|
STENT PROTEGE GPS 9mm X 80mm #SERB65-09-80-120
|
Facility
|
IP
|
$9,879.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
3107489
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,034.34 |
| Max. Negotiated Rate |
$9,452.23 |
| Rate for Payer: Aetna Commercial |
$9,246.74
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,835.78
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,445.30
|
| Rate for Payer: Cash Price |
$2,963.70
|
| Rate for Payer: Cigna Commercial |
$9,452.23
|
| Rate for Payer: Health EOS Commercial |
$9,144.00
|
| Rate for Payer: HFN Commercial |
$9,452.23
|
| Rate for Payer: Multiplan Commercial |
$8,219.33
|
| Rate for Payer: Preferred Network Access Commercial |
$9,452.23
|
| Rate for Payer: Quartz Beloit One Network |
$5,034.34
|
| Rate for Payer: Quartz Commercial |
$6,164.50
|
| Rate for Payer: WEA Trust Commercial |
$5,650.79
|
| Rate for Payer: WPS Commercial |
$7,609.79
|
|
|
Stent/PTA Iliac Artery
|
Facility
|
IP
|
$9,224.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
3052442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,700.55 |
| Max. Negotiated Rate |
$8,825.52 |
| Rate for Payer: Aetna Commercial |
$8,633.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,249.95
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,084.27
|
| Rate for Payer: Cash Price |
$2,767.20
|
| Rate for Payer: Cigna Commercial |
$8,825.52
|
| Rate for Payer: Health EOS Commercial |
$8,537.73
|
| Rate for Payer: HFN Commercial |
$8,825.52
|
| Rate for Payer: Multiplan Commercial |
$7,674.37
|
| Rate for Payer: Preferred Network Access Commercial |
$8,825.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,700.55
|
| Rate for Payer: Quartz Commercial |
$5,755.78
|
| Rate for Payer: WEA Trust Commercial |
$5,276.13
|
| Rate for Payer: WPS Commercial |
$7,105.25
|
|
|
Stent/PTA Iliac Artery
|
Facility
|
OP
|
$9,224.00
|
|
|
Service Code
|
CPT 37221
|
| Hospital Charge Code |
3052442
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,686.03 |
| Max. Negotiated Rate |
$19,394.96 |
| Rate for Payer: Aetna Commercial |
$8,633.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,249.95
|
| Rate for Payer: Aetna Managed Medicare |
$2,686.03
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,084.27
|
| Rate for Payer: Cash Price |
$2,767.20
|
| Rate for Payer: Cash Price |
$2,767.20
|
| Rate for Payer: Cash Price |
$2,767.20
|
| Rate for Payer: Cigna Commercial |
$8,825.52
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$8,537.73
|
| Rate for Payer: HFN Commercial |
$8,825.52
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,194.72
|
| Rate for Payer: Multiplan Commercial |
$7,674.37
|
| Rate for Payer: NAPHCARE Commercial |
$5,755.78
|
| Rate for Payer: Preferred Network Access Commercial |
$8,825.52
|
| Rate for Payer: Quartz Beloit One Network |
$4,700.55
|
| Rate for Payer: Quartz Commercial |
$6,235.42
|
| Rate for Payer: Quartz Medicare Advantage |
$5,755.78
|
| Rate for Payer: The Alliance Commercial |
$4,796.48
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$5,276.13
|
| Rate for Payer: WPS Commercial |
$7,105.25
|
|
|
Stent/PTA Iliac Artery BILAT 3722150
|
Facility
|
IP
|
$18,448.00
|
|
|
Service Code
|
CPT 37221 50
|
| Hospital Charge Code |
6017631
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$9,401.10 |
| Max. Negotiated Rate |
$17,651.05 |
| Rate for Payer: Aetna Commercial |
$17,267.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,499.89
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,168.54
|
| Rate for Payer: Cash Price |
$5,534.40
|
| Rate for Payer: Cigna Commercial |
$17,651.05
|
| Rate for Payer: Health EOS Commercial |
$17,075.47
|
| Rate for Payer: HFN Commercial |
$17,651.05
|
| Rate for Payer: Multiplan Commercial |
$15,348.74
|
| Rate for Payer: Preferred Network Access Commercial |
$17,651.05
|
| Rate for Payer: Quartz Beloit One Network |
$9,401.10
|
| Rate for Payer: Quartz Commercial |
$11,511.55
|
| Rate for Payer: WEA Trust Commercial |
$10,552.26
|
| Rate for Payer: WPS Commercial |
$14,210.49
|
|
|
Stent/PTA Iliac Artery BILAT 3722150
|
Facility
|
OP
|
$18,448.00
|
|
|
Service Code
|
CPT 37221 50
|
| Hospital Charge Code |
6017631
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$5,372.06 |
| Max. Negotiated Rate |
$19,394.96 |
| Rate for Payer: Aetna Commercial |
$17,267.33
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$16,499.89
|
| Rate for Payer: Aetna Managed Medicare |
$5,372.06
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$19,394.96
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,394.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$17,919.20
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$10,168.54
|
| Rate for Payer: Cash Price |
$5,534.40
|
| Rate for Payer: Cash Price |
$5,534.40
|
| Rate for Payer: Cash Price |
$5,534.40
|
| Rate for Payer: Cigna Commercial |
$17,651.05
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$17,075.47
|
| Rate for Payer: HFN Commercial |
$17,651.05
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$14,389.44
|
| Rate for Payer: Multiplan Commercial |
$15,348.74
|
| Rate for Payer: NAPHCARE Commercial |
$11,511.55
|
| Rate for Payer: Preferred Network Access Commercial |
$17,651.05
|
| Rate for Payer: Quartz Beloit One Network |
$9,401.10
|
| Rate for Payer: Quartz Commercial |
