|
Stent Venous
|
Facility
|
IP
|
$5,572.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
4125709
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,839.49 |
| Max. Negotiated Rate |
$5,331.29 |
| Rate for Payer: Aetna Commercial |
$5,215.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.60
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.29
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$5,331.29
|
| Rate for Payer: Health EOS Commercial |
$5,157.44
|
| Rate for Payer: HFN Commercial |
$5,331.29
|
| Rate for Payer: Multiplan Commercial |
$4,635.90
|
| Rate for Payer: Preferred Network Access Commercial |
$5,331.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.49
|
| Rate for Payer: Quartz Commercial |
$3,476.93
|
| Rate for Payer: WEA Trust Commercial |
$3,187.18
|
| Rate for Payer: WPS Commercial |
$4,292.11
|
|
|
Stent Venous
|
Facility
|
OP
|
$5,572.00
|
|
|
Service Code
|
CPT 37238
|
| Hospital Charge Code |
4125709
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$2,839.49 |
| Max. Negotiated Rate |
$48,595.91 |
| Rate for Payer: Aetna Commercial |
$5,215.39
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$4,983.60
|
| Rate for Payer: Aetna Managed Medicare |
$12,148.98
|
| 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: Anthem Medicare Advantage |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$3,071.29
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage HMO |
$12,148.98
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Medicare Advantage PPO |
$12,148.98
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cash Price |
$1,671.60
|
| Rate for Payer: Cigna Commercial |
$5,331.29
|
| Rate for Payer: Cook Children's Health Plan (CCHP) Commercial |
$12,148.98
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Dean Health Medicare Advantage/Medicare Select |
$12,148.98
|
| Rate for Payer: Health EOS Commercial |
$5,157.44
|
| Rate for Payer: HFN Commercial |
$5,331.29
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$45,194.20
|
| Rate for Payer: Humana Medicare EPO/Medicare HMO/Medicare PPO |
$12,148.98
|
| Rate for Payer: Independent Care Health Plan Medicare |
$12,148.98
|
| Rate for Payer: Managed Health Services Medicare Advantage |
$12,148.98
|
| Rate for Payer: Molina Healthcare Medicare Advantage/Molina Marketplace |
$12,148.98
|
| Rate for Payer: Multiplan Commercial |
$4,635.90
|
| Rate for Payer: NAPHCARE Commercial |
$18,223.47
|
| Rate for Payer: Preferred Network Access Commercial |
$5,331.29
|
| Rate for Payer: Quartz Beloit One Network |
$2,839.49
|
| Rate for Payer: Quartz Commercial |
$3,766.67
|
| Rate for Payer: Quartz Medicare Advantage |
$12,148.98
|
| Rate for Payer: The Alliance Commercial |
$48,595.91
|
| Rate for Payer: United Healthcare Medicare Advantage |
$12,148.98
|
| Rate for Payer: United Healthcare PPO |
$9,979.84
|
| Rate for Payer: WEA Trust Commercial |
$3,187.18
|
| Rate for Payer: Wellcare Medicare |
$12,148.98
|
| Rate for Payer: WPS Commercial |
$4,292.11
|
|
|
Stent Venous ea add +
|
Facility
|
IP
|
$1,853.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
4125710
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$944.29 |
| Max. Negotiated Rate |
$1,772.95 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,156.27
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
Stent Venous ea add +
|
Facility
|
OP
|
$1,853.00
|
|
|
Service Code
|
CPT 37239
|
| Hospital Charge Code |
4125710
|
|
Hospital Revenue Code
|
481
|
| Min. Negotiated Rate |
$488.09 |
| Max. Negotiated Rate |
$12,349.86 |
| Rate for Payer: Aetna Commercial |
$1,734.41
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$1,657.32
|
| Rate for Payer: Aetna Managed Medicare |
$539.59
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$1,252.63
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$963.56
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$925.02
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$1,021.37
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cash Price |
$555.90
|
| Rate for Payer: Cigna Commercial |
$1,772.95
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$12,349.86
|
| Rate for Payer: Health EOS Commercial |
$1,715.14
|
| Rate for Payer: HFN Commercial |
$1,772.95
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$1,445.34
|
| Rate for Payer: Multiplan Commercial |
$1,541.70
|
| Rate for Payer: NAPHCARE Commercial |
$1,156.27
|
| Rate for Payer: Preferred Network Access Commercial |
$1,772.95
|
| Rate for Payer: Quartz Beloit One Network |
$944.29
|
| Rate for Payer: Quartz Commercial |
$1,252.63
|
| Rate for Payer: Quartz Medicare Advantage |
$1,156.27
|
| Rate for Payer: The Alliance Commercial |
$488.09
|
| Rate for Payer: WEA Trust Commercial |
$1,059.92
|
| Rate for Payer: WPS Commercial |
$1,427.37
|
|
|
STENT VERIFLEX 3.0 X 28MM
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 3.0 X 28MM
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974800
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 4.0 X 12
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 4.0 X 12
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974798
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 4.0 X 16
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 4.0 X 16
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974797
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 4.0 X 20
|
Facility
|
OP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,069.21 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Aetna Managed Medicare |
$5,069.21
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,767.81
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,052.16
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,690.07
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,131.46
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,578.24
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: NAPHCARE Commercial |
$10,862.59
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$11,767.81
|
| Rate for Payer: Quartz Medicare Advantage |
