32
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6X28 LOOP 155-234
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2964817
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6X28 SOFT G49975
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.96 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Aetna Managed Medicare |
$414.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.35
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$963.30
|
| Rate for Payer: Quartz Medicare Advantage |
$889.20
|
| Rate for Payer: The Alliance Commercial |
$741.00
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6X28 SOFT G49975
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965882
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.18 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$889.20
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6 X 30 BLACK SILICONE LOOP G15148
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2965883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.83 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,126.32
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6 X 30 BLACK SILICONE LOOP G15148
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2965883
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6X30 FIRM G49908
|
Facility
|
IP
|
$1,425.00
|
|
| Hospital Charge Code |
2965884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$726.18 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$889.20
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
|
STENT 6X30 FIRM G49908
|
Facility
|
OP
|
$1,425.00
|
|
| Hospital Charge Code |
2965884
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$414.96 |
| Max. Negotiated Rate |
$1,363.44 |
| Rate for Payer: Aetna Commercial |
$1,333.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,274.52
|
| Rate for Payer: Aetna Managed Medicare |
$414.96
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$963.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$741.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$711.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$785.46
|
| Rate for Payer: Cash Price |
$427.50
|
| Rate for Payer: Cigna Commercial |
$1,363.44
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$829.35
|
| Rate for Payer: Health EOS Commercial |
$1,318.98
|
| Rate for Payer: HFN Commercial |
$1,363.44
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,111.50
|
| Rate for Payer: Multiplan Commercial |
$1,185.60
|
| Rate for Payer: NAPHCARE Commercial |
$889.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,363.44
|
| Rate for Payer: Quartz Beloit One Network |
$726.18
|
| Rate for Payer: Quartz Commercial |
$963.30
|
| Rate for Payer: Quartz Medicare Advantage |
$889.20
|
| Rate for Payer: The Alliance Commercial |
$741.00
|
| Rate for Payer: WEA Trust Commercial |
$815.10
|
| Rate for Payer: WPS Commercial |
$1,097.68
|
|
