|
STENT C-FLEX 10x5 PIGTAIL
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
2971852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
STENT C-FLEX 10x5 PIGTAIL
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
2971852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$266.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$475.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.53
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$713.70
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$570.96
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$570.96
|
| Rate for Payer: The Alliance Commercial |
$475.80
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
STENT CONTOUR SOFT 6 X 22-33 W/O GUIDEWIRE M0061801560
|
Facility
|
OP
|
$1,622.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.33 |
| Max. Negotiated Rate |
$1,551.93 |
| Rate for Payer: Aetna Commercial |
$1,518.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,450.72
|
| Rate for Payer: Aetna Managed Medicare |
$472.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,096.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$843.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$809.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.05
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,551.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$944.00
|
| Rate for Payer: Health EOS Commercial |
$1,501.32
|
| Rate for Payer: HFN Commercial |
$1,551.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,265.16
|
| Rate for Payer: Multiplan Commercial |
$1,349.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,551.93
|
| Rate for Payer: Quartz Beloit One Network |
$826.57
|
| Rate for Payer: Quartz Commercial |
$1,096.47
|
| Rate for Payer: Quartz Medicare Advantage |
$1,012.13
|
| Rate for Payer: The Alliance Commercial |
$843.44
|
| Rate for Payer: WEA Trust Commercial |
$927.78
|
| Rate for Payer: WPS Commercial |
$1,249.43
|
|
|
STENT CONTOUR SOFT 6 X 22-33 W/O GUIDEWIRE M0061801560
|
Facility
|
IP
|
$1,622.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.57 |
| Max. Negotiated Rate |
$1,551.93 |
| Rate for Payer: Aetna Commercial |
$1,518.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,450.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.05
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,551.93
|
| Rate for Payer: Health EOS Commercial |
$1,501.32
|
| Rate for Payer: HFN Commercial |
$1,551.93
|
| Rate for Payer: Multiplan Commercial |
$1,349.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,551.93
|
| Rate for Payer: Quartz Beloit One Network |
$826.57
|
| Rate for Payer: Quartz Commercial |
$1,012.13
|
| Rate for Payer: WEA Trust Commercial |
$927.78
|
| Rate for Payer: WPS Commercial |
$1,249.43
|
|
|
STENT CONTOUR SOFT 7 X 22-30 W/O GUIDEWIRE M0061801570
|
Facility
|
IP
|
$1,685.00
|
|
| Hospital Charge Code |
4520089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.68 |
| Max. Negotiated Rate |
$1,612.21 |
| Rate for Payer: Aetna Commercial |
$1,577.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.77
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,612.21
|
| Rate for Payer: Health EOS Commercial |
$1,559.64
|
| Rate for Payer: HFN Commercial |
$1,612.21
|
| Rate for Payer: Multiplan Commercial |
$1,401.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.21
|
| Rate for Payer: Quartz Beloit One Network |
$858.68
|
| Rate for Payer: Quartz Commercial |
$1,051.44
|
| Rate for Payer: WEA Trust Commercial |
$963.82
|
| Rate for Payer: WPS Commercial |
$1,297.96
|
|
|
STENT CONTOUR SOFT 7 X 22-30 W/O GUIDEWIRE M0061801570
|
Facility
|
OP
|
$1,685.00
|
|
| Hospital Charge Code |
4520089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.67 |
| Max. Negotiated Rate |
$1,612.21 |
| Rate for Payer: Aetna Commercial |
$1,577.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.06
|
| Rate for Payer: Aetna Managed Medicare |
$490.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,139.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$876.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.77
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,612.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$980.67
|
| Rate for Payer: Health EOS Commercial |
$1,559.64
|
| Rate for Payer: HFN Commercial |
$1,612.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,314.30
|
| Rate for Payer: Multiplan Commercial |
$1,401.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.21
|
| Rate for Payer: Quartz Beloit One Network |
$858.68
|
| Rate for Payer: Quartz Commercial |
$1,139.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,051.44
|
| Rate for Payer: The Alliance Commercial |
$876.20
|
| Rate for Payer: WEA Trust Commercial |
$963.82
|
| Rate for Payer: WPS Commercial |
$1,297.96
|
|
|
Stent-Coronary Bare Metal
|
Facility
|
IP
|
$5,153.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4001127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,625.97 |
| Max. Negotiated Rate |
$4,930.39 |
| Rate for Payer: Aetna Commercial |
$4,823.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,608.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,840.33
|
| Rate for Payer: Cash Price |
$1,545.90
|
| Rate for Payer: Cigna Commercial |
$4,930.39
|
| Rate for Payer: Health EOS Commercial |
$4,769.62
|
| Rate for Payer: HFN Commercial |
$4,930.39
|
| Rate for Payer: Multiplan Commercial |
$4,287.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,930.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.97
|
| Rate for Payer: Quartz Commercial |
$3,215.47
|
| Rate for Payer: WEA Trust Commercial |
$2,947.52
|
| Rate for Payer: WPS Commercial |
$3,969.36
|
|
|
Stent-Coronary Bare Metal
|
Facility
|
OP
|
$5,153.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4001127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.55 |
| Max. Negotiated Rate |
$4,930.39 |
| Rate for Payer: Aetna Commercial |
