|
STENT DE PROMUS 3.50mm x 12mm
|
Facility
|
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,648.60 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$13,039.10
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 12mm
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974871
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 16mm
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 16mm
|
Facility
|
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974870
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,648.60 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$13,039.10
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 20mm
|
Facility
|
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,648.60 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$13,039.10
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 20mm
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974869
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 24mm
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 24mm
|
Facility
|
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974868
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,648.60 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$13,039.10
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 28mm
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 28mm
|
Facility
|
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974867
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,648.60 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$13,039.10
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 8mm
|
Facility
|
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,648.60 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$13,039.10
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.50mm x 8mm
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974866
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 3.5 x 12
|
Facility
|
IP
|
$9,159.00
|
|
| Hospital Charge Code |
2973793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,667.43 |
| Max. Negotiated Rate |
$8,763.33 |
| Rate for Payer: Aetna Commercial |
$8,572.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,191.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,048.44
|
| Rate for Payer: Cash Price |
$2,747.70
|
| Rate for Payer: Cigna Commercial |
$8,763.33
|
| Rate for Payer: Health EOS Commercial |
$8,477.57
|
| Rate for Payer: HFN Commercial |
$8,763.33
|
| Rate for Payer: Multiplan Commercial |
$7,620.29
|
| Rate for Payer: Preferred Network Access Commercial |
$8,763.33
|
| Rate for Payer: Quartz Beloit One Network |
$4,667.43
|
| Rate for Payer: Quartz Commercial |
$5,715.22
|
| Rate for Payer: WEA Trust Commercial |
$5,238.95
|
| Rate for Payer: WPS Commercial |
$7,055.18
|
|
|
STENT DE PROMUS 3.5 x 12
|
Facility
|
OP
|
$9,159.00
|
|
| Hospital Charge Code |
2973793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,667.10 |
| Max. Negotiated Rate |
$8,763.33 |
| Rate for Payer: Aetna Commercial |
$8,572.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,191.81
|
| Rate for Payer: Aetna Managed Medicare |
$2,667.10
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,191.48
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,762.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,572.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,048.44
|
| Rate for Payer: Cash Price |
$2,747.70
|
| Rate for Payer: Cigna Commercial |
$8,763.33
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,330.54
|
| Rate for Payer: Health EOS Commercial |
$8,477.57
|
| Rate for Payer: HFN Commercial |
$8,763.33
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,144.02
|
| Rate for Payer: Multiplan Commercial |
$7,620.29
|
| Rate for Payer: NAPHCARE Commercial |
$5,715.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,763.33
|
| Rate for Payer: Quartz Beloit One Network |
$4,667.43
|
| Rate for Payer: Quartz Commercial |
$6,191.48
|
| Rate for Payer: Quartz Medicare Advantage |
$5,715.22
|
| Rate for Payer: The Alliance Commercial |
$4,762.68
|
| Rate for Payer: WEA Trust Commercial |
$5,238.95
|
| Rate for Payer: WPS Commercial |
$7,055.18
|
|
|
STENT DE PROMUS 3.5 x 15
|
Facility
|
OP
|
$10,067.00
|
|
| Hospital Charge Code |
2973794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.51 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,931.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,805.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,234.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,025.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,858.99
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,852.26
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,281.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,805.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6,281.81
|
| Rate for Payer: The Alliance Commercial |
$5,234.84
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
STENT DE PROMUS 3.5 x 15
|
Facility
|
IP
|
$10,067.00
|
|
| Hospital Charge Code |
2973794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,130.14 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,281.81
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
STENT DE PROMUS 3.5 x 18
|
Facility
|
OP
|
$10,983.00
|
|
| Hospital Charge Code |
2973795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,198.25 |
| Max. Negotiated Rate |
$10,508.53 |
| Rate for Payer: Aetna Commercial |
$10,280.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,823.20
|
| Rate for Payer: Aetna Managed Medicare |
$3,198.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,424.51
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,711.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,482.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,053.83
|
| Rate for Payer: Cash Price |
$3,294.90
|
| Rate for Payer: Cigna Commercial |
$10,508.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,392.11
|
| Rate for Payer: Health EOS Commercial |
$10,165.86
