|
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 |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
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 |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT 4X BILIARY 7FR. 5CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$474.66 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Aetna Managed Medicare |
$474.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,101.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$847.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$813.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$948.66
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,271.40
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: NAPHCARE Commercial |
$1,017.12
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,101.88
|
| Rate for Payer: Quartz Medicare Advantage |
$1,017.12
|
| Rate for Payer: The Alliance Commercial |
$847.60
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT 4X BILIARY 7FR. 5CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972365
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$830.65 |
| Max. Negotiated Rate |
$1,559.58 |
| Rate for Payer: Aetna Commercial |
$1,525.68
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,457.87
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$898.46
|
| Rate for Payer: Cash Price |
$489.00
|
| Rate for Payer: Cigna Commercial |
$1,559.58
|
| Rate for Payer: Health EOS Commercial |
$1,508.73
|
| Rate for Payer: HFN Commercial |
$1,559.58
|
| Rate for Payer: Multiplan Commercial |
$1,356.16
|
| Rate for Payer: Preferred Network Access Commercial |
$1,559.58
|
| Rate for Payer: Quartz Beloit One Network |
$830.65
|
| Rate for Payer: Quartz Commercial |
$1,017.12
|
| Rate for Payer: WEA Trust Commercial |
$932.36
|
| Rate for Payer: WPS Commercial |
$1,255.59
|
|
|
STENT 5X20 LOOP 155-220
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2964811
|
|
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 5X20 LOOP 155-220
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2964811
|
|
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 5X22 LOOP 155-221
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2964812
|
|
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 5X22 LOOP 155-221
|
Facility
|
OP
|
$1,805.00
|
|
| Hospital Charge Code |
2964812
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$525.62 |
| Max. Negotiated Rate |
$1,727.02 |
| Rate for Payer: Aetna Commercial |
$1,689.48
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,614.39
|
| Rate for Payer: Aetna Managed Medicare |
$525.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,220.18
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$938.60
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$901.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$994.92
|
| Rate for Payer: Cash Price |
$541.50
|
| Rate for Payer: Cigna Commercial |
$1,727.02
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,050.51
|
| Rate for Payer: Health EOS Commercial |
$1,670.71
|
| Rate for Payer: HFN Commercial |
$1,727.02
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,407.90
|
| Rate for Payer: Multiplan Commercial |
$1,501.76
|
| Rate for Payer: NAPHCARE Commercial |
$1,126.32
|
| Rate for Payer: Preferred Network Access Commercial |
$1,727.02
|
| Rate for Payer: Quartz Beloit One Network |
$919.83
|
| Rate for Payer: Quartz Commercial |
$1,220.18
|
| Rate for Payer: Quartz Medicare Advantage |
$1,126.32
|
| Rate for Payer: The Alliance Commercial |
$938.60
|
| Rate for Payer: WEA Trust Commercial |
$1,032.46
|
| Rate for Payer: WPS Commercial |
$1,390.39
|
|
|
STENT 6 X 20 BLACK SILICONE LOOP G15193
|
Facility
|
IP
|
$1,805.00
|
|
| Hospital Charge Code |
2965868
|
|
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
|
|
