|
STENT IRIS LIGHTED URETERAL 0220-180-518
|
Facility
|
OP
|
$2,537.00
|
|
| Hospital Charge Code |
5306838
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$738.77 |
| Max. Negotiated Rate |
$2,427.40 |
| Rate for Payer: Aetna Commercial |
$2,374.63
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,269.09
|
| Rate for Payer: Aetna Managed Medicare |
$738.77
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,715.01
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,319.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,266.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,398.39
|
| Rate for Payer: Cash Price |
$761.10
|
| Rate for Payer: Cigna Commercial |
$2,427.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,476.53
|
| Rate for Payer: Health EOS Commercial |
$2,348.25
|
| Rate for Payer: HFN Commercial |
$2,427.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,978.86
|
| Rate for Payer: Multiplan Commercial |
$2,110.78
|
| Rate for Payer: NAPHCARE Commercial |
$1,583.09
|
| Rate for Payer: Preferred Network Access Commercial |
$2,427.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,292.86
|
| Rate for Payer: Quartz Commercial |
$1,715.01
|
| Rate for Payer: Quartz Medicare Advantage |
$1,583.09
|
| Rate for Payer: The Alliance Commercial |
$1,319.24
|
| Rate for Payer: WEA Trust Commercial |
$1,451.16
|
| Rate for Payer: WPS Commercial |
$1,954.25
|
|
|
STENT LOOP 8 X 28 POLARIS 155-254
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2964819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT LOOP 8 X 28 POLARIS 155-254
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2964819
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.83 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,126.32
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT LOOP 8 X 30 POLARIS 155-255
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2964820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$919.83 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,126.32
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT LOOP 8 X 30 POLARIS 155-255
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2964820
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT METAL COLON 25x30mm 9cm #M00565050
|
Facility
|
OP
|
$14,613.00
|
|
| Hospital Charge Code |
3072501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,255.31 |
| Max. Negotiated Rate |
$13,981.72 |
| Rate for Payer: Aetna Commercial |
$13,677.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,069.87
|
| Rate for Payer: Aetna Managed Medicare |
$4,255.31
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,878.39
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,598.76
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,294.81
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,054.69
|
| Rate for Payer: Cash Price |
$4,383.90
|
| Rate for Payer: Cigna Commercial |
$13,981.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,504.77
|
| Rate for Payer: Health EOS Commercial |
$13,525.79
|
| Rate for Payer: HFN Commercial |
$13,981.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,398.14
|
| Rate for Payer: Multiplan Commercial |
$12,158.02
|
| Rate for Payer: NAPHCARE Commercial |
$9,118.51
|
| Rate for Payer: Preferred Network Access Commercial |
$13,981.72
|
| Rate for Payer: Quartz Beloit One Network |
$7,446.78
|
| Rate for Payer: Quartz Commercial |
$9,878.39
|
| Rate for Payer: Quartz Medicare Advantage |
$9,118.51
|
| Rate for Payer: The Alliance Commercial |
$7,598.76
|
| Rate for Payer: WEA Trust Commercial |
$8,358.64
|
| Rate for Payer: WPS Commercial |
$11,256.39
|
|
|
STENT METAL COLON 25x30mm 9cm #M00565050
|
Facility
|
IP
|
$14,613.00
|
|
| Hospital Charge Code |
3072501
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,446.78 |
| Max. Negotiated Rate |
$13,981.72 |
| Rate for Payer: Aetna Commercial |
$13,677.77
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,069.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,054.69
|
| Rate for Payer: Cash Price |
$4,383.90
|
| Rate for Payer: Cigna Commercial |
$13,981.72
|
| Rate for Payer: Health EOS Commercial |
$13,525.79
|
| Rate for Payer: HFN Commercial |
$13,981.72
|
| Rate for Payer: Multiplan Commercial |
$12,158.02
|
| Rate for Payer: Preferred Network Access Commercial |
$13,981.72
|
| Rate for Payer: Quartz Beloit One Network |
$7,446.78
|
| Rate for Payer: Quartz Commercial |
$9,118.51
|
| Rate for Payer: WEA Trust Commercial |
$8,358.64
|
| Rate for Payer: WPS Commercial |
$11,256.39
|
|
|
STENT METALLIC 6X22 URETERAL G34109
|
Facility
|
IP
|
$8,256.00
|
|
| Hospital Charge Code |
2964978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,207.26 |
| Max. Negotiated Rate |
$7,899.34 |
| Rate for Payer: Aetna Commercial |
$7,727.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,384.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,550.71
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$7,899.34
|
| Rate for Payer: Health EOS Commercial |
$7,641.75
|
| Rate for Payer: HFN Commercial |
$7,899.34
|
| Rate for Payer: Multiplan Commercial |
$6,868.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7,899.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,207.26
