|
STENT DUODENAL BEND PRELOADED ADVANIX 7FR X 15CM
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$8,184.00 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Aetna Managed Medicare |
$572.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.94
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.50
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,329.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.60
|
| Rate for Payer: The Alliance Commercial |
$8,184.00
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 7FR X 5CM M00534200
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$8,184.00 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Aetna Managed Medicare |
$572.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.94
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.50
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,329.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.60
|
| Rate for Payer: The Alliance Commercial |
$8,184.00
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 7FR X 5CM M00534200
|
Facility
|
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.54 |
| Max. Negotiated Rate |
$1,882.32 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,227.60
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 7FR X 7CM M00534210
|
Facility
|
IP
|
$2,122.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
2972822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,039.78 |
| Max. Negotiated Rate |
$1,952.24 |
| Rate for Payer: Aetna Commercial |
$1,909.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.66
|
| Rate for Payer: Cash Price |
$636.60
|
| Rate for Payer: Cigna Commercial |
$1,952.24
|
| Rate for Payer: Health EOS Commercial |
$1,888.58
|
| Rate for Payer: HFN Commercial |
$1,952.24
|
| Rate for Payer: Multiplan Commercial |
$1,697.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,273.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,952.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.78
|
| Rate for Payer: Quartz Commercial |
$1,273.20
|
| Rate for Payer: WEA Trust Commercial |
$1,167.10
|
| Rate for Payer: WPS Commercial |
$1,571.77
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 7FR X 7CM M00534210
|
Facility
|
OP
|
$2,122.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
2972822
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$594.16 |
| Max. Negotiated Rate |
$8,488.00 |
| Rate for Payer: Aetna Commercial |
$1,909.80
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,824.92
|
| Rate for Payer: Aetna Managed Medicare |
$594.16
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,379.30
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,061.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,018.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,124.66
|
| Rate for Payer: Cash Price |
$636.60
|
| Rate for Payer: Cigna Commercial |
$1,952.24
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,187.47
|
| Rate for Payer: Health EOS Commercial |
$1,888.58
|
| Rate for Payer: HFN Commercial |
$1,952.24
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,591.50
|
| Rate for Payer: Multiplan Commercial |
$1,697.60
|
| Rate for Payer: NAPHCARE Commercial |
$1,273.20
|
| Rate for Payer: Preferred Network Access Commercial |
$1,952.24
|
| Rate for Payer: Quartz Beloit One Network |
$1,039.78
|
| Rate for Payer: Quartz Commercial |
$1,379.30
|
| Rate for Payer: Quartz Medicare Advantage |
$1,273.20
|
| Rate for Payer: The Alliance Commercial |
$8,488.00
|
| Rate for Payer: WEA Trust Commercial |
$1,167.10
|
| Rate for Payer: WPS Commercial |
$1,571.77
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 7FR X 9CM M00534220
|
Facility
|
OP
|
$2,045.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
2972823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.60 |
| Max. Negotiated Rate |
$8,180.00 |
| Rate for Payer: Aetna Commercial |
$1,840.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,758.70
|
| Rate for Payer: Aetna Managed Medicare |
$572.60
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,022.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$981.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.85
|
| Rate for Payer: Cash Price |
$613.50
|
| Rate for Payer: Cigna Commercial |
$1,881.40
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.38
|
| Rate for Payer: Health EOS Commercial |
$1,820.05
|
| Rate for Payer: HFN Commercial |
$1,881.40
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,533.75
|
| Rate for Payer: Multiplan Commercial |
$1,636.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.05
|
| Rate for Payer: Quartz Commercial |
$1,329.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.00
|
| Rate for Payer: The Alliance Commercial |
$8,180.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.75
|
| Rate for Payer: WPS Commercial |
$1,514.73
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 7FR X 9CM M00534220
|
Facility
|
IP
|
$2,045.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
2972823
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.05 |
| Max. Negotiated Rate |
$1,881.40 |
| Rate for Payer: Aetna Commercial |
$1,840.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,758.70
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,083.85
|
| Rate for Payer: Cash Price |
$613.50
|
