|
Stenger Test-Pure Tone
|
Facility
|
IP
|
$148.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
3203501
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$72.52 |
| Max. Negotiated Rate |
$136.16 |
| Rate for Payer: Aetna Commercial |
$133.20
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$78.44
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$136.16
|
| Rate for Payer: Health EOS Commercial |
$131.72
|
| Rate for Payer: HFN Commercial |
$136.16
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: NAPHCARE Commercial |
$88.80
|
| Rate for Payer: Preferred Network Access Commercial |
$136.16
|
| Rate for Payer: Quartz Beloit One Network |
$72.52
|
| Rate for Payer: Quartz Commercial |
$88.80
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
Stenger Test-Pure Tone
|
Professional
|
Both
|
$148.00
|
|
|
Service Code
|
CPT 92565
|
| Hospital Charge Code |
3203501
|
|
Hospital Revenue Code
|
470
|
| Min. Negotiated Rate |
$58.39 |
| Max. Negotiated Rate |
$140.60 |
| Rate for Payer: Aetna Commercial |
$140.60
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$127.28
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cash Price |
$44.40
|
| Rate for Payer: Cigna Commercial |
$140.60
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Medicaid |
$74.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$88.80
|
| Rate for Payer: Health EOS Commercial |
$134.68
|
| Rate for Payer: HFN Commercial |
$140.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$58.39
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$58.39
|
| Rate for Payer: Multiplan Commercial |
$118.40
|
| Rate for Payer: Preferred Network Access Commercial |
$140.60
|
| Rate for Payer: Quartz Beloit One Network |
$65.12
|
| Rate for Payer: Quartz Commercial |
$84.36
|
| Rate for Payer: The Alliance Commercial |
$74.00
|
| Rate for Payer: WEA Trust Commercial |
$81.40
|
| Rate for Payer: WPS Commercial |
$109.62
|
|
|
STENT 10 X 37mm 80cm PXB35-10-37
|
Facility
|
OP
|
$6,442.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3533499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,803.76 |
| Max. Negotiated Rate |
$25,768.00 |
| Rate for Payer: Aetna Commercial |
$5,797.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,540.12
|
| Rate for Payer: Aetna Managed Medicare |
$1,803.76
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,187.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,221.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,092.16
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.26
|
| Rate for Payer: Cash Price |
$1,932.60
|
| Rate for Payer: Cigna Commercial |
$5,926.64
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,604.94
|
| Rate for Payer: Health EOS Commercial |
$5,733.38
|
| Rate for Payer: HFN Commercial |
$5,926.64
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,831.50
|
| Rate for Payer: Multiplan Commercial |
$5,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.58
|
| Rate for Payer: Quartz Commercial |
$4,187.30
|
| Rate for Payer: Quartz Medicare Advantage |
$3,865.20
|
| Rate for Payer: The Alliance Commercial |
$25,768.00
|
| Rate for Payer: WEA Trust Commercial |
$3,543.10
|
| Rate for Payer: WPS Commercial |
$4,771.59
|
|
|
STENT 10 X 37mm 80cm PXB35-10-37
|
Facility
|
IP
|
$6,442.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3533499
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,156.58 |
| Max. Negotiated Rate |
$5,926.64 |
| Rate for Payer: Aetna Commercial |
$5,797.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,540.12
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,414.26
|
| Rate for Payer: Cash Price |
$1,932.60
|
| Rate for Payer: Cigna Commercial |
$5,926.64
|
| Rate for Payer: Health EOS Commercial |
$5,733.38
|
| Rate for Payer: HFN Commercial |
$5,926.64
|
| Rate for Payer: Multiplan Commercial |
$5,153.60
|
| Rate for Payer: NAPHCARE Commercial |
$3,865.20
|
| Rate for Payer: Preferred Network Access Commercial |
$5,926.64
|
| Rate for Payer: Quartz Beloit One Network |
$3,156.58
|
| Rate for Payer: Quartz Commercial |
$3,865.20
|
| Rate for Payer: WEA Trust Commercial |
$3,543.10
|
| Rate for Payer: WPS Commercial |
$4,771.59
|
|
|
STENT 2.5 x 12mm #1007823-12
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973746
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| 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 2.5 x 12mm #1007823-12
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973746
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$69,624.00 |
| 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: The Alliance Commercial |
$69,624.00
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT 2.5 x 18mm #1007823-18
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973747
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$69,624.00 |
| 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: The Alliance Commercial |
$69,624.00
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT 2.5 x 18mm #1007823-18
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973747
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| 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 2.5 X 23mm #1007823-23
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973742
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$69,624.00 |
| 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: The Alliance Commercial |
$69,624.00
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT 2.5 X 23mm #1007823-23
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973742
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| 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 2.5 x 28mm #1007823-28
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973778
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$69,624.00 |
| 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: The Alliance Commercial |
$69,624.00
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT 2.5 x 28mm #1007823-28
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973778
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| 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 2.5 x8mm #1007823-08
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973745
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$69,624.00 |
| 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: The Alliance Commercial |
$69,624.00
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT 2.5 x8mm #1007823-08
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973745
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| 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 3.0 X 23mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973743
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$69,624.00 |
| 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: The Alliance Commercial |
$69,624.00
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT 3.0 X 23mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973743
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| 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 3.0 x 8MM #1007848-08
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973744
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$69,624.00 |
| 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: The Alliance Commercial |
$69,624.00
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT 3.0 x 8MM #1007848-08
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973744
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| 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 3.5 X 23mm #1007849-23
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973850
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$69,624.00 |
| 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: The Alliance Commercial |
$69,624.00
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT 3.5 X 23mm #1007849-23
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973850
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| 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 3.5 x 8mm #1007849-08
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973779
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$69,624.00 |
| 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: The Alliance Commercial |
$69,624.00
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT 3.5 x 8mm #1007849-08
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973779
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| 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 4.0 x 8mm #1007850-08
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973780
|
|
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: Aetna Gatekeeper/Not Gatekeeper |
$14,969.16
|
| 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 4.0 x 8mm #1007850-08
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973780
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,873.68 |
| Max. Negotiated Rate |
$69,624.00 |
| 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: The Alliance Commercial |
$69,624.00
|
| Rate for Payer: WEA Trust Commercial |
$9,573.30
|
| Rate for Payer: WPS Commercial |
$12,892.62
|
|
|
STENT 4X BILIARY 7FR. 5CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972365
|
|
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
|
|
