|
STENT RX BILIARY 7FR. 12CM 4558
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972367
|
|
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. 12CM 4558
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972367
|
|
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 7FR. 7CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972366
|
|
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. 7CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972366
|
|
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 8.5FR. 10CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972370
|
|
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 8.5FR. 10CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972370
|
|
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 8.5FR. 12CM
|
Facility
|
OP
|
$1,630.00
|
|
| Hospital Charge Code |
2972666
|
|
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 8.5FR. 12CM
|
Facility
|
IP
|
$1,630.00
|
|
| Hospital Charge Code |
2972666
|
|
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 8.5FR. 5CM
|
Facility
|
IP
|
$1,812.00
|
|
| Hospital Charge Code |
2972469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$1,733.72 |
| Rate for Payer: Aetna Commercial |
$1,696.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,620.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.77
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,733.72
|
| Rate for Payer: Health EOS Commercial |
$1,677.19
|
| Rate for Payer: HFN Commercial |
$1,733.72
|
| Rate for Payer: Multiplan Commercial |
$1,507.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,733.72
|
| Rate for Payer: Quartz Beloit One Network |
$923.40
|
| Rate for Payer: Quartz Commercial |
$1,130.69
|
| Rate for Payer: WEA Trust Commercial |
$1,036.46
|
| Rate for Payer: WPS Commercial |
$1,395.78
|
|
|
STENT RX BILIARY 8.5FR. 5CM
|
Facility
|
OP
|
$1,812.00
|
|
| Hospital Charge Code |
2972469
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.65 |
| Max. Negotiated Rate |
$1,733.72 |
| Rate for Payer: Aetna Commercial |
$1,696.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,620.65
|
| Rate for Payer: Aetna Managed Medicare |
$527.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,224.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$942.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$904.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.77
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,733.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,054.58
|
| Rate for Payer: Health EOS Commercial |
$1,677.19
|
| Rate for Payer: HFN Commercial |
$1,733.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,413.36
|
| Rate for Payer: Multiplan Commercial |
$1,507.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,130.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,733.72
|
| Rate for Payer: Quartz Beloit One Network |
$923.40
|
| Rate for Payer: Quartz Commercial |
$1,224.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,130.69
|
| Rate for Payer: The Alliance Commercial |
$942.24
|
| Rate for Payer: WEA Trust Commercial |
$1,036.46
|
| Rate for Payer: WPS Commercial |
$1,395.78
|
|
|
STENT RX BILIARY 8.5FR. 7CM
|
Facility
|
IP
|
$1,812.00
|
|
| Hospital Charge Code |
2972470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$923.40 |
| Max. Negotiated Rate |
$1,733.72 |
| Rate for Payer: Aetna Commercial |
$1,696.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,620.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.77
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,733.72
|
| Rate for Payer: Health EOS Commercial |
$1,677.19
|
| Rate for Payer: HFN Commercial |
$1,733.72
|
| Rate for Payer: Multiplan Commercial |
$1,507.58
|
| Rate for Payer: Preferred Network Access Commercial |
$1,733.72
|
| Rate for Payer: Quartz Beloit One Network |
$923.40
|
| Rate for Payer: Quartz Commercial |
$1,130.69
|
| Rate for Payer: WEA Trust Commercial |
$1,036.46
|
| Rate for Payer: WPS Commercial |
$1,395.78
|
|
|
STENT RX BILIARY 8.5FR. 7CM
|
Facility
|
OP
|
$1,812.00
|
|
| Hospital Charge Code |
2972470
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$527.65 |
| Max. Negotiated Rate |
$1,733.72 |
| Rate for Payer: Aetna Commercial |