$12,470.85
|
| Rate for Payer: Quartz Medicare Advantage |
$11,511.55
|
| Rate for Payer: The Alliance Commercial |
$9,592.96
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$10,552.26
|
| Rate for Payer: WPS Commercial |
$14,210.49
|
|
|
Stent/PTA Iliac Artery Ea Add +
|
Facility
|
OP
|
$3,166.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
3052444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$921.94 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$2,963.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,831.67
|
| Rate for Payer: Aetna Managed Medicare |
$921.94
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,140.22
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,646.32
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,580.47
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.10
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$3,029.23
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$2,930.45
|
| Rate for Payer: HFN Commercial |
$3,029.23
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,469.48
|
| Rate for Payer: Multiplan Commercial |
$2,634.11
|
| Rate for Payer: NAPHCARE Commercial |
$1,975.58
|
| Rate for Payer: Preferred Network Access Commercial |
$3,029.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,613.39
|
| Rate for Payer: Quartz Commercial |
$2,140.22
|
| Rate for Payer: Quartz Medicare Advantage |
$1,975.58
|
| Rate for Payer: The Alliance Commercial |
$1,646.32
|
| Rate for Payer: WEA Trust Commercial |
$1,810.95
|
| Rate for Payer: WPS Commercial |
$2,438.77
|
|
|
Stent/PTA Iliac Artery Ea Add +
|
Facility
|
IP
|
$3,166.00
|
|
|
Service Code
|
CPT 37223
|
| Hospital Charge Code |
3052444
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,613.39 |
| Max. Negotiated Rate |
$3,029.23 |
| Rate for Payer: Aetna Commercial |
$2,963.38
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,831.67
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,745.10
|
| Rate for Payer: Cash Price |
$949.80
|
| Rate for Payer: Cigna Commercial |
$3,029.23
|
| Rate for Payer: Health EOS Commercial |
$2,930.45
|
| Rate for Payer: HFN Commercial |
$3,029.23
|
| Rate for Payer: Multiplan Commercial |
$2,634.11
|
| Rate for Payer: Preferred Network Access Commercial |
$3,029.23
|
| Rate for Payer: Quartz Beloit One Network |
$1,613.39
|
| Rate for Payer: Quartz Commercial |
$1,975.58
|
| Rate for Payer: WEA Trust Commercial |
$1,810.95
|
| Rate for Payer: WPS Commercial |
$2,438.77
|
|
|
STENT QUICKERT LACRIMAL SP732871
|
Facility
|
OP
|
$1,736.00
|
|
| Hospital Charge Code |
2964772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$505.52 |
| Max. Negotiated Rate |
$1,661.00 |
| Rate for Payer: Aetna Commercial |
$1,624.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.68
|
| Rate for Payer: Aetna Managed Medicare |
$505.52
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,173.54
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$902.72
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$866.61
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.88
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,661.00
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,010.35
|
| Rate for Payer: Health EOS Commercial |
$1,606.84
|
| Rate for Payer: HFN Commercial |
$1,661.00
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,354.08
|
| Rate for Payer: Multiplan Commercial |
$1,444.35
|
| Rate for Payer: NAPHCARE Commercial |
$1,083.26
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.00
|
| Rate for Payer: Quartz Beloit One Network |
$884.67
|
| Rate for Payer: Quartz Commercial |
$1,173.54
|
| Rate for Payer: Quartz Medicare Advantage |
$1,083.26
|
| Rate for Payer: The Alliance Commercial |
$902.72
|
| Rate for Payer: WEA Trust Commercial |
$992.99
|
| Rate for Payer: WPS Commercial |
$1,337.24
|
|
|
STENT QUICKERT LACRIMAL SP732871
|
Facility
|
IP
|
$1,736.00
|
|
| Hospital Charge Code |
2964772
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$884.67 |
| Max. Negotiated Rate |
$1,661.00 |
| Rate for Payer: Aetna Commercial |
$1,624.90
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,552.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$956.88
|
| Rate for Payer: Cash Price |
$520.80
|
| Rate for Payer: Cigna Commercial |
$1,661.00
|
| Rate for Payer: Health EOS Commercial |
$1,606.84
|
| Rate for Payer: HFN Commercial |
$1,661.00
|
| Rate for Payer: Multiplan Commercial |
$1,444.35
|
| Rate for Payer: Preferred Network Access Commercial |
$1,661.00
|
| Rate for Payer: Quartz Beloit One Network |
$884.67
|
| Rate for Payer: Quartz Commercial |
$1,083.26
|
| Rate for Payer: WEA Trust Commercial |
$992.99
|
| Rate for Payer: WPS Commercial |
$1,337.24
|
|
|
STENT RAINS FRONTAL SINUS LARGE 7089-0931
|
Facility
|
IP
|
$896.00
|
|
| Hospital Charge Code |
3701495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.60 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$559.10
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
STENT RAINS FRONTAL SINUS LARGE 7089-0931
|
Facility
|
OP
|
$896.00
|
|
| Hospital Charge Code |
3701495
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.92 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Aetna Managed Medicare |
