|
STENT BANDER URETERAL DIVERSION 7.2FR X75CM G18070
|
Facility
|
IP
|
$4,290.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
2965894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,186.18 |
| Max. Negotiated Rate |
$4,104.67 |
| Rate for Payer: Aetna Commercial |
$4,015.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,836.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,364.65
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna Commercial |
$4,104.67
|
| Rate for Payer: Health EOS Commercial |
$3,970.82
|
| Rate for Payer: HFN Commercial |
$4,104.67
|
| Rate for Payer: Multiplan Commercial |
$3,569.28
|
| Rate for Payer: Preferred Network Access Commercial |
$4,104.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,186.18
|
| Rate for Payer: Quartz Commercial |
$2,676.96
|
| Rate for Payer: WEA Trust Commercial |
$2,453.88
|
| Rate for Payer: WPS Commercial |
$3,304.59
|
|
|
STENT BANDER URETERAL DIVERSION 7.2FR X75CM G18070
|
Facility
|
OP
|
$4,290.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
2965894
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,249.25 |
| Max. Negotiated Rate |
$4,104.67 |
| Rate for Payer: Aetna Commercial |
$4,015.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$3,836.98
|
| Rate for Payer: Aetna Managed Medicare |
$1,249.25
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,900.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,230.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,141.57
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,364.65
|
| Rate for Payer: Cash Price |
$1,287.00
|
| Rate for Payer: Cigna Commercial |
$4,104.67
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,496.78
|
| Rate for Payer: Health EOS Commercial |
$3,970.82
|
| Rate for Payer: HFN Commercial |
$4,104.67
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,346.20
|
| Rate for Payer: Multiplan Commercial |
$3,569.28
|
| Rate for Payer: NAPHCARE Commercial |
$2,676.96
|
| Rate for Payer: Preferred Network Access Commercial |
$4,104.67
|
| Rate for Payer: Quartz Beloit One Network |
$2,186.18
|
| Rate for Payer: Quartz Commercial |
$2,900.04
|
| Rate for Payer: Quartz Medicare Advantage |
$2,676.96
|
| Rate for Payer: The Alliance Commercial |
$2,230.80
|
| Rate for Payer: WEA Trust Commercial |
$2,453.88
|
| Rate for Payer: WPS Commercial |
$3,304.59
|
|
|
STENT BM VeriFLEX 3.0 x 12mm
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT BM VeriFLEX 3.0 x 12mm
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973672
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT BM VeriFLEX 3.0 x 16mm
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT BM VeriFLEX 3.0 x 16mm
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2973671
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENTBM VERIFLEX 3.0 X 20
|
Facility
|
IP
|
$6,204.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3521504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,161.56 |
| Max. Negotiated Rate |
$5,935.99 |
| Rate for Payer: Aetna Commercial |
$5,806.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,548.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,419.64
|
| Rate for Payer: Cash Price |
$1,861.20
|
| Rate for Payer: Cigna Commercial |
$5,935.99
|
| Rate for Payer: Health EOS Commercial |
$5,742.42
|
| Rate for Payer: HFN Commercial |
$5,935.99
|
| Rate for Payer: Multiplan Commercial |
$5,161.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,935.99
|
| Rate for Payer: Quartz Beloit One Network |
$3,161.56
|
| Rate for Payer: Quartz Commercial |
$3,871.30
|
| Rate for Payer: WEA Trust Commercial |
$3,548.69
|
| Rate for Payer: WPS Commercial |
$4,778.94
|
|
|
STENTBM VERIFLEX 3.0 X 20
|
Facility
|
OP
|
$6,204.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3521504
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,806.60 |
| Max. Negotiated Rate |
$5,935.99 |
| Rate for Payer: Aetna Commercial |
$5,806.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,548.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,806.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,193.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,226.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,097.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,419.64
|
| Rate for Payer: Cash Price |
$1,861.20
|
| Rate for Payer: Cigna Commercial |
$5,935.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,610.73
|
| Rate for Payer: Health EOS Commercial |
$5,742.42
|
| Rate for Payer: HFN Commercial |
$5,935.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,839.12