$10,862.59
|
| Rate for Payer: The Alliance Commercial |
$9,052.16
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX 4.0 X 20
|
Facility
|
IP
|
$17,408.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974796
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,871.12 |
| Max. Negotiated Rate |
$16,655.97 |
| Rate for Payer: Aetna Commercial |
$16,293.89
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,569.72
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,595.29
|
| Rate for Payer: Cash Price |
$5,222.40
|
| Rate for Payer: Cigna Commercial |
$16,655.97
|
| Rate for Payer: Health EOS Commercial |
$16,112.84
|
| Rate for Payer: HFN Commercial |
$16,655.97
|
| Rate for Payer: Multiplan Commercial |
$14,483.46
|
| Rate for Payer: Preferred Network Access Commercial |
$16,655.97
|
| Rate for Payer: Quartz Beloit One Network |
$8,871.12
|
| Rate for Payer: Quartz Commercial |
$10,862.59
|
| Rate for Payer: WEA Trust Commercial |
$9,957.38
|
| Rate for Payer: WPS Commercial |
$13,409.38
|
|
|
STENT VERIFLEX BARE 3.5 X 8MM
|
Facility
|
OP
|
$14,790.00
|
|
| Hospital Charge Code |
2974795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$4,306.85 |
| Max. Negotiated Rate |
$14,151.07 |
| Rate for Payer: Aetna Commercial |
$13,843.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,228.18
|
| Rate for Payer: Aetna Managed Medicare |
$4,306.85
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$9,998.04
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$7,690.80
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$7,383.17
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,152.25
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$14,151.07
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$8,607.78
|
| Rate for Payer: Health EOS Commercial |
$13,689.62
|
| Rate for Payer: HFN Commercial |
$14,151.07
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$11,536.20
|
| Rate for Payer: Multiplan Commercial |
$12,305.28
|
| Rate for Payer: NAPHCARE Commercial |
$9,228.96
|
| Rate for Payer: Preferred Network Access Commercial |
$14,151.07
|
| Rate for Payer: Quartz Beloit One Network |
$7,536.98
|
| Rate for Payer: Quartz Commercial |
$9,998.04
|
| Rate for Payer: Quartz Medicare Advantage |
$9,228.96
|
| Rate for Payer: The Alliance Commercial |
$7,690.80
|
| Rate for Payer: WEA Trust Commercial |
$8,459.88
|
| Rate for Payer: WPS Commercial |
$11,392.74
|
|
|
STENT VERIFLEX BARE 3.5 X 8MM
|
Facility
|
IP
|
$14,790.00
|
|
| Hospital Charge Code |
2974795
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$7,536.98 |
| Max. Negotiated Rate |
$14,151.07 |
| Rate for Payer: Aetna Commercial |
$13,843.44
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$13,228.18
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$8,152.25
|
| Rate for Payer: Cash Price |
$4,437.00
|
| Rate for Payer: Cigna Commercial |
$14,151.07
|
| Rate for Payer: Health EOS Commercial |
$13,689.62
|
| Rate for Payer: HFN Commercial |
$14,151.07
|
| Rate for Payer: Multiplan Commercial |
$12,305.28
|
| Rate for Payer: Preferred Network Access Commercial |
$14,151.07
|
| Rate for Payer: Quartz Beloit One Network |
$7,536.98
|
| Rate for Payer: Quartz Commercial |
$9,228.96
|
| Rate for Payer: WEA Trust Commercial |
$8,459.88
|
| Rate for Payer: WPS Commercial |
$11,392.74
|
|
|
STENT VISION 3.0 x 12mm #1007848-12
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.0 x 12mm #1007848-12
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974794
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.0 x 18mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.0 x 18mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974793
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.0 x 28mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.0 x 28mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974792
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 12mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 12mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974791
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 18mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 18mm
|
Facility
|
OP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974790
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$5,068.63 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Aetna Managed Medicare |
$5,068.63
|
| Rate for Payer: Anthem Blue Access PPO/Blue Traditional |
$11,766.46
|
| Rate for Payer: Anthem Blue Preferred/Blue Preferred Plus |
$9,051.12
|
| Rate for Payer: Anthem Blue Priority WI/Blue Priority X-WI |
$8,689.08
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Dean Health DHI/DHP/ASO |
$10,130.29
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Humana Commercial/EPO/HMO/POS/PPO |
$13,576.68
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: NAPHCARE Commercial |
$10,861.34
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$11,766.46
|
| Rate for Payer: Quartz Medicare Advantage |
$10,861.34
|
| Rate for Payer: The Alliance Commercial |
$9,051.12
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
|
STENT VISION 3.5 x 28mm
|
Facility
|
IP
|
$17,406.00
|
|
|
Service Code
|
HCPCS C1876
|
| Hospital Charge Code |
2974789
|
|
Hospital Revenue Code
|
278
|
| Min. Negotiated Rate |
$8,870.10 |
| Max. Negotiated Rate |
$16,654.06 |
| Rate for Payer: Aetna Commercial |
$16,292.02
|
| Rate for Payer: Aetna Gatekeeper/Not Gatekeeper |
$15,567.93
|
| Rate for Payer: Blue Cross Blue Shield of Illinois Blue Cross PPO |
$9,594.19
|
| Rate for Payer: Cash Price |
$5,221.80
|
| Rate for Payer: Cigna Commercial |
$16,654.06
|
| Rate for Payer: Health EOS Commercial |
$16,110.99
|
| Rate for Payer: HFN Commercial |
$16,654.06
|
| Rate for Payer: Multiplan Commercial |
$14,481.79
|
| Rate for Payer: Preferred Network Access Commercial |
$16,654.06
|
| Rate for Payer: Quartz Beloit One Network |
$8,870.10
|
| Rate for Payer: Quartz Commercial |
$10,861.34
|
| Rate for Payer: WEA Trust Commercial |
$9,956.23
|
| Rate for Payer: WPS Commercial |
$13,407.84
|
|