$1,696.03
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,620.65
|
| Rate for Payer: Aetna Managed Medicare |
$527.65
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,224.91
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$942.24
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$904.55
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$998.77
|
| Rate for Payer: Cash Price |
$543.60
|
| Rate for Payer: Cigna Commercial |
$1,733.72
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,054.58
|
| Rate for Payer: Health EOS Commercial |
$1,677.19
|
| Rate for Payer: HFN Commercial |
$1,733.72
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,413.36
|
| Rate for Payer: Multiplan Commercial |
$1,507.58
|
| Rate for Payer: NAPHCARE Commercial |
$1,130.69
|
| Rate for Payer: Preferred Network Access Commercial |
$1,733.72
|
| Rate for Payer: Quartz Beloit One Network |
$923.40
|
| Rate for Payer: Quartz Commercial |
$1,224.91
|
| Rate for Payer: Quartz Medicare Advantage |
$1,130.69
|
| Rate for Payer: The Alliance Commercial |
$942.24
|
| Rate for Payer: WEA Trust Commercial |
$1,036.46
|
| Rate for Payer: WPS Commercial |
$1,395.78
|
|
|
STENT SINGLE J 8FR
|
Facility
|
OP
|
$1,642.00
|
|
| Hospital Charge Code |
3072440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$478.15 |
| Max. Negotiated Rate |
$1,571.07 |
| Rate for Payer: Aetna Commercial |
$1,536.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.60
|
| Rate for Payer: Aetna Managed Medicare |
$478.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,109.99
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$853.84
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$819.69
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.07
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,571.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$955.64
|
| Rate for Payer: Health EOS Commercial |
$1,519.84
|
| Rate for Payer: HFN Commercial |
$1,571.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,280.76
|
| Rate for Payer: Multiplan Commercial |
$1,366.14
|
| Rate for Payer: NAPHCARE Commercial |
$1,024.61
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.07
|
| Rate for Payer: Quartz Beloit One Network |
$836.76
|
| Rate for Payer: Quartz Commercial |
$1,109.99
|
| Rate for Payer: Quartz Medicare Advantage |
$1,024.61
|
| Rate for Payer: The Alliance Commercial |
$853.84
|
| Rate for Payer: WEA Trust Commercial |
$939.22
|
| Rate for Payer: WPS Commercial |
$1,264.83
|
|
|
STENT SINGLE J 8FR
|
Facility
|
IP
|
$1,642.00
|
|
| Hospital Charge Code |
3072440
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$836.76 |
| Max. Negotiated Rate |
$1,571.07 |
| Rate for Payer: Aetna Commercial |
$1,536.91
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,468.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$905.07
|
| Rate for Payer: Cash Price |
$492.60
|
| Rate for Payer: Cigna Commercial |
$1,571.07
|
| Rate for Payer: Health EOS Commercial |
$1,519.84
|
| Rate for Payer: HFN Commercial |
$1,571.07
|
| Rate for Payer: Multiplan Commercial |
$1,366.14
|
| Rate for Payer: Preferred Network Access Commercial |
$1,571.07
|
| Rate for Payer: Quartz Beloit One Network |
$836.76
|
| Rate for Payer: Quartz Commercial |
$1,024.61
|
| Rate for Payer: WEA Trust Commercial |
$939.22
|
| Rate for Payer: WPS Commercial |
$1,264.83
|
|
|
STENT STRETCH VL 4.8FR X 22-30 W/O GUIDEWIRE M0061851550
|
Facility
|
OP
|
$1,646.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5384847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$479.32 |
| Max. Negotiated Rate |
$1,574.89 |
| Rate for Payer: Aetna Commercial |
$1,540.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,472.18
|
| Rate for Payer: Aetna Managed Medicare |
$479.32
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,112.70
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$855.92
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$821.68
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.28
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$1,574.89
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$957.97
|
| Rate for Payer: Health EOS Commercial |
$1,523.54
|
| Rate for Payer: HFN Commercial |