| Rate for Payer: Cigna Commercial |
$1,881.40
|
| Rate for Payer: Health EOS Commercial |
$1,820.05
|
| Rate for Payer: HFN Commercial |
$1,881.40
|
| Rate for Payer: Multiplan Commercial |
$1,636.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,881.40
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.05
|
| Rate for Payer: Quartz Commercial |
$1,227.00
|
| Rate for Payer: WEA Trust Commercial |
$1,124.75
|
| Rate for Payer: WPS Commercial |
$1,514.73
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 5CM M00534260
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$8,500.00 |
| Rate for Payer: Aetna Commercial |
$1,912.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,827.50
|
| Rate for Payer: Aetna Managed Medicare |
$595.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,381.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,062.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,126.25
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,955.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,189.15
|
| Rate for Payer: Health EOS Commercial |
$1,891.25
|
| Rate for Payer: HFN Commercial |
$1,955.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,593.75
|
| Rate for Payer: Multiplan Commercial |
$1,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,275.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,955.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,041.25
|
| Rate for Payer: Quartz Commercial |
$1,381.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,275.00
|
| Rate for Payer: The Alliance Commercial |
$8,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,168.75
|
| Rate for Payer: WPS Commercial |
$1,573.99
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 5CM M00534260
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.25 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Aetna Commercial |
$1,912.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,827.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,126.25
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,955.00
|
| Rate for Payer: Health EOS Commercial |
$1,891.25
|
| Rate for Payer: HFN Commercial |
$1,955.00
|
| Rate for Payer: Multiplan Commercial |
$1,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,275.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,955.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,041.25
|
| Rate for Payer: Quartz Commercial |
$1,275.00
|
| Rate for Payer: WEA Trust Commercial |
$1,168.75
|
| Rate for Payer: WPS Commercial |
$1,573.99
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 7CM M00534270
|
Facility
|
IP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,041.25 |
| Max. Negotiated Rate |
$1,955.00 |
| Rate for Payer: Aetna Commercial |
$1,912.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,827.50
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,126.25
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,955.00
|
| Rate for Payer: Health EOS Commercial |
$1,891.25
|
| Rate for Payer: HFN Commercial |
$1,955.00
|
| Rate for Payer: Multiplan Commercial |
$1,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,275.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,955.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,041.25
|
| Rate for Payer: Quartz Commercial |
$1,275.00
|
| Rate for Payer: WEA Trust Commercial |
$1,168.75
|
| Rate for Payer: WPS Commercial |
$1,573.99
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 7CM M00534270
|
Facility
|
OP
|
$2,125.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092801
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$595.00 |
| Max. Negotiated Rate |
$8,500.00 |
| Rate for Payer: Aetna Commercial |
$1,912.50
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,827.50
|
| Rate for Payer: Aetna Managed Medicare |
$595.00
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,381.25
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,062.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,020.00
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,126.25
|
| Rate for Payer: Cash Price |
$637.50
|
| Rate for Payer: Cigna Commercial |
$1,955.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,189.15
|
| Rate for Payer: Health EOS Commercial |
$1,891.25
|
| Rate for Payer: HFN Commercial |
$1,955.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,593.75
|
| Rate for Payer: Multiplan Commercial |
$1,700.00
|
| Rate for Payer: NAPHCARE Commercial |
$1,275.00
|
| Rate for Payer: Preferred Network Access Commercial |
$1,955.00
|
| Rate for Payer: Quartz Beloit One Network |
$1,041.25
|
| Rate for Payer: Quartz Commercial |
$1,381.25
|
| Rate for Payer: Quartz Medicare Advantage |
$1,275.00
|
| Rate for Payer: The Alliance Commercial |
$8,500.00
|
| Rate for Payer: WEA Trust Commercial |
$1,168.75
|
| Rate for Payer: WPS Commercial |
$1,573.99
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 9CM M00534280
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$8,184.00 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Aetna Managed Medicare |
$572.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.94
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.50
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,329.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.60
|
| Rate for Payer: The Alliance Commercial |