|
| Rate for Payer: Multiplan Commercial |
$5,161.73
|
| Rate for Payer: NAPHCARE Commercial |
$3,871.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,935.99
|
| Rate for Payer: Quartz Beloit One Network |
$3,161.56
|
| Rate for Payer: Quartz Commercial |
$4,193.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,871.30
|
| Rate for Payer: The Alliance Commercial |
$3,226.08
|
| Rate for Payer: WEA Trust Commercial |
$3,548.69
|
| Rate for Payer: WPS Commercial |
$4,778.94
|
|
|
STENTBM VERIFLEX 3.0 X 24
|
Facility
|
IP
|
$6,204.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3521506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,161.56 |
| Max. Negotiated Rate |
$5,935.99 |
| Rate for Payer: Aetna Commercial |
$5,806.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,548.86
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,419.64
|
| Rate for Payer: Cash Price |
$1,861.20
|
| Rate for Payer: Cigna Commercial |
$5,935.99
|
| Rate for Payer: Health EOS Commercial |
$5,742.42
|
| Rate for Payer: HFN Commercial |
$5,935.99
|
| Rate for Payer: Multiplan Commercial |
$5,161.73
|
| Rate for Payer: Preferred Network Access Commercial |
$5,935.99
|
| Rate for Payer: Quartz Beloit One Network |
$3,161.56
|
| Rate for Payer: Quartz Commercial |
$3,871.30
|
| Rate for Payer: WEA Trust Commercial |
$3,548.69
|
| Rate for Payer: WPS Commercial |
$4,778.94
|
|
|
STENTBM VERIFLEX 3.0 X 24
|
Facility
|
OP
|
$6,204.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3521506
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,806.60 |
| Max. Negotiated Rate |
$5,935.99 |
| Rate for Payer: Aetna Commercial |
$5,806.94
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,548.86
|
| Rate for Payer: Aetna Managed Medicare |
$1,806.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,193.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,226.08
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,097.04
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,419.64
|
| Rate for Payer: Cash Price |
$1,861.20
|
| Rate for Payer: Cigna Commercial |
$5,935.99
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,610.73
|
| Rate for Payer: Health EOS Commercial |
$5,742.42
|
| Rate for Payer: HFN Commercial |
$5,935.99
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,839.12
|
| Rate for Payer: Multiplan Commercial |
$5,161.73
|
| Rate for Payer: NAPHCARE Commercial |
$3,871.30
|
| Rate for Payer: Preferred Network Access Commercial |
$5,935.99
|
| Rate for Payer: Quartz Beloit One Network |
$3,161.56
|
| Rate for Payer: Quartz Commercial |
$4,193.90
|
| Rate for Payer: Quartz Medicare Advantage |
$3,871.30
|
| Rate for Payer: The Alliance Commercial |
$3,226.08
|
| Rate for Payer: WEA Trust Commercial |
$3,548.69
|
| Rate for Payer: WPS Commercial |
$4,778.94
|
|
|
STENT CATHETER BALLOON GRAFT REL46
|
Facility
|
IP
|
$5,059.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3104708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$2,578.07 |
| Max. Negotiated Rate |
$4,840.45 |
| Rate for Payer: Aetna Commercial |
$4,735.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,524.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,788.52
|
| Rate for Payer: Cash Price |
$1,517.70
|
| Rate for Payer: Cigna Commercial |
$4,840.45
|
| Rate for Payer: Health EOS Commercial |
$4,682.61
|
| Rate for Payer: HFN Commercial |
$4,840.45
|
| Rate for Payer: Multiplan Commercial |
$4,209.09
|
| Rate for Payer: Preferred Network Access Commercial |
$4,840.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,578.07
|
| Rate for Payer: Quartz Commercial |
$3,156.82
|
| Rate for Payer: WEA Trust Commercial |
$2,893.75
|
| Rate for Payer: WPS Commercial |
$3,896.95
|
|
|
STENT CATHETER BALLOON GRAFT REL46
|
Facility
|
OP
|
$5,059.00
|
|
|
Service Code
|
HCPCS C1725
|
| Hospital Charge Code |
3104708
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$1,473.18 |
| Max. Negotiated Rate |
$4,840.45 |
| Rate for Payer: Aetna Commercial |
$4,735.22
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,524.77
|
| Rate for Payer: Aetna Managed Medicare |
$1,473.18
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,419.88
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,630.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,525.45
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,788.52
|
| Rate for Payer: Cash Price |
$1,517.70
|
| Rate for Payer: Cigna Commercial |
$4,840.45
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,944.34
|
| Rate for Payer: Health EOS Commercial |