$1,574.89
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,283.88
|
| Rate for Payer: Multiplan Commercial |
$1,369.47
|
| Rate for Payer: NAPHCARE Commercial |
$1,027.10
|
| Rate for Payer: Preferred Network Access Commercial |
$1,574.89
|
| Rate for Payer: Quartz Beloit One Network |
$838.80
|
| Rate for Payer: Quartz Commercial |
$1,112.70
|
| Rate for Payer: Quartz Medicare Advantage |
$1,027.10
|
| Rate for Payer: The Alliance Commercial |
$855.92
|
| Rate for Payer: WEA Trust Commercial |
$941.51
|
| Rate for Payer: WPS Commercial |
$1,267.91
|
|
|
STENT STRETCH VL 4.8FR X 22-30 W/O GUIDEWIRE M0061851550
|
Facility
|
IP
|
$1,646.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5384847
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$838.80 |
| Max. Negotiated Rate |
$1,574.89 |
| Rate for Payer: Aetna Commercial |
$1,540.66
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,472.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$907.28
|
| Rate for Payer: Cash Price |
$493.80
|
| Rate for Payer: Cigna Commercial |
$1,574.89
|
| Rate for Payer: Health EOS Commercial |
$1,523.54
|
| Rate for Payer: HFN Commercial |
$1,574.89
|
| Rate for Payer: Multiplan Commercial |
$1,369.47
|
| Rate for Payer: Preferred Network Access Commercial |
$1,574.89
|
| Rate for Payer: Quartz Beloit One Network |
$838.80
|
| Rate for Payer: Quartz Commercial |
$1,027.10
|
| Rate for Payer: WEA Trust Commercial |
$941.51
|
| Rate for Payer: WPS Commercial |
$1,267.91
|
|
|
STENT STRETCH VL 6 X 22-30 W/O GUIDEWIRE M0061851560
|
Facility
|
IP
|
$1,622.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520088
|
|
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 STRETCH VL 6 X 22-30 W/O GUIDEWIRE M0061851560
|
Facility
|
OP
|
$1,622.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
4520088
|
|
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 STRETCH VL 7 X 22-30 W/O GUIDEWIRE M0061851570
|
Facility
|
IP
|
$1,685.00
|
|
| Hospital Charge Code |
4520087
|
|
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 STRETCH VL 7 X 22-30 W/O GUIDEWIRE M0061851570
|
Facility
|
OP
|
$1,685.00
|
|
| Hospital Charge Code |
4520087
|
|
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 Tib/Peroneal Ea Add Vessel +
|
Facility
|
OP
|
$3,223.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
3052455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$938.54 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$3,016.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,882.65
|
| Rate for Payer: Aetna Managed Medicare |
$938.54
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$2,178.75
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,675.96
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,608.92
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,776.52
|
| Rate for Payer: Cash Price |
$966.90
|
| Rate for Payer: Cash Price |
$966.90
|
| Rate for Payer: Cigna Commercial |
$3,083.77
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$2,983.21
|
| Rate for Payer: HFN Commercial |
$3,083.77
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$2,513.94
|
| Rate for Payer: Multiplan Commercial |
$2,681.54
|
| Rate for Payer: NAPHCARE Commercial |
$2,011.15
|
| Rate for Payer: Preferred Network Access Commercial |
$3,083.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,642.44
|
| Rate for Payer: Quartz Commercial |
$2,178.75
|
| Rate for Payer: Quartz Medicare Advantage |
$2,011.15
|
| Rate for Payer: The Alliance Commercial |
$1,675.96
|
| Rate for Payer: WEA Trust Commercial |
$1,843.56
|
| Rate for Payer: WPS Commercial |
$2,482.68
|
|
|
Stent Tib/Peroneal Ea Add Vessel +
|
Facility
|
IP
|
$3,223.00
|
|
|
Service Code
|
CPT 37234
|
| Hospital Charge Code |
3052455
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$1,642.44 |
| Max. Negotiated Rate |
$3,083.77 |
| Rate for Payer: Aetna Commercial |
$3,016.73
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$2,882.65
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,776.52
|
| Rate for Payer: Cash Price |
$966.90
|
| Rate for Payer: Cigna Commercial |
$3,083.77
|
| Rate for Payer: Health EOS Commercial |
$2,983.21
|
| Rate for Payer: HFN Commercial |
$3,083.77
|