$8,184.00
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5FR X 9CM M00534280
|
Facility
|
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3092802
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.54 |
| Max. Negotiated Rate |
$1,882.32 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,227.60
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5F X 12CM 3429
|
Facility
|
IP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3949318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,002.54 |
| Max. Negotiated Rate |
$1,882.32 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,227.60
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
STENT DUODENAL BEND PRELOADED ADVANIX 8.5F X 12CM 3429
|
Facility
|
OP
|
$2,046.00
|
|
|
Service Code
|
HCPCS C2625
|
| Hospital Charge Code |
3949318
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$572.88 |
| Max. Negotiated Rate |
$8,184.00 |
| Rate for Payer: Aetna Commercial |
$1,841.40
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,759.56
|
| Rate for Payer: Aetna Managed Medicare |
$572.88
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,329.90
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,023.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$982.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,084.38
|
| Rate for Payer: Cash Price |
$613.80
|
| Rate for Payer: Cigna Commercial |
$1,882.32
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,144.94
|
| Rate for Payer: Health EOS Commercial |
$1,820.94
|
| Rate for Payer: HFN Commercial |
$1,882.32
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,534.50
|
| Rate for Payer: Multiplan Commercial |
$1,636.80
|
| Rate for Payer: NAPHCARE Commercial |
$1,227.60
|
| Rate for Payer: Preferred Network Access Commercial |
$1,882.32
|
| Rate for Payer: Quartz Beloit One Network |
$1,002.54
|
| Rate for Payer: Quartz Commercial |
$1,329.90
|
| Rate for Payer: Quartz Medicare Advantage |
$1,227.60
|
| Rate for Payer: The Alliance Commercial |
$8,184.00
|
| Rate for Payer: WEA Trust Commercial |
$1,125.30
|
| Rate for Payer: WPS Commercial |
$1,515.47
|
|
|
STENT EVERFLEX 7mm X 20mm X120 #PRB35-07-20-120
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.29
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.25
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$6,421.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.40
|
| Rate for Payer: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT EVERFLEX 7mm X 20mm X120 #PRB35-07-20-120
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974859
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.71 |
| Max. Negotiated Rate |
$9,088.68 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$5,927.40
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT EVERFLEX 7mm X 40mm X120 #PRB35-07-40-120
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.71 |
| Max. Negotiated Rate |
$9,088.68 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$5,927.40
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT EVERFLEX 7mm X 40mm X120 #PRB35-07-40-120
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974858
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.29
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.25
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$6,421.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.40
|
| Rate for Payer: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT EVERFLEX 7 X 150mm #PRB35-07-150-120
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,840.71 |
| Max. Negotiated Rate |
$9,088.68 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$5,927.40
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
STENT EVERFLEX 7 X 150mm #PRB35-07-150-120
|
Facility
|
OP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107482
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,766.12 |
| Max. Negotiated Rate |
$39,516.00 |
| Rate for Payer: Aetna Commercial |
$8,891.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,495.94
|
| Rate for Payer: Aetna Managed Medicare |
$2,766.12
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$6,421.35
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,939.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,741.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,235.87
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,088.68
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,528.29
|
| Rate for Payer: Health EOS Commercial |
$8,792.31
|
| Rate for Payer: HFN Commercial |
$9,088.68
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,409.25
|
| Rate for Payer: Multiplan Commercial |
$7,903.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,927.40
|
| Rate for Payer: Preferred Network Access Commercial |
$9,088.68
|
| Rate for Payer: Quartz Beloit One Network |
$4,840.71
|
| Rate for Payer: Quartz Commercial |
$6,421.35
|
| Rate for Payer: Quartz Medicare Advantage |
$5,927.40
|
| Rate for Payer: The Alliance Commercial |
$39,516.00
|
| Rate for Payer: WEA Trust Commercial |
$5,433.45
|
| Rate for Payer: WPS Commercial |
$7,317.38
|
|
|
Stent Fem/Pop incl PTA
|
Facility
|
IP
|
$9,389.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
3052447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,600.61 |
| Max. Negotiated Rate |
$8,637.88 |