|
| Rate for Payer: HFN Commercial |
$10,508.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,566.74
|
| Rate for Payer: Multiplan Commercial |
$9,137.86
|
| Rate for Payer: NAPHCARE Commercial |
$6,853.39
|
| Rate for Payer: Preferred Network Access Commercial |
$10,508.53
|
| Rate for Payer: Quartz Beloit One Network |
$5,596.94
|
| Rate for Payer: Quartz Commercial |
$7,424.51
|
| Rate for Payer: Quartz Medicare Advantage |
$6,853.39
|
| Rate for Payer: The Alliance Commercial |
$5,711.16
|
| Rate for Payer: WEA Trust Commercial |
$6,282.28
|
| Rate for Payer: WPS Commercial |
$8,460.20
|
|
|
STENT DE PROMUS 3.5 x 18
|
Facility
|
IP
|
$10,983.00
|
|
| Hospital Charge Code |
2973795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,596.94 |
| Max. Negotiated Rate |
$10,508.53 |
| Rate for Payer: Aetna Commercial |
$10,280.09
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,823.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,053.83
|
| Rate for Payer: Cash Price |
$3,294.90
|
| Rate for Payer: Cigna Commercial |
$10,508.53
|
| Rate for Payer: Health EOS Commercial |
$10,165.86
|
| Rate for Payer: HFN Commercial |
$10,508.53
|
| Rate for Payer: Multiplan Commercial |
$9,137.86
|
| Rate for Payer: Preferred Network Access Commercial |
$10,508.53
|
| Rate for Payer: Quartz Beloit One Network |
$5,596.94
|
| Rate for Payer: Quartz Commercial |
$6,853.39
|
| Rate for Payer: WEA Trust Commercial |
$6,282.28
|
| Rate for Payer: WPS Commercial |
$8,460.20
|
|
|
STENT DE PROMUS 3.5 x 28
|
Facility
|
IP
|
$10,067.00
|
|
| Hospital Charge Code |
2973796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,130.14 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,281.81
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
STENT DE PROMUS 3.5 x 28
|
Facility
|
OP
|
$10,067.00
|
|
| Hospital Charge Code |
2973796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.51 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,931.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,805.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,234.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,025.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,858.99
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,852.26
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,281.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,805.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6,281.81
|
| Rate for Payer: The Alliance Commercial |
$5,234.84
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
STENT DE PROMUS 3.5 x 8
|
Facility
|
IP
|
$10,067.00
|
|
| Hospital Charge Code |
2973792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,130.14 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,281.81
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
STENT DE PROMUS 3.5 x 8
|
Facility
|
OP
|
$10,067.00
|
|
| Hospital Charge Code |
2973792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,931.51 |
| Max. Negotiated Rate |
$9,632.11 |
| Rate for Payer: Aetna Commercial |
$9,422.71
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$9,003.92
|
| Rate for Payer: Aetna Managed Medicare |
$2,931.51
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,805.29
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,234.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,025.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,548.93
|
| Rate for Payer: Cash Price |
$3,020.10
|
| Rate for Payer: Cigna Commercial |
$9,632.11
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,858.99
|
| Rate for Payer: Health EOS Commercial |
$9,318.02
|
| Rate for Payer: HFN Commercial |
$9,632.11
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,852.26
|
| Rate for Payer: Multiplan Commercial |
$8,375.74
|
| Rate for Payer: NAPHCARE Commercial |
$6,281.81
|
| Rate for Payer: Preferred Network Access Commercial |
$9,632.11
|
| Rate for Payer: Quartz Beloit One Network |
$5,130.14
|
| Rate for Payer: Quartz Commercial |
$6,805.29
|
| Rate for Payer: Quartz Medicare Advantage |
$6,281.81
|
| Rate for Payer: The Alliance Commercial |
$5,234.84
|
| Rate for Payer: WEA Trust Commercial |
$5,758.32
|
| Rate for Payer: WPS Commercial |
$7,754.61
|
|
|
STENT DE PROMUS 4.00mm x 12mm
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 4.00mm x 12mm
|
Facility
|
IP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974865
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$10,648.60 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$13,039.10
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
|
STENT DE PROMUS 4.00mm x 16mm
|
Facility
|
OP
|
$20,896.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
2974864
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$6,084.92 |
| Max. Negotiated Rate |
$19,993.29 |
| Rate for Payer: Aetna Commercial |
$19,558.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$18,689.38
|
| Rate for Payer: Aetna Managed Medicare |
$6,084.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$14,125.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$10,865.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$10,431.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$11,517.88
|
| Rate for Payer: Cash Price |
$6,268.80
|
| Rate for Payer: Cigna Commercial |
$19,993.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,161.47
|
| Rate for Payer: Health EOS Commercial |
$19,341.34
|
| Rate for Payer: HFN Commercial |
$19,993.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$16,298.88
|
| Rate for Payer: Multiplan Commercial |
$17,385.47
|
| Rate for Payer: NAPHCARE Commercial |
$13,039.10
|
| Rate for Payer: Preferred Network Access Commercial |
$19,993.29
|
| Rate for Payer: Quartz Beloit One Network |
$10,648.60
|
| Rate for Payer: Quartz Commercial |
$14,125.70
|
| Rate for Payer: Quartz Medicare Advantage |
$13,039.10
|
| Rate for Payer: The Alliance Commercial |
$10,865.92
|
| Rate for Payer: WEA Trust Commercial |
$11,952.51
|
| Rate for Payer: WPS Commercial |
$16,096.19
|
|