$4,823.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,608.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,500.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,483.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,679.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,572.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,840.33
|
| Rate for Payer: Cash Price |
$1,545.90
|
| Rate for Payer: Cigna Commercial |
$4,930.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,999.05
|
| Rate for Payer: Health EOS Commercial |
$4,769.62
|
| Rate for Payer: HFN Commercial |
$4,930.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,019.34
|
| Rate for Payer: Multiplan Commercial |
$4,287.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,215.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,930.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.97
|
| Rate for Payer: Quartz Commercial |
$3,483.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,215.47
|
| Rate for Payer: The Alliance Commercial |
$2,679.56
|
| Rate for Payer: WEA Trust Commercial |
$2,947.52
|
| Rate for Payer: WPS Commercial |
$3,969.36
|
|
|
Stent-Coronary DES
|
Facility
|
OP
|
$7,595.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
4001126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,211.66 |
| Max. Negotiated Rate |
$7,266.90 |
| Rate for Payer: Aetna Commercial |
$7,108.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,792.97
|
| Rate for Payer: Aetna Managed Medicare |
$2,211.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,134.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,949.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,791.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,186.36
|
| Rate for Payer: Cash Price |
$2,278.50
|
| Rate for Payer: Cigna Commercial |
$7,266.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,420.29
|
| Rate for Payer: Health EOS Commercial |
$7,029.93
|
| Rate for Payer: HFN Commercial |
$7,266.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,924.10
|
| Rate for Payer: Multiplan Commercial |
$6,319.04
|
| Rate for Payer: NAPHCARE Commercial |
$4,739.28
|
| Rate for Payer: Preferred Network Access Commercial |
$7,266.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,870.41
|
| Rate for Payer: Quartz Commercial |
$5,134.22
|
| Rate for Payer: Quartz Medicare Advantage |
$4,739.28
|
| Rate for Payer: The Alliance Commercial |
$3,949.40
|
| Rate for Payer: WEA Trust Commercial |
$4,344.34
|
| Rate for Payer: WPS Commercial |
$5,850.43
|
|
|
Stent-Coronary DES
|
Facility
|
IP
|
$7,595.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
4001126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,870.41 |
| Max. Negotiated Rate |
$7,266.90 |
| Rate for Payer: Aetna Commercial |
$7,108.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,792.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,186.36
|
| Rate for Payer: Cash Price |
$2,278.50
|
| Rate for Payer: Cigna Commercial |
$7,266.90
|
| Rate for Payer: Health EOS Commercial |
$7,029.93
|
| Rate for Payer: HFN Commercial |
$7,266.90
|
| Rate for Payer: Multiplan Commercial |
$6,319.04
|
| Rate for Payer: Preferred Network Access Commercial |
$7,266.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,870.41
|
| Rate for Payer: Quartz Commercial |
$4,739.28
|
| Rate for Payer: WEA Trust Commercial |
$4,344.34
|
| Rate for Payer: WPS Commercial |
$5,850.43
|
|
|
STENT COVERED COVERA 10MM X 60MM AVSM10060
|
Facility
|
IP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.98 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,376.30
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 10MM X 60MM AVSM10060
|
Facility
|
OP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204965
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.28 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,442.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,991.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,146.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,901.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,879.82
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,220.38
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: NAPHCARE Commercial |
$7,376.30
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,991.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,376.30
|
| Rate for Payer: The Alliance Commercial |
$6,146.92
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 10MM X 80MM AVSM10080
|
Facility
|
IP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.98 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,376.30
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 10MM X 80MM AVSM10080
|
Facility
|
OP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204969
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.28 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,442.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,991.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,146.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,901.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,879.82
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,220.38
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: NAPHCARE Commercial |
$7,376.30
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,991.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,376.30
|
| Rate for Payer: The Alliance Commercial |
$6,146.92
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 7MM X 60MM AVSM07060
|
Facility
|
IP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.98 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,376.30
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 7MM X 60MM AVSM07060
|
Facility
|
OP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204966
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.28 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,442.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,991.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,146.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,901.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,879.82