| Rate for Payer: Aetna Commercial |
$8,450.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,074.54
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,976.17
|
| Rate for Payer: Cash Price |
$2,816.70
|
| Rate for Payer: Cigna Commercial |
$8,637.88
|
| Rate for Payer: Health EOS Commercial |
$8,356.21
|
| Rate for Payer: HFN Commercial |
$8,637.88
|
| Rate for Payer: Multiplan Commercial |
$7,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$5,633.40
|
| Rate for Payer: Preferred Network Access Commercial |
$8,637.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,600.61
|
| Rate for Payer: Quartz Commercial |
$5,633.40
|
| Rate for Payer: WEA Trust Commercial |
$5,163.95
|
| Rate for Payer: WPS Commercial |
$6,954.43
|
|
|
Stent Fem/Pop incl PTA
|
Facility
|
OP
|
$9,389.00
|
|
|
Service Code
|
CPT 37226
|
| Hospital Charge Code |
3052447
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,600.61 |
| Max. Negotiated Rate |
$43,494.48 |
| Rate for Payer: Aetna Commercial |
$8,450.10
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,074.54
|
| Rate for Payer: Aetna Managed Medicare |
$10,873.62
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$18,649.00
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$18,649.00
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,230.00
|
| Rate for Payer: Anthem Medicare Advantage |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,976.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$10,873.62
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$10,873.62
|
| Rate for Payer: Cash Price |
$2,816.70
|
| Rate for Payer: Cash Price |
$2,816.70
|
| Rate for Payer: Cash Price |
$2,816.70
|
| Rate for Payer: Cigna Commercial |
$8,637.88
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$10,873.62
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$11,874.87
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$10,873.62
|
| Rate for Payer: Health EOS Commercial |
$8,356.21
|
| Rate for Payer: HFN Commercial |
$8,637.88
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$40,449.87
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$10,873.62
|
| Rate for Payer: Independent Care Health Plan Medicare |
$10,873.62
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$10,873.62
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$10,873.62
|
| Rate for Payer: Multiplan Commercial |
$7,511.20
|
| Rate for Payer: NAPHCARE Commercial |
$16,310.43
|
| Rate for Payer: Preferred Network Access Commercial |
$8,637.88
|
| Rate for Payer: Quartz Beloit One Network |
$4,600.61
|
| Rate for Payer: Quartz Commercial |
$6,102.85
|
| Rate for Payer: Quartz Medicare Advantage |
$10,873.62
|
| Rate for Payer: The Alliance Commercial |
$43,494.48
|
| Rate for Payer: United Healthcare Medicare Advantage |
$10,873.62
|
| Rate for Payer: United Healthcare PPO |
$9,596.00
|
| Rate for Payer: WEA Trust Commercial |
$5,163.95
|
| Rate for Payer: Wellcare Medicare |
$10,873.62
|
| Rate for Payer: WPS Commercial |
$6,954.43
|
|
|
STENT FLEX 6 x 60 120
|
Facility
|
IP
|
$6,711.00
|
|
| Hospital Charge Code |
2974857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$3,288.39 |
| Max. Negotiated Rate |
$6,174.12 |
| Rate for Payer: Aetna Commercial |
$6,039.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,771.46
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,556.83
|
| Rate for Payer: Cash Price |
$2,013.30
|
| Rate for Payer: Cigna Commercial |
$6,174.12
|
| Rate for Payer: Health EOS Commercial |
$5,972.79
|
| Rate for Payer: HFN Commercial |
$6,174.12
|
| Rate for Payer: Multiplan Commercial |
$5,368.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,026.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,174.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,288.39
|
| Rate for Payer: Quartz Commercial |
$4,026.60
|
| Rate for Payer: WEA Trust Commercial |
$3,691.05
|
| Rate for Payer: WPS Commercial |
$4,970.84
|
|
|
STENT FLEX 6 x 60 120
|
Facility
|
OP
|
$6,711.00
|
|
| Hospital Charge Code |
2974857
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$1,879.08 |
| Max. Negotiated Rate |
$26,844.00 |
| Rate for Payer: Aetna Commercial |
$6,039.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$5,771.46
|
| Rate for Payer: Aetna Managed Medicare |
$1,879.08
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$4,362.15
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$3,355.50
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$3,221.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,556.83
|
| Rate for Payer: Cash Price |
$2,013.30
|
| Rate for Payer: Cigna Commercial |
$6,174.12
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$3,755.48
|
| Rate for Payer: Health EOS Commercial |
$5,972.79
|
| Rate for Payer: HFN Commercial |
$6,174.12
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$5,033.25
|
| Rate for Payer: Multiplan Commercial |
$5,368.80
|
| Rate for Payer: NAPHCARE Commercial |
$4,026.60
|
| Rate for Payer: Preferred Network Access Commercial |
$6,174.12
|
| Rate for Payer: Quartz Beloit One Network |
$3,288.39
|
| Rate for Payer: Quartz Commercial |
$4,362.15
|
| Rate for Payer: Quartz Medicare Advantage |
$4,026.60
|
| Rate for Payer: The Alliance Commercial |
$26,844.00
|
| Rate for Payer: WEA Trust Commercial |
$3,691.05
|
| Rate for Payer: WPS Commercial |
$4,970.84
|
|