|
| Rate for Payer: Quartz Commercial |
$5,151.74
|
| Rate for Payer: WEA Trust Commercial |
$4,722.43
|
| Rate for Payer: WPS Commercial |
$6,359.60
|
|
|
STENT METALLIC 6X22 URETERAL G34109
|
Facility
|
OP
|
$8,256.00
|
|
| Hospital Charge Code |
2964978
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,404.15 |
| Max. Negotiated Rate |
$7,899.34 |
| Rate for Payer: Aetna Commercial |
$7,727.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,384.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,404.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,581.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,293.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,121.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,550.71
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$7,899.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,804.99
|
| Rate for Payer: Health EOS Commercial |
$7,641.75
|
| Rate for Payer: HFN Commercial |
$7,899.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,439.68
|
| Rate for Payer: Multiplan Commercial |
$6,868.99
|
| Rate for Payer: NAPHCARE Commercial |
$5,151.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,899.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,207.26
|
| Rate for Payer: Quartz Commercial |
$5,581.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5,151.74
|
| Rate for Payer: The Alliance Commercial |
$4,293.12
|
| Rate for Payer: WEA Trust Commercial |
$4,722.43
|
| Rate for Payer: WPS Commercial |
$6,359.60
|
|
|
STENT METALLIC 6X24 URETERAL G34110
|
Facility
|
IP
|
$8,574.00
|
|
| Hospital Charge Code |
2964979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,369.31 |
| Max. Negotiated Rate |
$8,203.60 |
| Rate for Payer: Aetna Commercial |
$8,025.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,668.59
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,725.99
|
| Rate for Payer: Cash Price |
$2,572.20
|
| Rate for Payer: Cigna Commercial |
$8,203.60
|
| Rate for Payer: Health EOS Commercial |
$7,936.09
|
| Rate for Payer: HFN Commercial |
$8,203.60
|
| Rate for Payer: Multiplan Commercial |
$7,133.57
|
| Rate for Payer: Preferred Network Access Commercial |
$8,203.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,369.31
|
| Rate for Payer: Quartz Commercial |
$5,350.18
|
| Rate for Payer: WEA Trust Commercial |
$4,904.33
|
| Rate for Payer: WPS Commercial |
$6,604.55
|
|
|
STENT METALLIC 6X24 URETERAL G34110
|
Facility
|
OP
|
$8,574.00
|
|
| Hospital Charge Code |
2964979
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,496.75 |
| Max. Negotiated Rate |
$8,203.60 |
| Rate for Payer: Aetna Commercial |
$8,025.26
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,668.59
|
| Rate for Payer: Aetna Managed Medicare |
$2,496.75
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,796.02
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,458.48
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,280.14
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,725.99
|
| Rate for Payer: Cash Price |
$2,572.20
|
| Rate for Payer: Cigna Commercial |
$8,203.60
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,990.07
|
| Rate for Payer: Health EOS Commercial |
$7,936.09
|
| Rate for Payer: HFN Commercial |
$8,203.60
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,687.72
|
| Rate for Payer: Multiplan Commercial |
$7,133.57
|
| Rate for Payer: NAPHCARE Commercial |
$5,350.18
|
| Rate for Payer: Preferred Network Access Commercial |
$8,203.60
|
| Rate for Payer: Quartz Beloit One Network |
$4,369.31
|
| Rate for Payer: Quartz Commercial |
$5,796.02
|
| Rate for Payer: Quartz Medicare Advantage |
$5,350.18
|
| Rate for Payer: The Alliance Commercial |
$4,458.48
|
| Rate for Payer: WEA Trust Commercial |
$4,904.33
|
| Rate for Payer: WPS Commercial |
$6,604.55
|
|
|
STENT METALLIC 6X28 URETERAL G34112
|
Facility
|
IP
|
$8,256.00
|
|
| Hospital Charge Code |
2964980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,207.26 |
| Max. Negotiated Rate |
$7,899.34 |
| Rate for Payer: Aetna Commercial |
$7,727.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,384.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,550.71
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$7,899.34
|
| Rate for Payer: Health EOS Commercial |
$7,641.75
|
| Rate for Payer: HFN Commercial |
$7,899.34
|
| Rate for Payer: Multiplan Commercial |
$6,868.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7,899.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,207.26
|
| Rate for Payer: Quartz Commercial |
$5,151.74
|
| Rate for Payer: WEA Trust Commercial |
$4,722.43
|
| Rate for Payer: WPS Commercial |
$6,359.60
|
|
|
STENT METALLIC 6X28 URETERAL G34112
|
Facility
|
OP
|
$8,256.00
|
|
| Hospital Charge Code |
2964980
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,404.15 |
| Max. Negotiated Rate |
$7,899.34 |
| Rate for Payer: Aetna Commercial |
$7,727.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,384.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,404.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,581.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,293.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,121.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,550.71