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,220.38
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: NAPHCARE Commercial |
$7,376.30
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,991.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,376.30
|
| Rate for Payer: The Alliance Commercial |
$6,146.92
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 7MM X 80MM AVSM07080
|
Facility
|
IP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.98 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,376.30
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 7MM X 80MM AVSM07080
|
Facility
|
OP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204967
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.28 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,442.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,991.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,146.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,901.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,879.82
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,220.38
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: NAPHCARE Commercial |
$7,376.30
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,991.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,376.30
|
| Rate for Payer: The Alliance Commercial |
$6,146.92
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 8MM X 60MM AVSM08060
|
Facility
|
OP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.28 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,442.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,991.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,146.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,901.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,879.82
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,220.38
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: NAPHCARE Commercial |
$7,376.30
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,991.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,376.30
|
| Rate for Payer: The Alliance Commercial |
$6,146.92
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 8MM X 60MM AVSM08060
|
Facility
|
IP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204963
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.98 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,376.30
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 8MM X 80MM AVSM08080
|
Facility
|
IP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.98 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,376.30
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 8MM X 80MM AVSM08080
|
Facility
|
OP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204968
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.28 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,442.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,991.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,146.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,901.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,879.82
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,220.38
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: NAPHCARE Commercial |
$7,376.30
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,991.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,376.30
|
| Rate for Payer: The Alliance Commercial |
$6,146.92
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 9MM X 60MM AVSM09060
|
Facility
|
OP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.28 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,442.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,991.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,146.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,901.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,879.82
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,220.38
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: NAPHCARE Commercial |
$7,376.30
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,991.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,376.30
|
| Rate for Payer: The Alliance Commercial |
$6,146.92
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 9MM X 60MM AVSM09060
|
Facility
|
IP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204970
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,023.98 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,376.30
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
|
STENT COVERED COVERA 9MM X 80MM AVSM09080
|
Facility
|
OP
|
$11,821.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
6204971
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,442.28 |
| Max. Negotiated Rate |
$11,310.33 |
| Rate for Payer: Aetna Commercial |
$11,064.46
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,572.70
|
| Rate for Payer: Aetna Managed Medicare |
$3,442.28
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,991.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$6,146.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,901.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,515.74
|
| Rate for Payer: Cash Price |
$3,546.30
|
| Rate for Payer: Cigna Commercial |
$11,310.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,879.82
|
| Rate for Payer: Health EOS Commercial |
$10,941.52
|
| Rate for Payer: HFN Commercial |
$11,310.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$9,220.38
|
| Rate for Payer: Multiplan Commercial |
$9,835.07
|
| Rate for Payer: NAPHCARE Commercial |
$7,376.30
|
| Rate for Payer: Preferred Network Access Commercial |
$11,310.33
|
| Rate for Payer: Quartz Beloit One Network |
$6,023.98
|
| Rate for Payer: Quartz Commercial |
$7,991.00
|
| Rate for Payer: Quartz Medicare Advantage |
$7,376.30
|
| Rate for Payer: The Alliance Commercial |
$6,146.92
|
| Rate for Payer: WEA Trust Commercial |
$6,761.61
|
| Rate for Payer: WPS Commercial |
$9,105.72
|
|