$4,682.61
|
| Rate for Payer: HFN Commercial |
$4,840.45
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$3,946.02
|
| Rate for Payer: Multiplan Commercial |
$4,209.09
|
| Rate for Payer: NAPHCARE Commercial |
$3,156.82
|
| Rate for Payer: Preferred Network Access Commercial |
$4,840.45
|
| Rate for Payer: Quartz Beloit One Network |
$2,578.07
|
| Rate for Payer: Quartz Commercial |
$3,419.88
|
| Rate for Payer: Quartz Medicare Advantage |
$3,156.82
|
| Rate for Payer: The Alliance Commercial |
$2,630.68
|
| Rate for Payer: WEA Trust Commercial |
$2,893.75
|
| Rate for Payer: WPS Commercial |
$3,896.95
|
|
|
STENT/CATHETER NEPHROSTOMY PERCUTANEOUS COMBINATION 8FR X 25CM M0064101260
|
Facility
|
IP
|
$1,334.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5459834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$679.81 |
| Max. Negotiated Rate |
$1,276.37 |
| Rate for Payer: Aetna Commercial |
$1,248.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,193.13
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$735.30
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$1,276.37
|
| Rate for Payer: Health EOS Commercial |
$1,234.75
|
| Rate for Payer: HFN Commercial |
$1,276.37
|
| Rate for Payer: Multiplan Commercial |
$1,109.89
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.37
|
| Rate for Payer: Quartz Beloit One Network |
$679.81
|
| Rate for Payer: Quartz Commercial |
$832.42
|
| Rate for Payer: WEA Trust Commercial |
$763.05
|
| Rate for Payer: WPS Commercial |
$1,027.58
|
|
|
STENT/CATHETER NEPHROSTOMY PERCUTANEOUS COMBINATION 8FR X 25CM M0064101260
|
Facility
|
OP
|
$1,334.00
|
|
|
Service Code
|
HCPCS C1729
|
| Hospital Charge Code |
5459834
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$388.46 |
| Max. Negotiated Rate |
$1,276.37 |
| Rate for Payer: Aetna Commercial |
$1,248.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,193.13
|
| Rate for Payer: Aetna Managed Medicare |
$388.46
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$901.78
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$693.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$665.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$735.30
|
| Rate for Payer: Cash Price |
$400.20
|
| Rate for Payer: Cigna Commercial |
$1,276.37
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$776.39
|
| Rate for Payer: Health EOS Commercial |
$1,234.75
|
| Rate for Payer: HFN Commercial |
$1,276.37
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,040.52
|
| Rate for Payer: Multiplan Commercial |
$1,109.89
|
| Rate for Payer: NAPHCARE Commercial |
$832.42
|
| Rate for Payer: Preferred Network Access Commercial |
$1,276.37
|
| Rate for Payer: Quartz Beloit One Network |
$679.81
|
| Rate for Payer: Quartz Commercial |
$901.78
|
| Rate for Payer: Quartz Medicare Advantage |
$832.42
|
| Rate for Payer: The Alliance Commercial |
$693.68
|
| Rate for Payer: WEA Trust Commercial |
$763.05
|
| Rate for Payer: WPS Commercial |
$1,027.58
|
|
|
STENT C-FLEX 10x10 PIGTAIL
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
2971853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$266.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$475.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.53
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$713.70
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$570.96
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$570.96
|
| Rate for Payer: The Alliance Commercial |
$475.80
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
STENT C-FLEX 10x10 PIGTAIL
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
2971853
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
STENT C-FLEX 10x5 PIGTAIL
|
Facility
|
OP
|
$915.00
|
|
| Hospital Charge Code |
2971852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$266.45 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Aetna Managed Medicare |
$266.45
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$618.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$475.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$456.77
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$532.53
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$713.70
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: NAPHCARE Commercial |
$570.96
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$618.54
|
| Rate for Payer: Quartz Medicare Advantage |
$570.96
|
| Rate for Payer: The Alliance Commercial |
$475.80
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
STENT C-FLEX 10x5 PIGTAIL
|
Facility