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$7,899.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,804.99
|
| Rate for Payer: Health EOS Commercial |
$7,641.75
|
| Rate for Payer: HFN Commercial |
$7,899.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,439.68
|
| Rate for Payer: Multiplan Commercial |
$6,868.99
|
| Rate for Payer: NAPHCARE Commercial |
$5,151.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,899.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,207.26
|
| Rate for Payer: Quartz Commercial |
$5,581.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5,151.74
|
| Rate for Payer: The Alliance Commercial |
$4,293.12
|
| Rate for Payer: WEA Trust Commercial |
$4,722.43
|
| Rate for Payer: WPS Commercial |
$6,359.60
|
|
|
STENT METALLIC 6 X 30 URETERAL G34176
|
Facility
|
IP
|
$8,256.00
|
|
| Hospital Charge Code |
2964981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,207.26 |
| Max. Negotiated Rate |
$7,899.34 |
| Rate for Payer: Aetna Commercial |
$7,727.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,384.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,550.71
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$7,899.34
|
| Rate for Payer: Health EOS Commercial |
$7,641.75
|
| Rate for Payer: HFN Commercial |
$7,899.34
|
| Rate for Payer: Multiplan Commercial |
$6,868.99
|
| Rate for Payer: Preferred Network Access Commercial |
$7,899.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,207.26
|
| Rate for Payer: Quartz Commercial |
$5,151.74
|
| Rate for Payer: WEA Trust Commercial |
$4,722.43
|
| Rate for Payer: WPS Commercial |
$6,359.60
|
|
|
STENT METALLIC 6 X 30 URETERAL G34176
|
Facility
|
OP
|
$8,256.00
|
|
| Hospital Charge Code |
2964981
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,404.15 |
| Max. Negotiated Rate |
$7,899.34 |
| Rate for Payer: Aetna Commercial |
$7,727.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,384.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,404.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,581.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,293.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,121.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,550.71
|
| Rate for Payer: Cash Price |
$2,476.80
|
| Rate for Payer: Cigna Commercial |
$7,899.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,804.99
|
| Rate for Payer: Health EOS Commercial |
$7,641.75
|
| Rate for Payer: HFN Commercial |
$7,899.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,439.68
|
| Rate for Payer: Multiplan Commercial |
$6,868.99
|
| Rate for Payer: NAPHCARE Commercial |
$5,151.74
|
| Rate for Payer: Preferred Network Access Commercial |
$7,899.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,207.26
|
| Rate for Payer: Quartz Commercial |
$5,581.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5,151.74
|
| Rate for Payer: The Alliance Commercial |
$4,293.12
|
| Rate for Payer: WEA Trust Commercial |
$4,722.43
|
| Rate for Payer: WPS Commercial |
$6,359.60
|
|
|
Stent-Palmaz Blue
|
Facility
|
OP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4139320
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$3,340.94 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,340.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,755.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,965.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,727.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,677.29
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,948.94
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: NAPHCARE Commercial |
$7,159.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,755.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,159.15
|
| Rate for Payer: The Alliance Commercial |
$5,965.96
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
Stent-Palmaz Blue
|
Facility
|
IP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4139320
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,846.64 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,159.15
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 6MMX 18MM X 135CM
|
Facility
|
OP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3082053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.94 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,340.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,755.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,965.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,727.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,677.29
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,948.94
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: NAPHCARE Commercial |
$7,159.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,755.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,159.15
|
| Rate for Payer: The Alliance Commercial |
$5,965.96
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 6MMX 18MM X 135CM
|
Facility
|
IP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3082053