| Rate for Payer: Multiplan Commercial |
$2,681.54
|
| Rate for Payer: Preferred Network Access Commercial |
$3,083.77
|
| Rate for Payer: Quartz Beloit One Network |
$1,642.44
|
| Rate for Payer: Quartz Commercial |
$2,011.15
|
| Rate for Payer: WEA Trust Commercial |
$1,843.56
|
| Rate for Payer: WPS Commercial |
$2,482.68
|
|
|
Stent Tib/Peroneal Incl PTA
|
Facility
|
OP
|
$9,506.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
3052451
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,768.15 |
| Max. Negotiated Rate |
$20,607.60 |
| Rate for Payer: Aetna Commercial |
$8,897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,502.17
|
| Rate for Payer: Aetna Managed Medicare |
$2,768.15
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$20,607.60
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$19,113.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$18,158.40
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,239.71
|
| Rate for Payer: Cash Price |
$2,851.80
|
| Rate for Payer: Cash Price |
$2,851.80
|
| Rate for Payer: Cash Price |
$2,851.80
|
| Rate for Payer: Cigna Commercial |
$9,095.34
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$8,798.75
|
| Rate for Payer: HFN Commercial |
$9,095.34
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$7,414.68
|
| Rate for Payer: Multiplan Commercial |
$7,908.99
|
| Rate for Payer: NAPHCARE Commercial |
$5,931.74
|
| Rate for Payer: Preferred Network Access Commercial |
$9,095.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,844.26
|
| Rate for Payer: Quartz Commercial |
$6,426.06
|
| Rate for Payer: Quartz Medicare Advantage |
$5,931.74
|
| Rate for Payer: The Alliance Commercial |
$4,943.12
|
| Rate for Payer: United Healthcare PPO |
$11,521.12
|
| Rate for Payer: WEA Trust Commercial |
$5,437.43
|
| Rate for Payer: WPS Commercial |
$7,322.47
|
|
|
Stent Tib/Peroneal Incl PTA
|
Facility
|
IP
|
$9,506.00
|
|
|
Service Code
|
CPT 37230
|
| Hospital Charge Code |
3052451
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$4,844.26 |
| Max. Negotiated Rate |
$9,095.34 |
| Rate for Payer: Aetna Commercial |
$8,897.62
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$8,502.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$5,239.71
|
| Rate for Payer: Cash Price |
$2,851.80
|
| Rate for Payer: Cigna Commercial |
$9,095.34
|
| Rate for Payer: Health EOS Commercial |
$8,798.75
|
| Rate for Payer: HFN Commercial |
$9,095.34
|
| Rate for Payer: Multiplan Commercial |
$7,908.99
|
| Rate for Payer: Preferred Network Access Commercial |
$9,095.34
|
| Rate for Payer: Quartz Beloit One Network |
$4,844.26
|
| Rate for Payer: Quartz Commercial |
$5,931.74
|
| Rate for Payer: WEA Trust Commercial |
$5,437.43
|
| Rate for Payer: WPS Commercial |
$7,322.47
|
|
|
STENT TRIA FIRM WITH SIDE HOLES 6 X 20 M0061902200
|
Facility
|
OP
|
$2,056.00
|
|
|
Service Code
|
HCPCS C2617
|
| Hospital Charge Code |
5617782
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$598.71 |
| Max. Negotiated Rate |
$1,967.18 |
| Rate for Payer: Aetna Commercial |
$1,924.42
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,838.89
|
| Rate for Payer: Aetna Managed Medicare |
$598.71
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,389.86
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$1,069.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$1,026.36
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,133.27
|
| Rate for Payer: Cash Price |
$616.80
|
| Rate for Payer: Cigna Commercial |
$1,967.18
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$1,196.59
|
| Rate for Payer: Health EOS Commercial |
$1,903.03
|
| Rate for Payer: HFN Commercial |
$1,967.18
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,603.68
|
| Rate for Payer: Multiplan Commercial |
$1,710.59
|
| Rate for Payer: NAPHCARE Commercial |
$1,282.94
|
| Rate for Payer: Preferred Network Access Commercial |
$1,967.18
|
| Rate for Payer: Quartz Beloit One Network |
$1,047.74
|
| Rate for Payer: Quartz Commercial |
$1,389.86
|
| Rate for Payer: Quartz Medicare Advantage |
$1,282.94
|
| Rate for Payer: The Alliance Commercial |
$1,069.12
|
| Rate for Payer: WEA Trust Commercial |
$1,176.03
|
| Rate for Payer: WPS Commercial |
$1,583.74
|
|