|
IP
|
$915.00
|
|
| Hospital Charge Code |
2971852
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$466.28 |
| Max. Negotiated Rate |
$875.47 |
| Rate for Payer: Aetna Commercial |
$856.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$818.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$504.35
|
| Rate for Payer: Cash Price |
$274.50
|
| Rate for Payer: Cigna Commercial |
$875.47
|
| Rate for Payer: Health EOS Commercial |
$846.92
|
| Rate for Payer: HFN Commercial |
$875.47
|
| Rate for Payer: Multiplan Commercial |
$761.28
|
| Rate for Payer: Preferred Network Access Commercial |
$875.47
|
| Rate for Payer: Quartz Beloit One Network |
$466.28
|
| Rate for Payer: Quartz Commercial |
$570.96
|
| Rate for Payer: WEA Trust Commercial |
$523.38
|
| Rate for Payer: WPS Commercial |
$704.82
|
|
|
STENT CONTOUR SOFT 6 X 22-33 W/O GUIDEWIRE M0061801560
|
Facility
|
IP
|
$1,622.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$826.57 |
| Max. Negotiated Rate |
$1,551.93 |
| Rate for Payer: Aetna Commercial |
$1,518.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,450.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.05
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,551.93
|
| Rate for Payer: Health EOS Commercial |
$1,501.32
|
| Rate for Payer: HFN Commercial |
$1,551.93
|
| Rate for Payer: Multiplan Commercial |
$1,349.50
|
| Rate for Payer: Preferred Network Access Commercial |
$1,551.93
|
| Rate for Payer: Quartz Beloit One Network |
$826.57
|
| Rate for Payer: Quartz Commercial |
$1,012.13
|
| Rate for Payer: WEA Trust Commercial |
$927.78
|
| Rate for Payer: WPS Commercial |
$1,249.43
|
|
|
STENT CONTOUR SOFT 6 X 22-33 W/O GUIDEWIRE M0061801560
|
Facility
|
OP
|
$1,622.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520090
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$472.33 |
| Max. Negotiated Rate |
$1,551.93 |
| Rate for Payer: Aetna Commercial |
$1,518.19
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,450.72
|
| Rate for Payer: Aetna Managed Medicare |
$472.33
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,096.47
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$843.44
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$809.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$894.05
|
| Rate for Payer: Cash Price |
$486.60
|
| Rate for Payer: Cigna Commercial |
$1,551.93
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$944.00
|
| Rate for Payer: Health EOS Commercial |
$1,501.32
|
| Rate for Payer: HFN Commercial |
$1,551.93
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,265.16
|
| Rate for Payer: Multiplan Commercial |
$1,349.50
|
| Rate for Payer: NAPHCARE Commercial |
$1,012.13
|
| Rate for Payer: Preferred Network Access Commercial |
$1,551.93
|
| Rate for Payer: Quartz Beloit One Network |
$826.57
|
| Rate for Payer: Quartz Commercial |
$1,096.47
|
| Rate for Payer: Quartz Medicare Advantage |
$1,012.13
|
| Rate for Payer: The Alliance Commercial |
$843.44
|
| Rate for Payer: WEA Trust Commercial |
$927.78
|
| Rate for Payer: WPS Commercial |
$1,249.43
|
|
|
STENT CONTOUR SOFT 7 X 22-30 W/O GUIDEWIRE M0061801570
|
Facility
|
OP
|
$1,685.00
|
|
| Hospital Charge Code |
4520089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$490.67 |
| Max. Negotiated Rate |
$1,612.21 |
| Rate for Payer: Aetna Commercial |
$1,577.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.06
|
| Rate for Payer: Aetna Managed Medicare |
$490.67
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,139.06
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$876.20
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$841.15
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.77
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,612.21
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$980.67
|
| Rate for Payer: Health EOS Commercial |
$1,559.64
|
| Rate for Payer: HFN Commercial |
$1,612.21
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,314.30
|
| Rate for Payer: Multiplan Commercial |
$1,401.92
|
| Rate for Payer: NAPHCARE Commercial |
$1,051.44
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.21
|
| Rate for Payer: Quartz Beloit One Network |
$858.68
|
| Rate for Payer: Quartz Commercial |
$1,139.06
|
| Rate for Payer: Quartz Medicare Advantage |
$1,051.44
|
| Rate for Payer: The Alliance Commercial |
$876.20
|
| Rate for Payer: WEA Trust Commercial |
$963.82
|
| Rate for Payer: WPS Commercial |
$1,297.96
|
|
|
STENT CONTOUR SOFT 7 X 22-30 W/O GUIDEWIRE M0061801570
|
Facility
|
IP
|
$1,685.00
|
|
| Hospital Charge Code |