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,846.64 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,159.15
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 7 X 15MM PB1570BSX
|
Facility
|
IP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3549514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,846.64 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,159.15
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 7 X 15MM PB1570BSX
|
Facility
|
OP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3549514
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.94 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,340.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,755.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,965.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,727.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,677.29
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,948.94
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: NAPHCARE Commercial |
$7,159.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,755.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,159.15
|
| Rate for Payer: The Alliance Commercial |
$5,965.96
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 7 X 18MM PB1870BSX
|
Facility
|
IP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3549515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,846.64 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,159.15
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PALMAZ BLUE 7 X 18MM PB1870BSX
|
Facility
|
OP
|
$11,473.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3549515
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,340.94 |
| Max. Negotiated Rate |
$10,977.37 |
| Rate for Payer: Aetna Commercial |
$10,738.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$10,261.45
|
| Rate for Payer: Aetna Managed Medicare |
$3,340.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$7,755.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$5,965.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$5,727.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$6,323.92
|
| Rate for Payer: Cash Price |
$3,441.90
|
| Rate for Payer: Cigna Commercial |
$10,977.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$6,677.29
|
| Rate for Payer: Health EOS Commercial |
$10,619.41
|
| Rate for Payer: HFN Commercial |
$10,977.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$8,948.94
|
| Rate for Payer: Multiplan Commercial |
$9,545.54
|
| Rate for Payer: NAPHCARE Commercial |
$7,159.15
|
| Rate for Payer: Preferred Network Access Commercial |
$10,977.37
|
| Rate for Payer: Quartz Beloit One Network |
$5,846.64
|
| Rate for Payer: Quartz Commercial |
$7,755.75
|
| Rate for Payer: Quartz Medicare Advantage |
$7,159.15
|
| Rate for Payer: The Alliance Commercial |
$5,965.96
|
| Rate for Payer: WEA Trust Commercial |
$6,562.56
|
| Rate for Payer: WPS Commercial |
$8,837.65
|
|
|
STENT PERCUFLEX INTRODUCER 10FR M00533920
|
Facility
|
IP
|
$855.00
|
|
| Hospital Charge Code |
2972181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$435.71 |
| Max. Negotiated Rate |
$818.06 |
| Rate for Payer: Aetna Commercial |
$800.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.71
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.28
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$818.06
|
| Rate for Payer: Health EOS Commercial |
$791.39
|
| Rate for Payer: HFN Commercial |
$818.06
|
| Rate for Payer: Multiplan Commercial |
$711.36
|
| Rate for Payer: Preferred Network Access Commercial |
$818.06
|
| Rate for Payer: Quartz Beloit One Network |
$435.71
|
| Rate for Payer: Quartz Commercial |
$533.52
|
| Rate for Payer: WEA Trust Commercial |
$489.06
|
| Rate for Payer: WPS Commercial |
$658.61
|
|
|
STENT PERCUFLEX INTRODUCER 10FR M00533920
|
Facility
|
OP
|
$855.00
|
|
| Hospital Charge Code |
2972181
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$248.98 |
| Max. Negotiated Rate |
$818.06 |
| Rate for Payer: Aetna Commercial |
$800.28
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$764.71
|
| Rate for Payer: Aetna Managed Medicare |
$248.98
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$577.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$444.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$426.82
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$471.28
|
| Rate for Payer: Cash Price |
$256.50
|
| Rate for Payer: Cigna Commercial |
$818.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$497.61
|
| Rate for Payer: Health EOS Commercial |
$791.39
|
| Rate for Payer: HFN Commercial |
$818.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$666.90
|
| Rate for Payer: Multiplan Commercial |
$711.36
|
| Rate for Payer: NAPHCARE Commercial |
$533.52
|
| Rate for Payer: Preferred Network Access Commercial |
$818.06
|
| Rate for Payer: Quartz Beloit One Network |
$435.71
|
| Rate for Payer: Quartz Commercial |
$577.98
|
| Rate for Payer: Quartz Medicare Advantage |
$533.52
|
| Rate for Payer: The Alliance Commercial |
$444.60
|
| Rate for Payer: WEA Trust Commercial |
$489.06
|
| Rate for Payer: WPS Commercial |
$658.61
|
|