$260.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$605.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$465.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$447.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$521.47
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.88
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: NAPHCARE Commercial |
$559.10
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$605.70
|
| Rate for Payer: Quartz Medicare Advantage |
$559.10
|
| Rate for Payer: The Alliance Commercial |
$465.92
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
STENT RAINS FRONTAL SINUS STD 7089-0932
|
Facility
|
OP
|
$896.00
|
|
| Hospital Charge Code |
3701496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$260.92 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Aetna Managed Medicare |
$260.92
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$605.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$465.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$447.28
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$521.47
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$698.88
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: NAPHCARE Commercial |
$559.10
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$605.70
|
| Rate for Payer: Quartz Medicare Advantage |
$559.10
|
| Rate for Payer: The Alliance Commercial |
$465.92
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
STENT RAINS FRONTAL SINUS STD 7089-0932
|
Facility
|
IP
|
$896.00
|
|
| Hospital Charge Code |
3701496
|
|
Hospital Revenue Code
|
272
|
| Min. Negotiated Rate |
$456.60 |
| Max. Negotiated Rate |
$857.29 |
| Rate for Payer: Aetna Commercial |
$838.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$801.38
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$493.88
|
| Rate for Payer: Cash Price |
$268.80
|
| Rate for Payer: Cigna Commercial |
$857.29
|
| Rate for Payer: Health EOS Commercial |
$829.34
|
| Rate for Payer: HFN Commercial |
$857.29
|
| Rate for Payer: Multiplan Commercial |
$745.47
|
| Rate for Payer: Preferred Network Access Commercial |
$857.29
|
| Rate for Payer: Quartz Beloit One Network |
$456.60
|
| Rate for Payer: Quartz Commercial |
$559.10
|
| Rate for Payer: WEA Trust Commercial |
$512.51
|
| Rate for Payer: WPS Commercial |
$690.19
|
|
|
STENT RX BILIARY 10FR 10CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972468
|
|
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 RX BILIARY 10FR 10CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972468
|
|
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 RXBILIARY 10FR 5CM #4560
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972368
|
|
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 RXBILIARY 10FR 5CM #4560
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972368
|
|
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 RXBILIARY 10fr x 12cm
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972369
|
|
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 RXBILIARY 10fr x 12cm
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972369
|
|
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 RXBILIARY 10fr x 7cm
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2983113
|
|
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 RXBILIARY 10fr x 7cm
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2983113
|
|
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 RX BILIARY 10fr x 7cm 4561
|
Facility
|
IP
|
$8,784.00
|
|
| Hospital Charge Code |
2969417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,476.33 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,481.22
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
STENT RX BILIARY 10fr x 7cm 4561
|
Facility
|
OP
|
$8,784.00
|
|
| Hospital Charge Code |
2969417
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$2,557.90 |
| Max. Negotiated Rate |
$8,404.53 |
| Rate for Payer: Aetna Commercial |
$8,221.82
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$7,856.41
|
| Rate for Payer: Aetna Managed Medicare |
$2,557.90
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$5,937.98
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$4,567.68
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$4,384.97
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$4,841.74
|
| Rate for Payer: Cash Price |
$2,635.20
|
| Rate for Payer: Cigna Commercial |
$8,404.53
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$5,112.29
|
| Rate for Payer: Health EOS Commercial |
$8,130.47
|
| Rate for Payer: HFN Commercial |
$8,404.53
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$6,851.52
|
| Rate for Payer: Multiplan Commercial |
$7,308.29
|
| Rate for Payer: NAPHCARE Commercial |
$5,481.22
|
| Rate for Payer: Preferred Network Access Commercial |
$8,404.53
|
| Rate for Payer: Quartz Beloit One Network |
$4,476.33
|
| Rate for Payer: Quartz Commercial |
$5,937.98
|
| Rate for Payer: Quartz Medicare Advantage |
$5,481.22
|
| Rate for Payer: The Alliance Commercial |
$4,567.68
|
| Rate for Payer: WEA Trust Commercial |
$5,024.45
|
| Rate for Payer: WPS Commercial |
$6,766.32
|
|
|
STENT RX BILIARY 7FR. 10CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2983112
|
|
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 RX BILIARY 7FR. 10CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2983112
|
|
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
|
|