4520089
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$858.68 |
| Max. Negotiated Rate |
$1,612.21 |
| Rate for Payer: Aetna Commercial |
$1,577.16
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,507.06
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$928.77
|
| Rate for Payer: Cash Price |
$505.50
|
| Rate for Payer: Cigna Commercial |
$1,612.21
|
| Rate for Payer: Health EOS Commercial |
$1,559.64
|
| Rate for Payer: HFN Commercial |
$1,612.21
|
| Rate for Payer: Multiplan Commercial |
$1,401.92
|
| Rate for Payer: Preferred Network Access Commercial |
$1,612.21
|
| Rate for Payer: Quartz Beloit One Network |
$858.68
|
| Rate for Payer: Quartz Commercial |
$1,051.44
|
| Rate for Payer: WEA Trust Commercial |
$963.82
|
| Rate for Payer: WPS Commercial |
$1,297.96
|
|
|
Stent-Coronary Bare Metal
|
Facility
|
IP
|
$5,153.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4001127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,625.97 |
| Max. Negotiated Rate |
$4,930.39 |
| Rate for Payer: Aetna Commercial |
$4,823.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,608.84
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,840.33
|
| Rate for Payer: Cash Price |
$1,545.90
|
| Rate for Payer: Cigna Commercial |
$4,930.39
|
| Rate for Payer: Health EOS Commercial |
$4,769.62
|
| Rate for Payer: HFN Commercial |
$4,930.39
|
| Rate for Payer: Multiplan Commercial |
$4,287.30
|
| Rate for Payer: Preferred Network Access Commercial |
$4,930.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.97
|
| Rate for Payer: Quartz Commercial |
$3,215.47
|
| Rate for Payer: WEA Trust Commercial |
$2,947.52
|
| Rate for Payer: WPS Commercial |
$3,969.36
|
|
|
Stent-Coronary Bare Metal
|
Facility
|
OP
|
$5,153.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
4001127
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,500.55 |
| Max. Negotiated Rate |
$4,930.39 |
| Rate for Payer: Aetna Commercial |
$4,823.21
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,608.84
|
| Rate for Payer: Aetna Managed Medicare |
$1,500.55
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$3,483.43
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$2,679.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$2,572.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$2,840.33
|
| Rate for Payer: Cash Price |
$1,545.90
|
| Rate for Payer: Cigna Commercial |
$4,930.39
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$2,999.05
|
| Rate for Payer: Health EOS Commercial |
$4,769.62
|
| Rate for Payer: HFN Commercial |
$4,930.39
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$4,019.34
|
| Rate for Payer: Multiplan Commercial |
$4,287.30
|
| Rate for Payer: NAPHCARE Commercial |
$3,215.47
|
| Rate for Payer: Preferred Network Access Commercial |
$4,930.39
|
| Rate for Payer: Quartz Beloit One Network |
$2,625.97
|
| Rate for Payer: Quartz Commercial |
$3,483.43
|
| Rate for Payer: Quartz Medicare Advantage |
$3,215.47
|
| Rate for Payer: The Alliance Commercial |
$2,679.56
|
| Rate for Payer: WEA Trust Commercial |
$2,947.52
|
| Rate for Payer: WPS Commercial |
$3,969.36
|
|
|
Stent-Coronary DES
|
Facility
|
OP
|
$7,595.00
|
|
|
Service Code
|
HCPCS C1874
|
| Hospital Charge Code |
4001126
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,211.66 |
| Max. Negotiated Rate |
$7,266.90 |
| Rate for Payer: Aetna Commercial |
$7,108.92
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$6,792.97
|
| Rate for Payer: Aetna Managed Medicare |
$2,211.66
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,134.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,949.40
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,791.42
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,186.36
|
| Rate for Payer: Cash Price |
$2,278.50
|
| Rate for Payer: Cigna Commercial |
$7,266.90
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$4,420.29
|
| Rate for Payer: Health EOS Commercial |
$7,029.93
|
| Rate for Payer: HFN Commercial |
$7,266.90
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,924.10
|
| Rate for Payer: Multiplan Commercial |
$6,319.04
|
| Rate for Payer: NAPHCARE Commercial |
$4,739.28
|
| Rate for Payer: Preferred Network Access Commercial |
$7,266.90
|
| Rate for Payer: Quartz Beloit One Network |
$3,870.41
|
| Rate for Payer: Quartz Commercial |
$5,134.22
|
| Rate for Payer: Quartz Medicare Advantage |
$4,739.28
|
| Rate for Payer: The Alliance Commercial |
$3,949.40
|
| Rate for Payer: WEA Trust Commercial |
$4,344.34
|
| Rate for Payer: WPS Commercial |
$5,850.43
|
|
